Comparison between potential risk factors for cardiovascular disease in people living with HIV/AIDS in areas of Brazil

Introduction: Coronary heart disease and its risk factors depend on genetic characteristics, behaviors, and habits, all of which vary in different regions. The use of antiretroviral therapy (ARV) has increased the survival of people living with HIV/AIDS (PLWHA), who begin to present mortality indicators similar to the general population. This study aimed to compare the prevalence of factors potentially associated with coronary heart disease in three cohorts of PLWHA from three different regions of Brazil. Methodology: The study population was composed of participants of the cohorts of Pernambuco, Goiás, and Rio Grande do Sul states. In these sites, adult patients attending reference centers for treatment of HIV/AIDS were consecutively enrolled. Results: Pernambuco and Goiás had a higher proportion of males and of individuals with high-risk high-density lipoprotein (HDL). Pernambuco also had a greater proportion of individuals with hypertension, elevated triglycerides, and CD4 counts below 200 cells/mm3. Lower education was more frequent in Rio Grande do Sul, and the use of cocaine was higher in this state. Conclusions: The results confirm the importance of risk factors for coronary heart disease in PLHIV and highlight differences in the three cohorts. Specific measures against smoking and sedentary lifestyle, avoidance of advanced stages of immunosuppression, and appropriate treatment of dyslipidemia and dysglicemia are urgently needed to cope with the disease in Brazil

Padrão de consumo de bebidas alcóolicas e sua associação com hipertensão arterial sistêmica em indivíduos infectados pelo HIV

A AIDS afeta em torno de 34 milhões de pessoas no mundo. Conforme estimativas da UNAIDS, em 2007, 0.8% adultos entre 15-49 anos eram infectados pelo HIV. No Brasil, entre 1980-2011 foram notificados 608.230 casos de AIDS. No RS neste mesmo período foram 60512 casos, com uma taxa de incidência de 38/100.000. O consumo de bebidas alcoólicas também é prevalente na população geral variando de 12,3 a 65,8% a sua prevalência. Em pessoas Infectadas pelo HIV estas prevalências chegam a variar de 19 a 67 %. Além do consumo usual encontra-se como importante problema de saúde pública o consumo abusivo de bebidas alcoólicas, com prevalências que variam de 0,5 a 18% na população geral e em populações de infectados 8 a 35%. O consumo abusivo de bebidas alcoólicas tem sido frequentemente associado à Hipertensão Arterial Sistêmica, que por sua vez é um dos mais importantes fatores de risco para doença cardiovascular. A prevalência de hipertensão arterial sistêmica em indivíduos infectados pelo HIV é variada, associada a fatores de risco clássicos, ao consumo de bebidas alcoólicas e a fatores relacionados a infecção pelo HIV, incluindo terapia antirretroviral. Nesta tese apresentamos dois artigos: Artigo 1: Foi avaliado o padrão de consumo e determinada a prevalência de abuso de bebidas alcoólicas em indivíduos infectados pelo HIV e comparado o padrão de consumo de bebidas alcoólicas de indivíduos infectados pelo HIV com a população geral Foram analisados e comparados dois estudos transversais originais. Foram encontradas prevalências de consumo usual de bebidas alcoólicas de 66,6% na população de pacientes infectados pelo HIV. O consumo abusivo entre os bebedores correntes foi de 8,4% entre os infectados e 16,7% na população geral, sendo esta diferença estatisticamente significativa. Conclui-se que a prevalência de consumo de bebidas alcoólicas entre indivíduos infectados pelo HIV é alta e semelhante a da população geral e a prevalência de abuso é menor que a população geral e associada de forma inversa e independente com educação. Artigo 2: Avaliamos a prevalência de hipertensão, os fatores de risco associados e a associação de hipertensão com os padrões de consumo de bebidas alcoólicas conforme a cor da pele em indivíduos infectados pelo HIV. Realizado um estudo transversal, onde foram incluídos 1240 pacientes infectados pelo HIV atendidos em um ambulatório de referência. Conclui-se que o abuso de bebidas alcoólicas está associado com HAS em indivíduos infectados pelo HIV e essa associação é significativa para brancos e não brancos. O consumo abusivo também foi associado com aumento das pressões sistólica e diastólica apenas entre os não brancos.Não houve associação entre HAS e variáveis associadas ao HIV Concluindo, estes dois artigos apresentam a prevalência de consumo de bebidas alcoólicas e do padrão de consumo abusivo entre indivíduos infectados pelo HIV, bem como compara este consumo com o observado na população geral. Apresentou-se também a associação entre consumo abusivo e hipertensão arterial estratificado para a cor da pele. Observa-se que, apesar da doença, a população estudada mantém uma alta prevalência de consumo de bebidas alcoólicas, o padrão de consumo abusivo, apesar de menor que na população em geral, também foi encontrado. Observou-se a associação do consumo abusivo com hipertensão arterial sistêmica, sendo o efeito no aumento da pressão maior entre os indivíduos não brancos. Considerando que a hipertensão é um importante fator de risco cardiovascular e que existem evidências de sua associação com o consumo abusivo de bebidas alcoólicas na população estudada; este estudo contribui para reforçar a recomendação de diminuição deste consumo. Sugere-se como importante a avaliação rotineira do padrão de consumo de bebidas alcoólicas na assistência às pessoas infectadas pelo HIV

