Alterações no perfil metabólico e incidência de comorbidades não infecciosas em pessoas vivendo com HIV após início do tratamento antirretroviral

Abstract

The advent of antiretroviral therapy (ART) has resulted in a considerable increase of survival in people living with HIV (PLH) and consequently the emergence of non-infectious comorbidities and cardiovascular diseases, becoming an important challenge in the clinical management of this infection. A better understanding of the incidence of comorbidities after the beginning of ART might allow more effective clinical treatment. The aim of this study was to describe the metabolic profile, the incidence of non-infectious comorbidities and the increase of cardiovascular risk of the PLH 66 months after the beginning of ART. This is a cohort study with HIV-infected patients with 18 years or more of age, that have had medical indication for the beginning of ART in the period between January and September 2012 at a Reference Service of Infectious Diseases in Belo Horizonte - MG. The results of this study are presented through two scientific articles: Article 1 - It is a cross-sectional study published in Revista da Sociedade Brasileira de Medicina Tropical (2017), aiming to describe the initial metabolic profile and cardiovascular risk and determine the prevalence of dyslipidemia and metabolic syndrome of the 87 initial HIV-infected patients included in this cohort study, before the beginning of ART. Dyslipidemia was prevalent in 62.6% of the study population, whereas metabolic syndrome (MS) was prevalent in 11.5% of patients assessed by the IDF criteria and 10.8% assessed by the NCEP-ATPIII criteria. Regarding the Framingham risk score, 89.7% of the population presented a low risk of developing cardiovascular events in 10 years. Metabolic disorders, evidenced mainly by low HDL-cholesterol, may be due to HIV infection and/or lifestyle (sedentary life and inadequate diet). The introduction of ART may increase cardiovascular risk, especially among those who have classic risks of non-infectious comorbidities. Article 2: The aim of this study is to evaluate the effectiveness of ART between 2012 and 2018. After 66 months of the beginning of ART, 82 PLH had viral load results available for analysis. The effectiveness of ART, defined as viral load < 50 copies/mL, was of 75.6% and 80.5% after 12 and 66 months, respectively. In spite of the late introduction of ART in this population, the therapeutic response was better than the values described by Ministry of Health and similar to efficacy studies. Article 3: The aim of this study was to compare the metabolic profile and cardiovascular risk according to the Framingham risk score in two analysis: before and 66 months after the beginning of ART and determine the incidence of non-infectious comorbidities such as dyslipidemia, MS, hypertension, diabetes mellitus and obesity. There was no incidence of dyslipidemia and MS after 66 months the beginning of ART, however, it was observed incidence of hypertension (11.9%), obesity (12.3%) and increased cardiovascular risk (14.9%). In this population, there has been necessary an effective multidisciplinary intervention for lifestyle improvement, selection of ART regimens with lower toxicity and long-term prevention strategies for incident comorbidities and cardiovascular diseases