Low bone mineral density among HIV-infected patients in Brazil

Decrease in bone mineral density (BMD) has been a complication among people living with HIV/AIDS. To investigate the prevalence of osteopenia/osteoporosis among HIV-infected people living in São Paulo city, we studied 108 HIV-infected patients (79 men and 29 women). We extracted data from patients’ medical records and BMD was measured by dual-energy X-ray absorptiometry (DXA). Median age of participants was 42 years (interquartile range [IQR] 36-48 years), and the median time since HIV diagnosis was 4.01 years (IQR 2-11 years). Patients had acquired HIV primarily by the sexual route (men who have sex with men 44%, heterosexual 49%). Median age, duration of HIV infection, duration of ART and CD4 nadir were similar for men and women. Plasma viral load was undetectable for 53 patients (49%). Median CD4 T cell count was 399 cells/µL (IQR 247 - 568). Twenty five patients (23%) had LBMD, and there was no statistically significant difference between men and women

Bone Mineral Density assessment among inviduals living with HIV/AIDS

Redução da densidade mineral óssea tem sido descrita como uma complicação clínica entre as pessoas vivendo com HIV/AIDS. Entretanto não há dados descrevendo essa alteração entre os pacientes brasileiros. Nosso objetivo foi investigar a prevalência de baixa densidade mineral óssea entre pessoas vivendo com HIV/AIDS na cidade de São Paulo. Nós estudamos108 pacientes infectados pelo HIV (78 homens e 30 mulheres). Foram utilizados neste estudo dados secundários. Os dados foram originalmente coletados com o objetivo de acompanhamento de rotina dos pacientes na clínica e para este estudo estes dados foram coletados dos prontuários médicos. Todos os pacientes foram submetidos ao exame de densitometria óssea, que é uma técnica radiológica que mensura a densidade mineral óssea. Os pacientes foram classificados como tendo baixa densidade mineral óssea de acordo com a classificação da organização mundial da saúde que define osteopenia quando o T-score a partir de -1,1 e osteoporose quando T-score abaixo de -2,5 quando se tratava de homens e mulheres com idade acima de 50 anos. Quando homens e mulheres tinham idade até 50 anos, utilizamos a classificação da ISCO, neste grupo baixa densidade mineral óssea foi definida quando os pacientes apresentavam um Z-score abaixo de -2. Entretanto para este estudo ambas as classificações foram definidas como baixa densidade mineral óssea. A mediana de idade, tempo de infecção pelo HIV a partir da data do diagnóstico, tempo sob terapia antiretroviral, número de células linfócitos TCD4+ no momento da avaliação e Nadir foram similares entre homens e mulheres. A mediana de idade foi de 43 anos (intervalo interquartílico [li] 43-48 anos) e mediana de tempo de infecção pelo HIV foi de 3,66 anos (intervalo interquartílico [li] 1,72- 10,91 anos). Os pacientes tinham adquirido o HIV principalmente pela via sexual (homens que fazem sexo com home 46% e 50% eram heterossexuais). A mediana de células linfócitos TCD4+ foi de 399céls/mm 3(intervalo interquartílico [li] 275 - 566,5). Vinte e cinco pacientes foram classificados como tendo baixa DMO (23,15%). Não houve associação estatisticamente significante entre sexo, IMC, nadir e baixa DMO. Os fatores de risco associados à baixa DMO foram células linfócitos TCD4+ <350 céls/mm3 idade acima de 502 anos e tabagismo (p=0,003; p= 0,001; p=0,002) respectivamente. Quando avaliamos HAART VS baixa DMO encontramos 14,28% de baixa DMO entre os que usavam HAART e 26,25% entre os que não usavam e essa diferença não foi estatisticamente significante. Uma limitação de nosso estudo foi o tamanho de nossa amostra, coortes maiores talvez encontrem resultados diferentes. Contudo, nossos achados fortemente sugerem que a identificação de fatores de risco para baixa DMO e que são modificáveis são um importante componente no manejo desses pacientes para prevenção da baixa DMO e do risco de fratura atribuído a essa alteração. Portanto nossos resultados sugerem que esforços no sentido de encorajamento de cessação do tabagismo devem ser realizados e considerados um importante componente de qualquer programa de saúde dos indivíduos com HIV/AIDS. Identificar fatores de risco modificáveis pode contribuir para formulação de melhores políticas de saúde.Reductions in bone mineral density (BMD) has been reported as a complication among people living with HIV/AIDS. However, no data describing this complication in Brazilian HIV infected patients have been reported . To investigate the prevalence of osteopenia/osteoporosi s among HIV-infected persons living in Sao Paulo City. We studied 108 HIV-infected patients (78 men and 30 women). We abstracted data from medical charts. All subjects enrolled in this study were submitted to Bone densitometry or dual-X-ray absorptiometry , a radiological technique using low-intensity X-ray . lt measures the bone mineral density content. lf the patients were postmenopausal woman and men aged 50 or above , they were classified as having low bone mineral dens ity when a T-score < -1 at the lumbar spine or femoral neck was detected. lf it was from -1,.1 to -2,5 osteopenia was defined and if it was < -2.5 osteoporosis was defined , using the WHO organization definition. Premenopausal woman and men younger than 50years are classified according to the current ISCO criteria, using Z-score <- 2,0 SD at the lumbar spine or femoral neck. For the propose of this study we combined both classification as Low Bone Mienral Density. Median age was 43 years (IQR 43 - 48 years). and the emdian time since HIV diagnosis was 3,66 years (IQR 1.72 - 10.91). Patients had acquired HIV primarily sexually (men who hasve sex with men 46%, heterosexual 50%). Plasma virai load was undetectable in 53 patients (40.09%) The CD4 T cell count was 399 cells/µ (IQR 275 - 566.5). Twenty-five patients (23.15%) had LBMD. There was no statiscally significant amng gender , body mass índex, nadir and LBMD. The risk factores associetaed were related to having CD4 T cells count <350 mm3 , being older than 50 years and being smoker (p=0.003; p= 0.001; p= 0.002) respectively. Low Bone Mineral Density was encountred 14.28% of patients with HAART, and in 26.25% with no haart. There, HAART was not statistically associated with LBMD. Our study was limited by its small sample. Larger cohort may have different results. Nonetheless, ou finding are compelling and suggesting that addressing modifiable risk factors for low bone mineral density and fragility fractures is an important component of both apporachs. Therefore ou data also suggest that efforts should be directed towards appropriate enouragment of lifestyle change alterations . Specifically , smoking cessation should be a major component of any health program within the HIV/AIDS population. Assessing such risk factors can contribute to the formulation of health policies to address this issue