People living with HIV on ART have accurate perception of lipodystrophy signs : a cross sectional study

Background: The prevalence of lipodystrophy ranges from 31 to 65%, depending on the criteria adopted for diagnosis. The usual methods applied in the diagnosis vary from self-perception, medical examination, skinfolds measurements, or even imaging assessment for confirmation of fat distribution changes. Although several methods have been developed, there is no gold standard for characterization of LA and LH, or mixed forms. This study aimed to compare self-reported signs of lipodystrophy with objective measures by skinfolds and circumferences, and to evaluate the prevalence of lipoatrophy (LA) and lipohypertrophy (LH) among subjects living with HIV/AIDS on ART. Methods: A cross-sectional study enrolled participants living with HIV/AIDS receiving ART, aged 18 years or older from an outpatient health care center, in Southern Brazil. Self-reported body fat enlargement in the abdomen, chest or breasts, and dorsocervical fat pad were used to determine LH, while LA was identified by self-reported fat wasting of the face, neck, legs, arms or buttocks. Measurements were obtained with a scientific caliper for infraorbital, buccal, and submandibular skinfolds, and using an inelastic tape to measure circumferences of waist, hip, neck, and arm. LH and LA were established by the presence of at least one self-reported sign Results: Comparisons of self-reported signs with objective measurements for men and women were carried out in 815 participants on ART, out of 1240 participants with HIV infection. Self-report of decreased facial fat and sunken cheeks was associated with lower infraorbital, buccal, and submandibular skinfolds. Participants who reported buffalo hump had, on average, greater neck circumference, as well as those who have increased waist circumference also reported abdominal enlargement, but no buttock wasting. Men were most commonly affected by lipoatrophy (73 vs. 53%; P < 0.001), and women by lipohypertrophy (79 vs. 56%; P < 0.001). Conclusion: In conclusion, self-reported signs of lipodystrophy and lipoatrophy are prevalent, differ by gender, and are associated with objective measurements in people living with HIV/AIDS

People living with HIV on ART have accurate perception of lipodystrophy signs : a cross sectional study

