ABSTRACT
INTRODUÇÃO: Desde a introdução do tratamento do HIV com uso da terapia antirretroviral altamente ativa, a mortalidade por essa doença foi reduzida drasticamente em todo o mundo. Um dos parefeitos relacionados à utilização desses fármacos é a lipodistrofia glútea. O objetivo deste trabalho é verificar o impacto da correção dessa deformidade na qualidade de vida de pacientes com HIV. MÉTODOS: Foi conduzido um estudo de coorte histórica com 23 pacientes submetidos à gluteoplastia com implante intramuscular, entre janeiro de 2010 e dezembro de 2014, avaliando a qualidade de vida por meio do em Nottingham Health Profile em. As informações foram coletadas de julho a agosto de 2015. A análise estatística foi feita utilizando-se o em Related-Samples McNemar Test em. RESULTADOS: strong Houve diferença significativa entre o pré-operatório e pós-operatório em 19 das 38 perguntas. CONCLUSÃO: É possível afirmar que a reconstrução glútea melhora a qualidade de vida de pacientes HIV positivos acometidos por lipodistrofia glútea relacionada a antirretrovirais.
INTRODUCTION: Since the introduction of highly active antiretroviral therapy for the treatment of human immunodeficiency virus (HIV), disease mortality has been dramatically reduced worldwide. One related side effect from the use of these drugs is gluteal lipodystrophy. The aim of this study is to assess the quality-of-life impact of correcting this deformity in HIV patients. METHODS: A historical cohort study was conducted between January 2010 and December 2014 with 23 patients, assessing the quality of their lives using the Nottingham Health Profile. A statistical analysis was performed using the McNemar test for related samples. RESULTS: There was a significant difference between preoperative and postoperative response in 19 of the 38 questions. CONCLUSION: We may say that gluteal reconstruction plays a role in improving quality of life for HIV patients who have been affected by antiretroviral related gluteal lipodystrophy.
Subject(s)
Humans , Male , Female , Middle Aged , History, 21st Century , Quality of Life , Congenital Abnormalities , Buttocks , Cohort Studies , HIV , Retroviridae Infections , HIV-Associated Lipodystrophy Syndrome , Anti-Retroviral Agents , Lipodystrophy , Medication Systems , Congenital Abnormalities/surgery , Buttocks/surgery , HIV/drug effects , Retroviridae Infections/drug therapy , HIV-Associated Lipodystrophy Syndrome/drug therapy , Anti-Retroviral Agents/analysis , Anti-Retroviral Agents/pharmacology , Lipodystrophy/drug therapy , Medication Systems/historyABSTRACT
Introdução: O tratamento de pacientes portadores da síndrome da imunodeficiência adquirida deve ser integral e se basear no controle da doença e das complicações relacionadas ao uso de medicações antirretrovirais, como a lipodistrofia. Esse estudo tem como objetivo avaliar as principais queixas, os aspectos epidemiológicos e os procedimentos cirúrgicos realizados para corrigir a lipodistrofia em pacientes em uso crônico de antirretrovirais. Método: Estudo retrospectivo, no qual foram coletados dados dos prontuários de 27 pacientes submetidos a 36 procedimentos cirúrgicos relacionados à correção de lipodistrofia no período de março de 2010 a junho de 2014 no serviço de Cirurgia Plástica do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto. Resultados: A idade média dos pacientes foi 47,2 anos, 22,2% homens e 77,8% mulheres. O tempo médio de uso da terapia antirretroviral (TARV) foi de 12,1 anos. As queixas mais encontradas foram: giba dorsal (44,4%), lipodistrofia abdominal (44,4%) e lipoatrofia glútea (37,04%). Na maioria dos pacientes (70,4%), foi realizada uma cirurgia. Quanto às cirurgias, a lipoaspiração de giba foi realizada em 48,1% dos pacientes, seguida da lipoaspiração de abdome, dorso ou flancos (44,4%) e gluteoplastia (22,2%). Entre todos os 36 procedimentos realizados, apenas dois apresentaram complicações. O tempo médio de seguimento pós-operatório foi de 11,2 meses. Do total, 70,4% dos pacientes mostraram-se satisfeitos após os procedimentos. Conclusões: O sucesso do tratamento cirúrgico da lipodistrofia causada pelo uso da TARV baseia-se na seleção pré-operatória adequada e em seguimento constante e prolongado. A melhoria da autoestima facilita a adesão ao tratamento com antirretrovirais.
