Lipodystrophic syndrome of HIV and associated factors: a study in a university hospital

Silva, Lídia Laís Gomes; Santos, Eryka Maria dos; Nascimento, Luciana Caroline Paulino do; Cavalcanti, Mikaella Carla de França; Arruda, Ilma Kruze Grande de; Luz, Marcella Campos Lima; Cabral, Poliana Coelho

doi:10.1590/1413-81232020253.11772018

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FREE THEMES • Ciênc. saúde coletiva 25 (3) • Mar 2020 • https://doi.org/10.1590/1413-81232020253.11772018 copy

Lipodystrophic syndrome of HIV and associated factors: a study in a university hospital

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The use of antiretroviral drugs has increased the survival of HIV patients, but may have side effects, such as lipodystrophic syndrome. This article aims to identify the frequency of the lipodystrophic syndrome and its associated factors in patients with HIV using antiretroviral therapy. It involved a cross-sectional study with HIV patients, monitored on an outpatient basis. The syndrome was evaluated by the association of two parameters: peripheral weight loss through the lipodystrophy severity scale and central fat accumulation, measured by the hip waist ratio. Poisson regression analysis was performed to identify the associated variables. Of the 104 patients evaluated, 27.9% presented the syndrome. After adjustment, the female sex (PR_adjusted = 2.16 CI_95% 1.43-3.39), being overweight (PR_adjusted = 2.23 CI_95% 1.35-2.65) and a longer period of use of antiretrovirals (PR_adjusted = 1.64 CI_95% 1.16-2.78), remained positively associated with the syndrome. On the other hand, a negative association with CD4 count £ 350 (PR_adjusted = 0.39 CI_95% 0.10-0.97) was observed The high prevalence of the syndrome and its association with specific groups reinforce the need for adequate follow-up and early identification to intervene in modifiable factors.

Key words
Lipodystrophy; AIDS; Anthropometry; Antiretroviral therapy

Variables	HIV-associated lipodystrophy syndrome
Variables	Yes		No		Total		^† † PR - crude prevalence ratio, PR	CI_95%	p
Sex	N	%	N	%	N	%
Female	15	45.5	18	54.5	33	31.7	2.31	1.27-9.23	0.013^a
Male	14	19.7	57	80.3	71	68.3	1.00
Age (years)
> 45	15	37.5	25	62.5	40	38.5	1.71	0.93-3.16	0.133^a
20-44	14	21.9	50	78.1	64	61.5	1.00
Family income (Brazilian currency)
<1000	16	30.8	36	69.2	52	51.0	1.59	0.85-2.97	0.216^a
> 1000	12	24.0	38	76.0	50	49.0	1.00
Schooling (years)
< 9	13	28.3	33	71.7	46	46	1.09	0.57-2.08	0.971^a
> 10	14	25.9	40	74.1	54	54	1.00
Alcohol intake^ intake independently of quantity or quality of beverage, IC - confidence interval, achi-square test with Yates correction, blinear trend chi-square test.
Yes	11	22.4	38	77.6	49	47.1	0.69	0.36-1.31	0.343^a
No	18	32.7	37	67.3	55	52.9	1.00
Smoking
Smoker	04	20.0	16	80.0	20	19.2	0.74	0.23-1.95	0.491^b
Ex-smoker	08	38.1	13	61.9	21	20.2	1.41	0.72-2.79
Non-smoker	17	27.0	46	73.0	63	60.6	1.00
Level of physical activity
Sedentary/insufficiently active	08	25.0	24	75.0	32	30.8	0.94	0.33-2.63	0.967^b
Active	17	29.8	40	70.2	57	54.8	1.12	0.44-2.83
Very active	04	26.7	11	73.3	15	14.4	1.00

Variables	HIV-associated lipodystrophy syndrome
Variables	Yes		No		Total		^† † PR - crude prevalence ratio, IC - confidence interval, ART - antiretroviral therapy, NARTI - nucleoside analog reverse-transcriptase inhibitor, NNRTI - non-nucleoside reverse-transcriptase inhibitor, PI - protease inhibitor, HDL - high-density lipoprotein, LDL: low-density lipoprotein, achi-square test with Yates correction. PR	CI_95%	p
Time diagnosis (months)	N	%	N	%	N	%
> 60	17	37	29	63	46	44.2	1.79	0.95-3.35	0.106
60	12	20.7	46	79.3	58	55.8	1.00
Use of ART (months)
> 60	16	38.1	26	61.9	42	40.4	1.82	0.98-3.37	0.091
60	13	21	49	79.0	62	59.6	1.00
Type of ART
2 NARTIs + 1 NNRTI	17	30.4	39	69.6	56	59.6	1.15	0.59-2.24	0.847
2 NARTIs + 1 PI	10	26.3	28	73.7	38	40.4	1.00
Viral load (copies/ml)
> 40	04	28.6	10	71.4	14	16.3	0.98	0.40-2.42	0.782
40	21	29.2	51	70.8	72	83.7	1.00
CD4+ count (cells/mm³)
350	02	9.1	20	90.9	22	25.3	0.26	0.07-1.00	0.037
>350	23	35.4	42	64.6	65	74.7	1.00
Hypercholesterolemia (mg/dL)
Yes	12	46.2	14	53.8	26	31.7	1.99	1.06-3.74	0.065
No	13	23.2	43	76.8	56	68.3	1.00
Hypertriglyceridemia (mg/dL)
Yes	09	25.0	27	75.0	36	42.9	0.80	0.40-1.62	0.701
No	15	31.3	33	68.8	48	57.1	1.00
Low HDL (mg/dL)
Yes	18	27.7	47	72.3	65	83.3	0.72	0.33-1.59	0.320
No	05	38.5	08	61.5	13	16.6	1.00
High LDL (mg/dL)
Yes	14	33.3	28	66.7	42	53.2	1.50	0.71-3.16	0.404
No	08	22.2	28	77.8	36	46.8	1.00
Excess weight (≥ 25 kg/m²)
Yes	22	43.1	29	56.9	51	49.5	3.20	1.50-6.84	0.002
No	07	13.5	45	86.5	52	50.5	1.00
Altered fasting glucose (mg/dL)
Yes	18	28.1	46	71.9	64	77.1	0.76	0.38-1.55	0.658
No	7	36.8	12	63.2	19	22.9	1.00

Variables	HIV-associated lipodystrophy syndrome
Variables	Crude PR^† † PR - prevalence ratio, IC - confidence interval, ART - antiretroviral therapy.	CI_95%	p	Adjusted PR^† † PR - prevalence ratio, IC - confidence interval, ART - antiretroviral therapy.	CI_95%	p
Female sex	2.31	1.27-9.23	0.013	2.16	1.43-3.39	0.022
Age ≥ 45 years	1.71	0.93-3.16	0.133	1.14	0.88-3.04	0.413
Time diagnosis > 60 months	1.79	0.95-3.35	0.106	1.84	0.56-3.22	0.214
Duration ART > 60 months	1.82	0.98-3.37	0.091	1.64	1.16-2.78	0.042
CD4+ count ≤ 350	0.26	0.07-1.00	0.037	0.39	0.10-0.97	0.034
Excess weight	3.20	1.50-6.84	0.002	2.23	1.35-2.65	0.000
Hypercholesterolemia	1.99	1.06-3.74	0.065	1.43	0.53-3.24	0.112

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[1] Collaborations

LLG Silva, development of the study and writing of the manuscript; Santos EM, data collection; LCP Nascimento, tabulation of data; M Cavalcanti, correction of the introduction and development of the manuscript; MCL Luz, co-adviser and final corrections; PC Cabral, guidance and statistics.