DISCORDANCE BETWEEN BODY MASS INDEX AND ANTHROPOMETRIC MEASUREMENTS AMONG HIV-1-INFECTED PATIENTS ON ANTIRETROVIRAL THERAPY AND WITH LIPOATROPHY/LIPOHYPERTROPHY SYNDROME

Objetivos: A terapia antirretroviral altamente ativa (HAART) tem melhorado e aumentado a vida de milhares de pessoas que vivem com a infecção pelo HIV/AIDS em todo o mundo. No entanto, este tratamento pode levar ao desenvolvimento da síndrome da lipodistrofia (LDS). Este estudo foi desenvolvido para avaliar a prevalência de auto-relato de LDS, perfil nutricional e medidas antropométricas de pacientes com HIV/AIDS. Métodos: Estudo observacional de 227 pacientes adultos, divididos em: Grupo 1: 92 pacientes em HAART e com LDS; Grupo 2: 70 pacientes em tratamento com HAART e sem LDS e Grupo 3: 65 pacientes que não tomam HAART. O estado nutricional foi avaliado pelo índice de massa corporal (IMC) e o percentual de gordura corporal (%GC) por meio de medidas antropométricas. Resultados: A prevalência de auto-relato de LDS foi de 44% entre as mulheres e 39% entre os homens. DC do tríceps (PCT) apresentou-se mais elevada no grupo HAART e LDS (homens p < 0,001; mulheres p < 0,007) em comparação com aqueles sem HAART, respectivamente. IMC revelou excesso de peso para a maioria dos indivíduos. Conclusões: As medidas antropométricas foram úteis para confirmar a prevalência de auto-relato da síndrome da lipodistrofia. A avaliação das dobras dos braços e pernas revelou-se um bom método para avaliação antropométrica de lipoatrofia de membro, independentemente do sexo. Estes resultados permitiram o estabelecimento de estratégias para o diagnóstico precoce da LDS na prática clínica, em pessoas vivendo com HIV / AIDS.Introduction: Highly Active Antiretroviral Therapy (HAART) has improved and extended the lives of thousands of people living with HIV/AIDS around the world. However, this treatment can lead to the development of adverse reactions such as lipoatrophy/lipohypertrophy syndrome (LLS) and its associated risks. Objective: This study was designed to assess the prevalence of self-reported lipodystrophy and nutritional status by anthropometric measurements in patients with HIV/AIDS. Methods: An observational study of 227 adult patients in the Secondary Immunodeficiencies Outpatient Department of Dermatology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo (3002 ADEE-HCFMUSP). The sample was divided into three groups; Group 1 = 92 patients on HAART and with self-reported lipodystrophy, Group 2 = 70 patients on HAART without self-reported lipodystrophy and Group 3 = 65 patients not taking HAART. The nutritional status of individuals in the study sample was determined by body mass index (BMI) and percentage of body fat (% BF). The cardiovascular risk and diseases associated with abdominal obesity were determined by waist/hip ratio (WHR) and waist circumference (WC). Results: The prevalence of self-reported lipoatrophy/lipohypertrophy syndrome was 33% among women and 59% among men. Anthropometry showed depletion of fat mass in the evaluation of the triceps (TSF) in the treatment groups with HAART and was statistically independent of gender; for men p = 0.001, and for women p = 0.007. Similar results were found in the measurement of skin folds of the upper and lower body (p = 0.001 and p = 0.003 respectively). In assessing the nutritional status of groups by BMI and % BF, excess weight and body fat were more prevalent among women compared to men (p = 0.726). The WHR and WC revealed risks for cardiovascular and other diseases associated with abdominal obesity for women on HAART and with self-reported LLS (p = 0.005) and (p = 0.011). Conclusions: Anthropometric measurements were useful in the confirmation of the prevalence of LLS. BMI alone does not appear to be a good parameter for assessing the nutritional status of HIV-infected patients on HAART and with LLS. Other anthropometric measurements are needed to evaluate patients with the lipoatrophy/lipohypertrophy syndrome