Background: The prevalence of lipodystrophy ranges from 31 to 65%, depending on the criteria adopted for diagnosis. The usual methods applied in the diagnosis vary from self-perception, medical examination, skinfolds measurements, or even imaging assessment for confirmation of fat distribution changes. Although several methods have been developed, there is no gold standard for characterization of LA and LH, or mixed forms. This study aimed to compare self-reported signs of lipodystrophy with objective measures by skinfolds and circumferences, and to evaluate the prevalence of lipoatrophy (LA) and lipohypertrophy (LH) among subjects living with HIV/AIDS on ART. Methods: A cross-sectional study enrolled participants living with HIV/AIDS receiving ART, aged 18 years or older from an outpatient health care center, in Southern Brazil. Self-reported body fat enlargement in the abdomen, chest or breasts, and dorsocervical fat pad were used to determine LH, while LA was identified by self-reported fat wasting of the face, neck, legs, arms or buttocks. Measurements were obtained with a scientific caliper for infraorbital, buccal, and submandibular skinfolds, and using an inelastic tape to measure circumferences of waist, hip, neck, and arm. LH and LA were established by the presence of at least one self-reported sign Results: Comparisons of self-reported signs with objective measurements for men and women were carried out in 815 participants on ART, out of 1240 participants with HIV infection. Self-report of decreased facial fat and sunken cheeks was associated with lower infraorbital, buccal, and submandibular skinfolds. Participants who reported buffalo hump had, on average, greater neck circumference, as well as those who have increased waist circumference also reported abdominal enlargement, but no buttock wasting. Men were most commonly affected by lipoatrophy (73 vs. 53%; P < 0.001), and women by lipohypertrophy (79 vs. 56%; P < 0.001). Conclusion: In conclusion, self-reported signs of lipodystrophy and lipoatrophy are prevalent, differ by gender, and are associated with objective measurements in people living with HIV/AIDS

