Frequência de lipodistrofia e de alteração na densidade mineral óssea de Crianças e adolescentes infectados verticalmente pelo HIV

Abstract

The use of combination antiretroviral therapy (ART) reduced the mortality and morbidity associated with HIV infection. Noninfectious complications of HIV infection and ART have become increasingly evident. Metabolic disorders such as dyslipidemia, insulin resistance, lactic acidosis and change in the body fat redistribution and bone metabolism are the main causes of morbidity associated with prolonged use of HAART. Dual-energy X-ray absorptiometry (DXA) is a reliable technique for measuring bone mineral density (BMD) and soft tissue composition. Few studies have thus far assessed body composition by DXA in children with HIV. Objective: Determine the frequency and factors associated with lipodystrophy and low BMD among vertically HIV-infected children. Methods: A cross-sectional study of 105 HIV infected children and adolescents aged 10 to 25 years, attended at a Reference Center in DIP, in Belo Horizonte / MG, from April 2012 to December 2014. Lipodystrophy was assessed clinically by physical findings of central lipohypertrophy and/or peripheral lipoatrophy. Low BMD was defined by DXA as BMD for whole body and/or spine Z-score that is less than or equal to -2, adjusted for age, gender and race. The proportion of children with lipodystrophy and low BMD was calculated. Univariate analyzes followed by the multivariate analysis for factors associated with lipodystrophy and low BMD were performed. Results: The median age of the participants was 15.3 years (IRQ25-75%: 13.3-17.5) and median duration of antiretroviral therapy was 12.05 years (IRQ25-75%: 10.1 – 14.2). The frequency of lipodystrofy was 18.9% (IC95%: 9,9-31,4%). Peripheral lipoatrophy occurred in 12% of the subjects, central lipohypertrophy in 5.2% and mixed lipodystrophy in 1.7%. In multivariate analysis, nutritional state and use of stavudine were associated with risk of lipodystrophy (p< 0.05). Fat mass ratio (ratio of percent trunk fat mass to percent lower limb fat mass) by DXA showed a significant correlation with lipodystrophy (OR: 36.1; 95% CI: 1.9-67.3.8; p = 0.016). Right arm circumference at the 5% or less percentile adjusted for age and gender and waist circumference at the 90% or greater percentile adjusted for age and sex had a positive correlation with the presence of lipodystrophy. The frequency of low spine or whole body BMD was 26.2% (IC95%: 18.0 – 35.8%). The factors associated with low BMD were the nutritional status and use of lopinavir / ritonavir (p <0.05) in the multivariate analysis. No association was observed between low BMD and lipodystrophy. Conclusion: The frequency of lipodystrophy and low BMD is high among HIV-infected children and adolescents. The data from this study underline the importance of continuous surveillance of children using HAART and the necessity for periodic evaluation of BMD in HIV-infected patients and the importance of improving access to DXA in public health services in Brazil.