Introduction: Treatment of patients with acquired immunodeficiency syndrome should be complete and based on controlling the disease and the complications related to the use of antiretroviral medications, such as lipodystrophy. This study aimed to evaluate the main complaints, epidemiological aspects, and surgical procedures performed for lipodystrophy correction among patients receiving long-term antiretroviral therapy. Method: In this retrospective study, data were collected from the medical records of 27 patients who underwent 36 surgical procedures associated with lipodystrophy correction, from March 2010 to June 2014, at the Plastic Surgery Service of the Hospital das Clínicas, Faculty of Medicine of Ribeirão Preto. Results: The average age of the patients was 47.2 years; 22.2% were men and 77.8% were women. The average duration of antiretroviral therapy (HAAR ) was 12.1 years. The most frequent complaints were dorsal hump (44.4%), abdominal lipodystrophy (44.4%), and gluteal lipoatrophy (37.04%). The majority of patients (70.4%) had undergone surgery . The most common type of surgery performed was hump liposuction (carried out in 48.1% of the patients), followed by abdominal, back, or flank liposuction (44.4%) and gluteoplasty (22.2%). Among all 36 procedures performed, only 2 resulted in complications. The average postoperative follow-up period was 11.2 months. In total, 70.4% of patients were satisfied with the results of their procedure. Conclusions: The success of surgical treatment of HAARinduced lipodystrophy is based on proper preoperative selection as well as constant and prolonged follow-up. Improved selfesteem facilitates the adherence to antiretroviral drug treatment.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , History, 21st Century , Lipectomy , Medical Records , Epidemiology, Descriptive , Retrospective Studies , Acquired Immunodeficiency Syndrome , Plastic Surgery Procedures , Antiretroviral Therapy, Highly Active , HIV-Associated Lipodystrophy Syndrome , Anti-Retroviral Agents , Observational Study , Lipodystrophy , Lipectomy/methods , Medical Records/standards , Acquired Immunodeficiency Syndrome/surgery , Acquired Immunodeficiency Syndrome/pathology , Acquired Immunodeficiency Syndrome/drug therapy , Plastic Surgery Procedures/methods , Antiretroviral Therapy, Highly Active/methods , HIV-Associated Lipodystrophy Syndrome/surgery , HIV-Associated Lipodystrophy Syndrome/pathology , HIV-Associated Lipodystrophy Syndrome/drug therapy , Anti-Retroviral Agents/therapeutic use , Lipodystrophy/drug therapy , Lipodystrophy/therapyABSTRACT
OBJECTIVE: To study whether patients with HIV-1 associated lipodystrophy (LD) on highly active antiretroviral treatment (HAART) have more psychopathology and worse psychosocial adjustment than a similar group without this syndrome. METHODS: In a cross-sectional, observational study we compared 47 HIV-1 infected patients with LD (LD group) with 39 HIV-1 infected patients without LD (non-LD group). All participants were on HAART. The Beck Depression Inventory (BDI), the State and Trait Anxiety Inventory (STAI) and the Goldberg Health Questionnaire (GHQ-60) were administered. Levels of familial, work and social adjustment and adjustment to stressful events were evaluated in a semi-structured interview. Clinical information was extracted from the clinical records. RESULTS: In the univariate analysis patients with LD showed higher state anxiety scores (p = 0.009) and worse work adjustment (p = 0.019) than those without LD. A total of 45.3% of LD patients scored above the cut-off point on the trait anxiety scale, and over 33.3% scored above the cut-off point on the BDI, GHQ and state anxiety scales. However, in multivariate analyses LD was not independently associated with psychopathology or with worse adjustment in the studied areas. CONCLUSIONS: The finding that LD was not a predictor of greater psychopathology or worse psychosocial adjustment in HIV-1 infected patients, despite the high scores found, suggests that factors not taken into account in this study, such as LD severity and self-perception should have been included in the analysis. Further studies including a greater number of variables and a larger sample size will advance our understanding of this complex condition.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Young Adult , Antiretroviral Therapy, Highly Active/psychology , HIV-Associated Lipodystrophy Syndrome/psychology , Social Adjustment , Case-Control Studies , Cross-Sectional Studies , HIV-Associated Lipodystrophy Syndrome/drug therapy , Life Change Events , Socioeconomic Factors , Surveys and QuestionnairesABSTRACT
OBJETIVO: Este estudo procurou avaliar o conteúdo de gordura dos portadores do HIV segundo o tempo de uso da terapia antirretroviral (TEMPARV), < 1 ano e > 1 ano. MÉTODOS: A regressão linear múltipla foi utilizada para investigar a associação entre as variáveis ultrassonográficas dos compartimentos corporais de gordura (CCG) da face, braço, abdômen subcutâneo e visceral e as seguintes variáveis explanatórias: sexo, idade, IMC e TEMPARV. RESULTADOS: Do total de pacientes (187), 102 com TEMPARV > 1ano eram portadores de lipodistrofia relacionada ao HIV (LD-HIV), diagnosticados de acordo com os questionários clínicos. Já aqueles com TEMPARV < 1 ano (n= 85, ≈46%) não apresentavam LD-HIV. Com relação ao compartimento visceral, a diferença entre os pacientes com TEMPARV > 1 ano e < 1 ano foi de 11 mm de gordura adicionais naqueles em TEMPARV > 1 ano. As mulheres tinham mais gordura que os homens em todos os CCG periféricos, enquanto eles tinham 7,2 mm a mais de gordura visceral que elas, em média. CONCLUSÃO: A ultrassonografia é um método capaz de medir a espessura de gordura dos CGC aplicável à prática clínica para diagnosticar a LD-HIV.
