Reabsorção no metabolismo ósseo de pacientes HIV-positivos / Reabsorption in bone metabolism of HIV-positive patients

INTRODUÇÃO: Pacientes infectados pelo HIV apresentam osteoporose ou osteopenia densitométrica numa taxa de 28 a 50 por cento. O objetivo deste estudo é verificar alterações na taxa de reabsorção/formação destes pacientes. MATERIAL E MÉTODOS: Realizou-se revisão sistemática com metanálise de estudos controlados que avaliaram a associação entre osteopenia e/ou alterações no metabolismo ósseo com a infecção pelo HIV. Todos os estudos que incluíam osteocalcina ou NTX com marcadores respectivos de formação e reabsorção ósseos foram incuidos. Cinco estudos foram classificados como evidência classe III e envolveram 456 indivíduos HIV positivos e 590 controles. O NTX teve aumento significante (p < 0.00014) no grupo HIV-positivo, enquanto osteocalcina não se mostrou alterada. CONCLUSÃO: O presente estudo permite concluir que, durante a infecção pelo HIV, o marcador NTX está significantemente elevado, refletido alta atividade reabsortiva no tecido ósseo. Isto aponta um papel importante na atividade osteoclástica na perda óssea de pacientes HIV-positivos.

INTRODUCTION: HIV-infected patients show osteoporosis or densitometric osteopenia at a rate of 28-50 percent. The objective of this study is to check the changes on reabsorption/ development rates on these patients. MATERIALS AND METHODS: A systematic review was carried out with meta-analysis of controlled studies assessing the correlation between osteopenia and/ or bone metabolism changes with HIV infection. All studies including osteocalcin or NTX with corresponding markers of bone development and reabsorption were included. Five studies were classified as class-III evidence, and involved 456 HIV-positive individuals and 590 controls. NTX had a significant increase (p < 0.00014) on the HIV-positive group, while osteocalcin has shown to be unchanged. CONCLUSION: This study allows us to conclude that, during HIV infection, the NTX marker is significantly high, reflecting a high reabsorptive activity on the bone tissue. This suggests an important role on osteoclastic activity in bone loss for HIV-positive patients.

Prevalencia de incapacidades em dois diferentes grupos sociais em Salvador, Brasil / Disability prevalence in two social groups of Salvador, Brazil

To assess physical and/or mental disability prevalence in Salvador, Bahia, 485 favela (shantytown) dwellers and 753 non-favela dwellers age 7 and older were studied in October 1985. Some 77.3 percent of the favela dwellers were either illiterate or had incomplete primary schooling, while 77.2 percent of the non-favela dwellers had completed high school or college. The total prevalence of disability, adjusted by age, was 8 percent for favela dwellers and 2.5 percent for non-favela dwellers. The prevalence of physical disability was 6.2 percent among favela dwellers and 1.9 percent among non-favela dwellers; mental disability occurred among 1.8 percent of favela dwellers and 0.7 percent of non-favela dwellers. Prevalences of disability in the favela group were higher among men than women (ratio of 4.4); there was no difference between sexes in the group of non-favela dwellers (ratio of 1.1). Locomotor impairment was the most prevalent, followed by mental and sensory disabilities. The authors discused the need for more detailed studies on disability, including aspects related to availability of and access to médical care and rehabilitation