The HIV-Brazil cohort study: design, methods and participant characteristics

Submitted by Rodrigo Senorans ([email protected]) on 2015-06-01T18:08:15Z No. of bitstreams: 1 The HIV-Brazil Cohort study Design, methods and participant characteristics.pdf: 1222683 bytes, checksum: ef2a13de6007bf7b2e9e6b1341982954 (MD5)Approved for entry into archive by Anderson Silva ([email protected]) on 2015-06-01T18:45:27Z (GMT) No. of bitstreams: 1 The HIV-Brazil Cohort study Design, methods and participant characteristics.pdf: 1222683 bytes, checksum: ef2a13de6007bf7b2e9e6b1341982954 (MD5)Approved for entry into archive by Anderson Silva ([email protected]) on 2015-06-01T18:46:20Z (GMT) No. of bitstreams: 1 The HIV-Brazil Cohort study Design, methods and participant characteristics.pdf: 1222683 bytes, checksum: ef2a13de6007bf7b2e9e6b1341982954 (MD5)Made available in DSpace on 2015-06-03T17:03:57Z (GMT). No. of bitstreams: 1 The HIV-Brazil Cohort study Design, methods and participant characteristics.pdf: 1222683 bytes, checksum: ef2a13de6007bf7b2e9e6b1341982954 (MD5) Previous issue date: 2014CNPq, Ministério da Saúde do Brasil, Organização Pan-Americana da Saúde, Secretaria Estadual de Saúde de São Paulo, Centro de Referência e Treinamento DST/AIDS, INI/FIOCRUZUniversidade de São Paulo. Escola de Medicina. Departamento de Medicina Preventiva. São Paulo, SP, BrasilSecretaria Estadual de Saúde de São Paulo. Instituto de Saúde. São Paulo, SP, BrasilUniversidade de São Paulo. Escola de Medicina. Programa de Pós-Graduação em Doenças Infecciosas e Parasitárias . São Paulo, SP, BrasilSecretaria Estadual de Saúde de São Paulo. Centro de Referência e Treinamento DST/AIDS. São Paulo, SP, BrasilSecretaria Estadual de Saúde de São Paulo. Centro de Referência e Treinamento DST/AIDS. São Paulo, SP, BrasilFundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, BrasilSecretaria Estadual de Saúde do Rio grande do Sul. Hospital Sanatório Partenon. Porto Alegre, RS, BrasilSecretaria Estadual de Saúde do Rio grande do Sul. Hospital Sanatório Partenon. Porto Alegre, RS, BrasilUniversidade Federal da Bahia. Complexo Hospitalar Universitário Professor Edgard Santos. Salvador, BA, BrasilUniversidade Federal de Minas Gerais. Faculdade de Medicina. Belo Horizonte, MG, BrasilFundação de Medicina Tropical Doutor Heitor Vieira Dourado. Departamento de Saúde do Estado do Amazonas , ManausSecretaria Estadual de Saúde da Bahia. Centro Estadual Especializado em Diagnóstico, Assistência e Pesquisa. Salvador, BA, BrasilUniversidade Federal de Pernambuco. Recife, PE, BrasilFundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST e AIDS. Rio de Janeiro, RJ, BrasilUniversidade de São Paulo. Escola de Medicina. Departamento de Medicina Preventiva. São Paulo, SP, BrasilBackground: The HIV-Brazil Cohort Study was established to analyze the effectiveness of combination antiretroviral therapy (cART) and the impact of this treatment on morbidity, quality of life (QOL) and mortality. The study design, patients’ profiles and characteristics of cART initiation between 2003 and 2010 were described. Methodology/Principal Findings: Since 2003, the HIV-Brazil Cohort has been following HIV-infected adults receiving cART at 26 public health care facilities, using routine clinical care data and self-reported QOL questionnaires. When not otherwise available, data are obtained from national information systems. The main outcomes of interest are diseases related or unrelated to HIV; suppression of viral replication; adverse events; virological, clinical and immunological failures; changes in the cART; and mortality. For the 5,061 patients who started cART between 2003 and 2010, the median follow-up time was 4.1 years (IQR 2.2–5.9 years) with an 83.4% retention rate. Patient profiles were characterized by a predominance of men (male/female ratio 1.7:1), with a mean age of 36.9 years (SD 9.9 years); 55.2% had been infected with HIV via heterosexual contact. The majority of patients (53.4%) initiated cART with a CD4+ T-cell count #200 cells/mm3. The medications most often used in the various treatment regimens were efavirenz (59.7%) and lopinavir/ritonavir (18.2%). The proportion of individuals achieving viral suppression within the first 12 months of cART use was 77.4% (95% CI 76.1–78.6). Nearly half (45.4%) of the patients presented HIV-related clinical manifestations after starting cART, and the AIDS mortality rate was 13.9 per 1,000 person-years. Conclusions/Significance: Results from cART use in the daily practice of health services remain relatively unknown in lowand middle-income countries, and studies with the characteristics of the HIV-Brazil Cohort contribute to minimizing these shortcomings, given its scope and patient profile, which is similar to that of the AIDS epidemic in the country

Physical activity : Do patients infected with HIV practice? How much? A systematic review

Several studies have suggested that aerobic physical activity is safe and beneficial for HIV-infected adults. However, there is information lacking regarding whether HIV-infected patients practice physical activity and to what extent. Therefore, the aim of this systematic review was to determine the prevalence of physical activity, sedentary lifestyle or lack of physical activity in non-experimental conditions performed by HIV-infected subjects. The electronic search was conducted using Medline and EMBASE bibliographic databases and the platforms of Bireme, Ovid, Science Direct, High Wire and SCIELO from January 1990 to July 2011. Original observational studies were included. Of the 2,838 articles found, 48 met the inclusion criteria. Following data extraction and after reading the manuscripts, 24 were selected for systematic review. Of the 24 studies, most were cross-sectional studies. The average quality score using the modified Newcastle-Ottawa scale was 2.8±1.5. The diversity of methods used to assess physical activity precluded the calculated summary estimate of prevalence. The percentage of sedentary lifestyle was determined in 13 articles which conducted studies on HIV-infected individuals. The percentage of sedentary lifestyle or physical inactivity ranged from 19% to 73%, with the level determined by different methods. In conclusion, there are few well-designed studies with adequate sample size to represent the population of HIV-infected individuals. A pooled estimate could not be calculated due to the differences in physical activity measurements and definitions of physically active and non-active HIV-infected individuals