Anemia esferocítica hereditária.

Trabalho de Conclusão de Curso - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Departamento de Clínica Médica, Curso de Medicina, Florianópolis, 198

ATIVIDADE FÍSICA E GORDURA CORPORAL DE ADOLESCENTES VIVENDO COM HIV: UM ESTUDO COMPARATIVO

RESUMO Objetivo: Comparar a atividade física habitual entre adolescentes que vivem com o vírus da imunodeficiência humana (HIV) e seus pares saudáveis e testar a relação com indicadores antropométricos de gordura corporal. Método: Estudo transversal, com dois grupos de investigação, composto por 57 adolescentes (10-15 anos) com HIV e 54 adolescentes aparentemente saudáveis, pareados por sexo e idade. Medidas antropométricas foram realizadas e a atividade física habitual foi obtida por um questionário aplicado em entrevista. Os grupos foram comparados de acordo com os exercícios físicos e foi testada a correlação linear e correlação parcial (ajustada por sexo e idade) entre atividade física e os indicadores antropométricos. Resultados: Adolescentes que vivem com HIV apresentaram menor escore total de atividade física, comparados aos pares saudáveis (1,73 versus 2,14; p<0,001); porém tiveram maior participação nas práticas de educação física escolar. Ambos os grupos praticaram futebol e caminhadas mais frequentemente, entre as atividades físicas relatadas. Não houve correlação entre o escore total de atividade física e os indicadores antropométricos de gordura corporal, quando ajustado por sexo e idade. As variáveis sexo feminino (&#946;=21,51), meses de exposição à terapia antirretroviral (&#946;=1,26) e as classes econômicas &#8220;B&#8221; e &#8220;C&#8221; (&#946;= 22,05 e &#946;=28,15, respectivamente) explicaram 33% do somatório de dobras cutâneas de adolescentes que vivem com HIV (F=6,70; p<0,001). Conclusões: Adolescentes com o HIV têm menor escore de atividade física comparados aos pares saudáveis, porém a educação física escolar se mostrou um espaço favorável para o aumento dessa prática

ATIVIDADE FÍSICA E GORDURA CORPORAL DE ADOLESCENTES VIVENDO COM HIV: UM ESTUDO COMPARATIVO

RESUMO Objetivo: Comparar a atividade física habitual entre adolescentes que vivem com o vírus da imunodeficiência humana (HIV) e seus pares saudáveis e testar a relação com indicadores antropométricos de gordura corporal. Método: Estudo transversal, com dois grupos de investigação, composto por 57 adolescentes (10-15 anos) com HIV e 54 adolescentes aparentemente saudáveis, pareados por sexo e idade. Medidas antropométricas foram realizadas e a atividade física habitual foi obtida por um questionário aplicado em entrevista. Os grupos foram comparados de acordo com os exercícios físicos e foi testada a correlação linear e correlação parcial (ajustada por sexo e idade) entre atividade física e os indicadores antropométricos. Resultados: Adolescentes que vivem com HIV apresentaram menor escore total de atividade física, comparados aos pares saudáveis (1,73 versus 2,14; p<0,001); porém tiveram maior participação nas práticas de educação física escolar. Ambos os grupos praticaram futebol e caminhadas mais frequentemente, entre as atividades físicas relatadas. Não houve correlação entre o escore total de atividade física e os indicadores antropométricos de gordura corporal, quando ajustado por sexo e idade. As variáveis sexo feminino (β=21,51), meses de exposição à terapia antirretroviral (β=1,26) e as classes econômicas “B” e “C” (β= 22,05 e β=28,15, respectivamente) explicaram 33% do somatório de dobras cutâneas de adolescentes que vivem com HIV (F=6,70; p<0,001). Conclusões: Adolescentes com o HIV têm menor escore de atividade física comparados aos pares saudáveis, porém a educação física escolar se mostrou um espaço favorável para o aumento dessa prática

Long-term efficacy and safety of tenofovir disoproxil fumarate in Hiv-1-infected adolescents failing antiretroviral therapy: the final results of study Gs-us-104-0321

