Aerobic capacity and health-related quality of life in adults HIV-infected patients with and without lipodystrophy

Abstract Introduction HIV infection and its therapy which can affect their aerobic capacity and health-related quality of life of patients. Objective We conducted a cross-sectional study to determine if aerobic capacity and health related quality of life was decreased in HIV-infected patients receiving highly active antiretroviral therapy and comparing patients with and without lipodystrophy. Research design and methods HIV-infected patients older than 18 years, and in current use of highly active antiretroviral therapy drugs, were evaluated for blood count, fasting total cholesterol, high density lipoprotein, triglycerides, glucose, HIV viral load and CD4/CD8 counts, body composition, peak oxygen consumption (peak VO2) and metabolic equivalent. Health related quality of life was assessed by using Short Form-36 (SF-36). Statistical analysis was carried out using SPSS version 20.0. Results A total of 63 patients with mean age of 43.1 ± 6.4 years were evaluated, of these 34 (54%) had lipodystrophy. The average peak VO2 (31.4 ± 7.6 mL kg−1 min−1) was significantly lower (p < 0.01) than expected values (37.9 ± 5.6 mL kg−1 min−1) according to the characteristics of the patients. The lipodystrophy group presented with a significant difference in muscle mass, body fat, peak VO2 and metabolic equivalent and in functional capacity domains of SF-36. Conclusion Aerobic capacity values were reduced in HIV-infected patients under highly active antiretroviral therapy when compared to predicted values. Lipodystrophy was associated with reduced aerobic capacity and higher frequency of metabolic syndrome. Lifestyle modification should be a priority in the management of chronic HIV disease.

Estudo anatômico de bolsões adiposos na região hipogástrica / Anatomic study of pockets areas in the hypogastrium

INTRODUÇÃO: Nas lipodistrofias da parede abdominal anterior, fatores genéticos, aumento de peso, idade e lasseamento da musculatura, de forma isolada ou associada, determinam alterações estéticas generalizadas ou localizadas no epigástrio, no hipogástrio ou, mesmo, em ambas as regiões. O objetivo deste estudo é descrever os limites, a disposição, as relações anatômicas das bolsas adiposas no hipogástrio com as estruturas vizinhas e suas dimensões. MÉTODO: Foram dissecadas 57 peças anatômicas de pacientes submetidas a abdominoplastia, em que o hipogástrio foi ressecado em monobloco. Além disso, foi realizada dissecção da parede abdominal anterior em 8 cadáveres. Em todas as peças, a camada lamelar foi ressecada, mantendo-se a derme-epiderme, a camada areolar e a fáscia superficial íntegras. RESULTADOS: Em todas as peças, foram observados dois cúmulos adiposos na camada areolar bilateralmente, simétricos, em forma de bolsa e de coloração peculiar. Essas bolsas foram também analisadas em relação aos tecidos cutâneos vizinhos: pele, fáscia superficial, camada profunda de gordura. CONCLUSÕES: A camada lamelar foi considerada estrutural como base da pele, pela sua fina espessura, e a camada areolar apresentou acúmulos e volumes variáveis de tecido adiposo nas diversas regiões do corpo, sem limites precisos, particularmente observados nas dissecções da parede abdominal inferior, pela sua elasticidade, pelo volume e pela coloração.

BACKGROUND: In lipodystrophies of the anterior abdominal wall, variables such as genetic factors, weight gain, age, and loss of muscle tone, either alone or in combination, determine generalized aesthetic changes or changes localized in the epigastrium, hypogastrium, or both. The aim of this study was to describe the limits, distribution, and dimensions of fat bags in the hypogastrium, as well as their anatomic relationships with the neighboring structures. METHODS: Fifty-seven anatomical specimens were dissected from patients undergoing abdominoplasty, during which the hypogastrium was resected en bloc. Moreover, the anterior abdominal wall was also dissected in 8 cadavers. In all samples, the lamellar layer was resected, keeping the dermis-epidermis, areolar layer, and superficial fascia intact. RESULTS: In all specimens, 2 symmetrical adipose clusters were observed bilaterally in the areolar layer, which were in the shape of a bag and had peculiar coloration. These bags were analyzed in relation to their neighboring tissues: the skin, superficial fascia, and deep fat layer. CONCLUSIONS: The lamellar layer was considered as a structural base of the skin, owing to its thinness. The areolar layer showed accumulations and varying amounts of fat in the various body regions without precise limits, which were particularly observed in dissections of the lower abdominal wall and identified by their elasticity, volume, and coloration.

