Self-reported HIV/HAART-associated Lipodystrophy and Modifiable Risk Factors for Cardiovascular Disease

Jardim, Thiago Veiga; Cardoso, Rodrigo de Castro; Santos, Annelisa Silva e Alves de Carvalho; Falco, Marianne de Oliveira; Silveira, Erika Aparecida

doi:10.36660/ijcs.20190128

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Brasil

International Journal of Cardiovascular Sciences

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Brasil

Español English

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Sumário

ORIGINAL ARTICLE • Int J Cardiovasc Sci 33 (6) • Nov-Dec 2020 • https://doi.org/10.36660/ijcs.20190128 copy

Self-reported HIV/HAART-associated Lipodystrophy and Modifiable Risk Factors for Cardiovascular Disease

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background

Patient self-report is the most common diagnostic tool in the literature to detect HIV/HAART-associated lipodystrophy. However, data on the association of cardiovascular risk factors with HIV/HAART-associated lipodystrophy assessed by self-report are still missing.

Objectives

To determine the prevalence of self-reported HIV/HAART-associated lipodystrophy and to identify independent associations between traditional modifiable cardiovascular risk factors and self-reported lipodystrophy.

Methods

We conducted a retrospective observational study at an outpatient infectious disease clinic in the Central-West of Brazil to identify the association between traditional modifiable cardiovascular risk factors and self-reported lipodystrophy. Sedentary lifestyle, smoking status, family history of cardiovascular disease, hypertension, diabetes, dyslipidemia, increased waist circumference and overweight were the cardiovascular risk factors assessed. Self-reported HIV/HART-associated lipodystrophy was categorized as: mild (noticeable by patients’ close inspection), moderate (easily noticeable by patient and physician) or severe (readily noticeable by a casual observer). Prevalence ratio (PR) and 95% confidence interval (CI95%) were calculated. Multivariate Poisson’s regression was used to analyze factors associated to HIV/HAART-associated lipodystrophy assessed by self-report considering a significance level of 5%.

Results

A total of 183 patients were included, with a mean age of 39.3±10.9 years. Most of the sample were male (77.6%), non-white (50.8%) and single (53.0%). The overall prevalence of HIV/HAART-associated lipodystrophy was 52.5% (95% CI 44.96 - 59.88). Severe lipodystrophy was observed in more than half patients (55.2%). No traditional modifiable cardiovascular risk factor was independently associated with lipodystrophy. Female sex (PR 1.49; 95% CI 1.15 – 1.95; p =0.003), time of HIV infection diagnosis of 1-3 years (PR 1.83; 95% CI 1.09 - 3.08; p =0.002) and a positive family history of CVD (PR 1.62; 95% CI 1.11 - 2.36; p <0.001) were independently associated with lipodystrophy.

Conclusion

HIV/HAART-associated lipodystrophy assessed by patient self-report was not associated with traditional modifiable cardiovascular risk factors. Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0

Retroviridae; Antivirals/therapeutic use; Cardiovascular Diseases/complications; Risk Factors; Metabolic Diseases/complications; Lipodystrophy

Variables	Total		Lipodystrophy prevalence				p-value*

	n	%	n	%	PR	95% CI
Sex							0.003
Male	142	77.60	67	47.18	1.00
Female	41	22.40	29	70.73	1.50	1.15 – 1.95
Age							0.952
19-29 years	35	19.13	18	51.43	1.01	0.67 – 1.52
30-39 years	61	33.33	32	52.46	1.03	0.73 – 1.46
40-49 years	59	32.24	30	50.85	1.00
≥50 years	28	15.30	16	57.14	0.51	0.75 – 1.69
Skin color							0.598
White	90	49.18	49	54.44	1.07	0.82 – 1.42
Non-white	93	50.82	47	50.54	1.00
Schooling (years)							0.808
≤4 years	30	16.39	18	60.00	1.20	0.79 – 1.81
5-8 years	42	22.95	22	52.38	1.05	0.70 – 1.58
9-11 years	65	35.52	33	50.77	1.01	0.70 – 1.48
≥12 years	46	25.14	23	50.00	1.00
Marital Status							0.434
Single	97	53.01	50	51.55	1.07	0.76 – 1.52
Married	50	27.32	24	48.00	1.00
Widowed/Divorced	36	19.67	22	61.11	1.27	0.86 – 1.88
Monthly income							0.864
1^st quartile	59	32.24	31	52.54	1.07	0.74 – 1.55
^2nd quartile	35	19.13	18	51.43	1.05	0.68 – 1.61
3^rd quartile	51	27.87	25	49.02	1.00
4^th quartile	38	20.77	22	57.89	1.18	0.79 – 1.74

Variables	Total		Lipodystrophy prevalence				p-value*

	n	%	n	%	PR	95% CI
CD4 lymphocyte count							0.564
≤ 350 cells/mm³	64	36.36	36	56.25	1.09	0.82 – 1.44
> 350 cells/mm³	112	63.64	58	51.79	1.00
Time of HIV infection diagnosis							0.025
< 1 year	31	18.24	11	35.48	1.00
1 - 3 years	51	30.00	34	66.67	1.88	1.12 – 3.14
> 3 years	88	51.76	45	51.14	1.44	0.86 – 2.42
ART time							0.131
< 1 year	58	35.58	25	43.10	1.00
1 - 3 years	41	25.15	26	63.41	1.88	1.01 – 2.14
> 3 years	64	39.26	36	56.25	1.31	0.90 – 1.88
Drug classes
NRTI							-
Yes	173	100.00	93	53.76		-
No	0	0.00	0	0.00
NNRTI							0.436
Yes	133	76.88	69	51.88	1.00
No	40	23.12	24	60.00	1.16	0.85 – 1.56
PI							0.799
Yes	47	27.17	26	55.32	1.04	0.77 – 1.41
No	126	72.83	67	53.17	1.00

Variables	Total		Lipodystrophy prevalence				p-value*

	n	%	n	%	PR	CI 95%
Sedentary lifestyle							0.087
No	105	57.38	61	58.10	1.29	0.96 – 1.74
Yes	78	42.62	35	44.87	1.00
Smoking							0.646
No	89	48.63	44	49.44	1.00
Yes	49	26.78	26	53.06	1.07	0.77 – 1.50
Former smoker	45	24.59	26	57.78	1.17	0.84 – 1.62
Family history of CVD							0.002
No	173	96.11	87	50.29	1.00
Yes	7	3.89	6	85.71	1.70	1.22 – 2.39
Hypertension							0.230
No	166	90.71	85	51.20	1.00
Yes	17	17	11	64.71	1.26	0.86 – 1.85
Diabetes							0.905
No	177	96.72	93	52.54	1.05	0.46 – 2.37
Yes	6	3.28	3	50.00	1.00
Dyslipidemia							0.132
No	65	35.52	29	44.62	1.00
Yes	118	64.48	67	56.78	1.27	0.93 – 1.74
Waist circumference							0.018
Normal	123	71.93			1.00
Increased or very increased	48	28.07			1.39	1.06 -1.82
Overweight							0.306
No	122	71.35	62	50.82	1.00
Yes	49	28.65	29	59.18	1.16	0.87 – 1.56

Variables	Lipodystrophy		p-value*

	_aPR	95% CI
Sex			0.003
Male	1.00
Female	1.49	1.15 – 1.95
Time of HIV infection diagnosis			0.002
< 1 year	1.00
1 - 3 years	1.83	1.09 – 3.08
> 3 years	1.39	0.83 – 2.33
Family history of CVD			<0.001
No	1.00
Yes	1.62	1.11 – 2.36

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