Reports of long-term tenofovir disoproxil fumarate (TDF) treatment in HIV-infected adolescents are limited. We present final results from the open-label (OL) TDF extension following the randomized, placebo (PBO)-controlled, double-blind phase of GS-US-104-0321 (Study 321). HIV-infected 12- to 17-year-olds treated with TDF 300 mg or PBO with an optimized background regimen (OBR) for 24-48 weeks subsequently received OL TDF plus OBR in a single arm study extension. HIV-1 RNA and safety, including bone mineral density (BMD), was assessed in all TDF recipients. Eighty-one subjects received TDF (median duration 96 weeks). No subject died or discontinued OL TDF for safety/tolerability. At week 144, proportions with HIV-1 RNA 1000 c/mL initially randomized to TDF), 41.7% (5 of 12 subjects with HIV-1 RNA 1000 c/mL and switched PBO to TDF). Viral resistance to TDF occurred in 1 subject. At week 144, median decrease in estimated glomerular filtration rate was 38.1 mL/min/1.73 m (n = 25). Increases in median spine (+12.70%, n = 26) and total body less head BMD (+4.32%, n = 26) and height-age adjusted Z-scores (n = 21; +0.457 for spine, +0.152 for total body less head) were observed at week 144. Five of 81 subjects (6%) had persistent >4% BMD decreases from baseline. Some subjects had virologic responses to TDF plus OBR, and TDF resistance was rare. TDF was well tolerated and can be considered for treatment of HIV-infected adolescents.Reports of long-term tenofovir disoproxil fumarate (TDF) treatment in HIV-infected adolescents are limited. We present final results from the open-label (OL) TDF extension following the randomized, placebo (PBO)-controlled, double-blind phase of GS-US-104-0321 (Study 321). Methods: HIV-infected 12- to 17-year-olds treated with TDF 300mg or PBO with an optimized background regimen (OBR) for 24–48 weeks subsequently received OL TDF plus OBR in a single arm study extension. HIV-1 RNA and safety, including bone mineral density (BMD), was assessed in all TDF recipients. Results: Eighty-one subjects received TDF (median duration 96 weeks). No subject died or discontinued OL TDF for safety/tolerability. At week 144, proportions with HIV-1 RNA 1000 c/mL initially randomized to TDF), 41.7% (5 of 12 subjects with HIV-1 RNA 1000 c/mL and switched PBO to TDF). Viral resistance to TDF occurred in 1 subject. At week 144, median decrease in estimated glomerular filtration rate was 38.1mL/min/1.73 m2 (n = 25). Increases in median spine (+12.70%, n = 26) and total body less head BMD (+4.32%, n = 26) and height-age adjusted Z-scores (n = 21; +0.457 for spine, +0.152 for total body less head) were observed at week 144. Five of 81 subjects (6%) had persistent >4% BMD decreases from baseline. Conclusions: Some subjects had virologic responses to TDF plus OBR, and TDF resistance was rare. TDF was well tolerated and can be considered for treatment of HIV-infected adolescents34439840

Dyslipidemia, chronic inflammation, and subclinical atherosclerosis in children and adolescents infected with HIV: The PositHIVe Health Study

<div><p>HIV-infected children and adolescents may be at risk for cardiovascular disease due to chronic inflammation and exacerbation of risk factors. The aim of this study was as follows: 1) compare cardiovascular risk factors, chronic inflammation, and carotid intima-media thickness (IMTc) between the HIV and control groups; 2) determine the association of HIV and antiretroviral (ART) regimens with cardiovascular risk factors, chronic inflammation, and IMTc; and 3) identify variables associated with elevated IMTc. Cross-sectional analysis of 130 children and adolescents, 8–15 years of age, divided into HIV-infected (n = 65) and healthy control (n = 65) participants. Body fat, blood pressure, glycemia, insulin, and glycated hemoglobin, total cholesterol and fractions (LDL-C and HDL-C), triglycerides, C-reactive protein (CRP), interleukin (IL)-6, tumor necrosis factor-alpha (TNF-α), and the IMTc were measured. The results showed HIV-infected children and adolescents had higher levels of glycemia (87.9 vs. 75.9 mg.dL⁻¹, p< 0.001), LDL-c (94.7 vs. 79.5 mg.dL⁻¹, p = 0.010), triglycerides (101.2 vs. 61.6 mg.dL⁻¹, p< 0.001), CRP (1.6 vs. 1.0 mg.L⁻¹, p = 0.007), IL-6 (1.42 vs. 0.01 pg.mL⁻¹, p< 0.001), TNF-α (0.49 vs. 0.01 pg.mL⁻¹, p< 0.001), mean IMTc (0.526 vs. 0.499 mm, p = 0.009), and lower HDL-c (53.7 vs. 69.4 mg.dL⁻¹, p< 0.001) compared to controls. Systolic blood pressure (β = 0.006, p = 0.004) and TNF-α (β = −0.033, p = 0.029) accounted for 16% of IMTc variability in HIV-infected children and adolescents. In patients using protease inhibitors-based ART, male gender (β = −0.186, p = 0.008), trunk body fat (β = −0.011, p = 0.006), glucose (β = 0.005, p = 0.046), and IL-6 (β = 0.017, p = 0.039) accounted for 28% of IMTc variability. HIV-infected children and adolescents may be at risk for premature atherosclerosis due to chronic inflammation and dyslipidemia. Interventions with the potential to improve lipid profile, mitigate inflammation, and reduce cardiovascular risk are needed.</p></div

Beta regression coefficients of group associations with cardiovascular risk factors, inflammation and intimal-media thickness.

<p>Independent variable: Control = 0 (reference); HIV-infected not treated = 1; HIV-infected non PI-ART = 2; HIV-infected PI-ART = 3. * p-value < 0.05; ** < 0.01; *** <0.001. All models were adjusted by age, sex and pubertal status.</p

Multiple linear regression analysis of the independent predictors of IMTc (ln).

<p>Multiple linear regression analysis of the independent predictors of IMTc (ln).</p

Comparison of HIV-infected children and adolescents in different ART regimens.

<p>Comparison of HIV-infected children and adolescents in different ART regimens.</p

Flowchart of participants.

<p>PositHIVe Health Study.</p

Characteristics of the participants.

<p>Characteristics of the participants.</p