OBJECTIVE: This study aimed to evaluate the body fat content of HIV patients according to the duration of antiretroviral therapy use (DURARV), < 1 year and > 1 year. METHODS: Multiple linear regression was used to investigate the association between ultrasonographic variables of body fat compartments (BFCs) of the face, arm, subcutaneous and visceral abdomen, and the following explanatory variables: gender, age, BMI, and DURARV. RESULTS: Of all patients (187), 102 of them with DURARV > 1 year were suffering from HIV-related lipodystrophy (HIV-LD), diagnosed through clinical questionnaires. Those with DURARV < 1 year (n = 85, = 46%) did not have HIV-LD. Regarding the visceral compartment, the difference between those with DURARV > 1 year and < 1 year was 11 mm of additional fat content in those with DURARV > 1 year. Women had more fat than men in all peripheral BFCs, while men had 7.2 mm more visceral fat than women, on average. CONCLUSION: Ultrasonography is a method capable of measuring the thickness of BFCs and is applicable to clinical practice to diagnose HIV-LD.
Subject(s)
Adult , Female , Humans , Anti-Retroviral Agents/therapeutic use , Body Fat Distribution , HIV-Associated Lipodystrophy Syndrome , Skinfold Thickness , Antiretroviral Therapy, Highly Active , HIV-Associated Lipodystrophy Syndrome/drug therapy , Linear Models , Sex FactorsABSTRACT
As primeiras descrições da síndrome da imunodeficiência adquirida (Aids) associavam-se à síndrome de emaciamento, e os distúrbios metabólicos às alterações na composição corporal. Após a introdução da terapia anti-retroviral altamente ativa (HAART), houve declínio na desnutrição, e surge a lipodistrofia como importante distúrbio metabólico. A Aids também se caracteriza por distúrbios hormonais, principalmente no eixo hormônio de crescimento/fator de crescimento insulina-like tipo 1 (GH/IGF-1). O uso do GH recombinante humano (hrGH) foi inicialmente indicado na síndrome de emaciamento, a fim de aumentar a massa muscular. Embora também não existam dúvidas quanto aos efeitos do hrGH na lipodistrofia, a diminuição na sensibilidade à insulina limita o seu uso, o qual ainda não está oficialmente aprovado. A diversidade nos esquemas de tratamento é outro limitante do uso dessa medicação em pacientes com Aids. Esta revisão apresenta os principais distúrbios endócrino-metabólicos associados à Aids e ao uso do hrGH nessas condições.
Acquired Immunodeficiency Syndrome (Aids) was initially related to HIV-associated wasting syndrome, and its metabolic disturbances to altered body composition. After Highly Active Antiretroviral Therapy (HAART) was started, malnutrition has declined and HIV-associated lipodystrophy syndrome has emerged as an important metabolic disorder. Aids is also characterized by hormonal disturbances, principally in growth hormone/insulin-like growth factor 1 (GH/IGF-1) axis. The use of recombinant human GH (hrGH) was formerly indicated to treat wasting syndrome, in order to increase lean body mass. Even though the use of hrGH in lipodystrophy syndrome has been considered, the decrease in insulin sensitivity is a limitation for its use, which has not been officially approved yet. Diversity in therapeutic regimen is another limitation to its use in Aids patients. The present study has reviewed the main HIV-related endocrine-metabolic disorders as well as the use of hrGH in such conditions.
Subject(s)
Adolescent , Adult , Child , Humans , Acquired Immunodeficiency Syndrome/complications , HIV Wasting Syndrome/drug therapy , HIV-Associated Lipodystrophy Syndrome/drug therapy , Human Growth Hormone/therapeutic use , Insulin-Like Growth Factor I/metabolism , Acquired Immunodeficiency Syndrome/drug therapy , Antiretroviral Therapy, Highly Active/adverse effects , HIV Wasting Syndrome/complications , HIV-Associated Lipodystrophy Syndrome/complications , Human Growth Hormone/adverse effects , Human Growth Hormone/metabolism , Recombinant Proteins/therapeutic useABSTRACT
A introdução da highly active antiretroviral therapy (HAART) - terapia anti-retroviral fortemente ativa - vem reduzindo a morbidade e a mortalidade em pacientes infectados com o vírus da imunodeficiência humana (HIV). Entretanto, tratamentos prolongados, com combinações de drogas, são de difícil manutenção devido à má aderência e aos efeitos tóxicos. O tratamento com agentes anti-retrovirais, especialmente os inibidores da protease, fez surgir uma síndrome caracterizada por redistribuição anormal da gordura corporal, alterações no metabolismo glicêmico, resistência insulínica e dislipidemia, chamada de síndrome lipodistrófica do HIV (SLHIV). Atualmente não existe nenhum consenso para prevenção ou tratamento da síndrome, cuja causa permanece desconhecida. Esta revisão enfatiza os achados clínicos e dados da literatura a respeito da SLHIV, pois um melhor entendimento desta síndrome por infectologistas, cardiologistas e endocrinologistas é essencial para o manejo da doença.