Composição corporal e densidade mineral óssea em crianças e adolescentes pré-puberes infectados pelo HIV

Abstract

Objetivo: Avaliar prospectivamente as alteracoes ocorridas na composicao corporal de pacientes infectados pelo HIV e identificar as variaveis determinantes de lipodistrofia ao longo do tempo. Metodos: Estudo de coorte prospectivo, avaliado em periodo de dois anos e meio, incluindo 35 pre-puberes infectados pelo HIV, ambos os sexos, entre 7 a 12 anos atendidos em centro de referencia. Os pacientes foram distribuidos em dois grupos: sem lipodistrofia (SL) e com lipodistrofia (CL). Compararam-se dados clinicos, antropometricos, de composicao corporal e bioquimicos alem da determinacao dos fatores preditores de lipodistrofia no tempo 1 (T1) e tempo 2 (T2). Resultados: A media (DP) de idade foi de 9,6(1,1) e 11,6 (1,2) anos, no T1 e T2, respectivamente. No T2, 16 (45,7%) criancas continuavam pre-puberes. O grupo CL (n=8) apresentou maior prevalencia de baixa estatura (p =0,008) no T1, maiores valores de insulina (p=0,010) e HOMA-IR (p=0,013) e reducao da dobra cutanea tricipital (p=0,026) no T2 comparado ao grupo SL (n=27). Nos dois tempos, observou-se menores concentracoes de HDLc (p=0,027), maiores valores de relacao tronco/braco (p=0,002;p=0,001) e menores valores da relacao braco+perna/tronco (p=0,001) no grupo CL. No T1, os fatores preditores independentes de lipodistrofia foram baixa estatura (OR= 46,198; p= 0,019) e relacao braco+perna/tronco (OR=0,00009; p= 0,011); no T2 foram circunferencia abdominal (OR= 1,199; p = 0,025) e HDLc (OR = 0,835; p = 0,015). Conclusao: Em periodo curto de tempo, o grupo CL apresentou significativa redistribuicao de gordura corporal com adiposidade central e alteracoes bioquimicas compativeis com a sindrome lipodistrofica que aumenta o risco cardiovascular desses pacientes

Objective: To evaluate longitudinal body composition changes in HIV-infected patients and identify risk factors for lipodystrophy. Methods: A prospective study, evaluated over two and a half years, with 35 pre-pubertal, HIV-infected children and adolescents, ranging from 7 to 12 years 11 months, attending a reference center.Patients were distributed into two groups: without lipodistrophy (LD-) and with lipodystrophy (LD+). Clinical, anthropometric, body composition and biochemical data were compared. Determinant factors of lipodystrophy were indentified at time 1 (T1) and time 2 (T2). Results: Median age (SD) was 9.6 (1.1) and 11.6 (1.2) at T1 and T2, respectively. At T2, 16 (45.7%) children remained at prepubertal stage. LD + group had higher prevalence of short stature (p =0.008) at T1, higher values of insulin (p=0.010) and HOMA –IR (p=0.013) and also lower values of tricipital skinfold thickness (p=0.026) at T2 compared to LD – patients. At both time of the study, LD + group presented reduced HDLc concentrations (p=0.027), increased values of trunk to arm ratio (p=0.002; p=0.001) and lower values of limb to trunk ratio (p=0.001). At T1, short stature (OR= 46.198; p= 0.019) and limb to trunk ratio (OR=0.00009; p= 0.011) were independent determinants of lipodystrophy, while abdominal circumference (OR= 1.199; p = 0.025) and HDLc (OR = 0.835; p = 0.015) were at T2. Conclusion: In a short period of time, LD + group had significant changes in body fat distribution with visceral fat accumulation and also biochemical alterations associated to lipodystrophy syndrome that increase cardiovascular risk in these patients.