A síndrome de lipodistrofia: um marcador de risco para doença cardiovascular em indivíduos com HIV-AIDS
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Data
2015-09-14
Autores
Pereira, Valdelias Xavier [UNIFESP]
Orientadores
Ferreira, Celso [UNIFESP]
Tipo
Tese de doutorado
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Introdução: A terapia antirretroviral, especialmente a altamente ativa (HAART), desenvolveu significativo avanço para o tratamento de pessoas que vivem com AIDS, e por isso a doença adquiriu características de moléstia crônica. Após a introdução da HAART, várias alterações foram observadas tais como a síndrome da lipodistrofia (SL), além de desajustes metabólicos e disfunções autonômicas. Objetivo: Avaliar se a síndrome da lipodistrofia em indivíduos com HIV/AIDS constitui marcador de risco para a doença cardiovascular. Método: Trata se de um estudo transversal, por amostragem de conveniência em que foram analisados 144 pacientes adultos, que vivem com HIV/AIDS em seguimento no ambulatório especifico no serviço de referência do Programa Municipal de DST/AIDS da Prefeitura de São Bernardo do Campo (PM-DST/AIDS-PSBC). Destes, 72 eram pacientes adultos que apresentavam a SL. Foram considerados também outros 72 pacientes adultos seguidos no referido ambulatório e que viviam com AIDS sem a SL e compuseram o grupo controle, todos controlados imunologicamente e sem manifestações clínicas de envolvimento cardiovascular. Foi utilizado escore de risco de Framingham e a caracterização de Síndrome Metabólica para a avaliação do risco cardiovascular. A análise da modulação autonômica foi realizada por intermédio dos índices de variabilidade da frequência cardíaca (VFC) com análise linear [nos domínios do tempo (DT) e da frequência (DF)]. Para análise dos dados, foram utilizados Teste T de Student não pareado e Mann-Whitney. Considerou-se como significante p<0,05. Resultados: Após critérios inclusão/exclusão, dos 144 pacientes recrutados, a amostra final constituiu-se de 81 pacientes que foram subdivididos e integraram dois grupos. De acordo com o escore de Framingham, o risco cardiovascular era moderado a alto em 46,59% dos pacientes do grupo com SL e 14,29% dos pacientes grupo sem a SL. De acordo com a definição do NCEP-ATPIII, a síndrome metabólica foi observada em 54,76% nos pacientes do grupo sem a SL e 35,90% dos pacientes com a SL. A analise da VFC demonstrou menor variabilidade estatisticamente nos pacientes com SL nos Indexes: LF(ms2), HF(ms2) e SDNN(ms2), em relação ao grupo sem a SL. Conclusão: Apresentaram maior risco cardiovascular os indivíduos que vivem com HIV/AIDS e com a SL quando comparados aos que não apresentavam a síndrome. A lipodistrofia confere aos 20 sujeitos com HIV/AIDS um fenótipo que os identifica e caracteriza como marcador de risco cardiovascular.
Introduction: Highly-active antiretroviral therapy (HAART) has developed significant advance in the treatment of HIV/AIDS patients and so it acquired chronic disease characteristics. After HAART, several changes were observed such as lipodystrophy syndrome (LS), autonomic dysfunctions and metabolic imbalances, which greatly increases the risk of cardiovascular disease. Objective: Evaluate whether the lipodystrophy syndrome in individuals with HIV / AIDS is a risk marker for cardiovascular disease. Method: This is a cross-sectional study of a convenience sample, which analyzed 144 HIV/AIDS adult patients attended in a specialized service in a city of Greater Sao Paulo, Brazil, of which 72 have LS, The other patients (72) who have HIV/AIDS, however without that syndrome were used as control group. All patients are immunologically controlled and without clinical cardiovascular manifestations. We used the Framingham risk score and the characterization of metabolic syndrome for the assessment of cardiovascular risk of metabolic condition. In addition we performed the linear analysis of time and frequency indices of heart rate variability to access the cardiac autonomic modulation. We used Student's t and unpaired Mann-Whitney test. Was considered as significant values p<0.05. Results: After the criteria of inclusion and exclusion, the final sample consisted of 81 patients divided into the two groups. According to Framingham risk score, the cardiovascular risk was considerated from moderate to high in 46.59% of patients of experimental group and 14.29% of the control group. According to the definition of the NCEP-ATPIII, metabolic syndrome was observed in 54.76% of experimental group and 35.90% of control group. Finally the analysis of HRV showed statistically lower in the experimental group in LF (ms2), HF (ms2) and SDNN (ms2) indices compared to control group. Conclusion: Patients with HIV / AIDS and LS had higher cardiovascular risk compared with those without the syndrome. Lipodystrophy gives to HIV / AIDS patients a phenotype that identifies them and it is characterized as a cardiovascular risk marker.
Introduction: Highly-active antiretroviral therapy (HAART) has developed significant advance in the treatment of HIV/AIDS patients and so it acquired chronic disease characteristics. After HAART, several changes were observed such as lipodystrophy syndrome (LS), autonomic dysfunctions and metabolic imbalances, which greatly increases the risk of cardiovascular disease. Objective: Evaluate whether the lipodystrophy syndrome in individuals with HIV / AIDS is a risk marker for cardiovascular disease. Method: This is a cross-sectional study of a convenience sample, which analyzed 144 HIV/AIDS adult patients attended in a specialized service in a city of Greater Sao Paulo, Brazil, of which 72 have LS, The other patients (72) who have HIV/AIDS, however without that syndrome were used as control group. All patients are immunologically controlled and without clinical cardiovascular manifestations. We used the Framingham risk score and the characterization of metabolic syndrome for the assessment of cardiovascular risk of metabolic condition. In addition we performed the linear analysis of time and frequency indices of heart rate variability to access the cardiac autonomic modulation. We used Student's t and unpaired Mann-Whitney test. Was considered as significant values p<0.05. Results: After the criteria of inclusion and exclusion, the final sample consisted of 81 patients divided into the two groups. According to Framingham risk score, the cardiovascular risk was considerated from moderate to high in 46.59% of patients of experimental group and 14.29% of the control group. According to the definition of the NCEP-ATPIII, metabolic syndrome was observed in 54.76% of experimental group and 35.90% of control group. Finally the analysis of HRV showed statistically lower in the experimental group in LF (ms2), HF (ms2) and SDNN (ms2) indices compared to control group. Conclusion: Patients with HIV / AIDS and LS had higher cardiovascular risk compared with those without the syndrome. Lipodystrophy gives to HIV / AIDS patients a phenotype that identifies them and it is characterized as a cardiovascular risk marker.
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Citação
PEREIRA, Valdelias Xavier. A síndrome de lipodistrofia: um marcador de risco para doença cardiovascular em indivíduos com HIV-AIDS. 2015. 113 f. Tese (Doutorado em Cardiologia) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, 2015.