Envolvimento cardíaco na lipodistrofia total generalizada (síndrome de Berardinelli-Seip) / Cardiac involvement in total generalized lipodystrophy (Berardinelli- Seip syndrome)

Total generalized lipodystrophy (Berardinelli--Seip Syndrome) is a rare hereditary disease characterized by insulin-resistant diabetes mellitus and a small quantity of adipose tissue and is of unknown origin. Common cardiovascular alterations related to this syndrome are cardiac hypertrophy and arterial hypertension. This article reports a case of Berardinelli--Seip syndrome and reviews the literature with special emphasis on the cardiovascular manifestations of this syndrome.

Tratamiento antirretroviral / Antiretroviral therapy

En el presente trabajo se analizan los beneficios y limitaciones de la terapia antirretroviral de alta eficacia (HAART). Los objetivos de esta terapia son reducir la carga viral plasmática lo máximo posible y durante el mayor tiempo posible. Esto implica alcanzar niveles de carga viral no detectables con técnicas ultrasensibles. Se evalúan los resultados obtenidos con los principales esquemas de tratamiento asi como sus indicaciones y efectos adversos.

Lipodistrofia generealizada congênita - relato de um caso / Congenital generalized lipodystrophy - a case report

A lipodistrofia generalizada congênita é doença é doença rara, de etiologia desconhecida, provavelmente hereditária e de caráter autossômico recessivo, com predominância no sexo feminino. Neste trabalho é relatado um caso de lipodistrofia generalizada congênita em um homem de 36 anos de idade, que apresentava clinicamente dispnéia e diabetes mellitus. No estudo radiográfico foram evidenciadas lesões líticas no esqueleto, fibrose intersticial pulmonar e pobreza de gordura abdominal. Serão descritos aos achados radiologógicos e anatomapatológicos, além da revisão da literatura sobre o assunto.

Sindrome de Lipodistrofia Congénita Generalizada / Congenital generalized lipodystrophy syndrome

El actual estudio trata sobre la forma de presentación y evolución de los pacientes con lipodistrofia congénita generalizada o el Síndrome de Seip-Berardinelli. Se caracteriza por la ausencia de tejido graso subcutáneo, cirrosis hepática, desarrollo de diabetes resistente a la insulina, hiperlipemia, y crecimiento corporal rápido con edad ósea avanzada en la infancia, coexistiendo alteraciones cutáneas, desarrollo muscular exagerado y compromiso de otros órganos. Se presentan 3 casos de esta patología diagnosticados entre 9 y 19 meses de edad. Las 3 pacientes presentaban varias características en común: aparentaban una edad mayor a la cronlógica, cara triangular, abundante cabello, lesiones hiperpigmentadas a predominio de pliegues, marcada disminución de tejido celular subcutáneo, prominencia muscular y hepatomegalia. Otros hallazgos clínicos sólo se demostraron en una u otra de las pacientes. La evaluación de laboratorio muestra alteración precoz de lípidos a predominio de triglicéridos, conservando la glicemia y la curva de tolerancia a la glucosa dentro de límites normales. Edad ósea avanzada en 1 de los 3 casos. Analizando los datos de las pacientes y de la literatura respecto a la fisiopatología y posibles efectos beneficiosos de los neurolépticos, se sugiere existencia de alguna anomalía a nivel del hipotálamo y/o hipófisis responsable de la presentacióm del cuadro clínico.