Retroviridae – ABC CARDIOL

IJCS

Editorial

Lipodystrophy Associated with HIV/ART and Cardiovascular Risk Factors

Before effective antiretroviral therapy (ART) became available, patients with advanced acquired immunodeficiency syndrome had devastating losses and their metabolic profile was characterized by reduced cholesterol levels. Since introduction of ART, numerous studies have reported changes in body composition with accumulation of central fat and loss of peripheral fat. The term “human immunodeficiency virus (HIV)-associated lipodystrophy syndrome” was then coined, which was soon recognized as several phenotypes that varied from person to person, rather than a unique syndrome. While some individuals had solely lipoatrophy, others had fat accumulation with varied presentation or a mixed condition of the two morphological patterns.

Lipoatrophy involves loss of subcutaneous fat in the face, arms, legs, abdomen, and buttocks. Abdominal fat accumulation is featured mainly by excess visceral fat and consequent increased waist circumference, but also in the dorsal cervical region (“buffalo hump”), trunk, breasts (in both women and men), and lipomas of the upper extremities.

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IJCS

Original Article

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

Thiago Veiga Jardim et al. Rodrigo de Castro Cardoso Annelisa Silva e Alves de Carvalho Santos Marianne de Oliveira Falco Erika Aparecida Silveira

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