People living with HIV on ART have accurate perception of lipodystrophy signs: a cross-sectional study

Forecasting and validating fat mass ratio models through anthropometric measurements and health-related factors among people with HIV: a cross-sectional investigation

Background

There is a limited research on predictive models of fat mass ratio (FMR) in people living with human immunodeficiency virus (HIV) (PWH). This study aimed to develop models considering anthropometric and health-related factors to predict and validate FMR in PWH regardless of sex.

Methods

One hundred and six Brazilian PWH (46.4±9.8 years) were evaluated for body composition using dual-energy X-ray absorptiometry (DXA), body circumference (BC), and skinfold thicknesses (SKs). FMR predictive models were developed using stepwise linear regression, and their agreement with DXA was assessed using Bland-Altman plots. Cross-validation was performed using the predicted residual error sum of squares (PRESS) method.

Results

Six FMR estimation models were developed for PWH, with adjusted R2 ranging from 0.43 to 0.72, standard error of the estimate (SEE) from 0.16% to 0.22%, and 95% confidence interval (CI) from 1.03 to 1.15. Model 6, including thigh SK, waist BC, therapy duration, subscapular SK, education years, and abdominal SK, exhibited the highest determination power (R2 adjusted 0.72, SEE 0.16%, and 95% CI: 1.06-1.15). The agreement between DXA-based FMR and predictive models showed minimal bias (-0.03 to +0.04) and narrower limits of agreement, particularly for the top-performing model (-0.33 to +0.30). Model 6 exhibited a high adjusted Q2PRESS (0.70) and low SPRESS (0.17).

Conclusions

Our predictive models advance the study of body composition in PWH by consolidating the use of anthropometry for diagnosing and monitoring lipodystrophy regardless of sex.

Different factors are associated with changing body composition in people living with HIV

INTRODUCTION

Antiretroviral Therapy (ART) gives people living with HIV/AIDS (PLWHA) a new perspective of life, although some develop changes in impaired body composition. This study aimed to assess the factors associated with changes in body composition in PLWHA using ART, depending food consumption.

MATERIAL AND METHODS

It was a cross-sectional study and took place through interviews with patients treated at an University Hospital. Secondary data: CD4+ T cells, ART time and age. The level of physical activity and smoking were self-reported. For the assessment of body composition, electrical bioimpedance and measurements of weight, height and waist circumference were used.

RESULTS

The highest percentages of fat mass and fat-free mass, in treatment for more than 5 years, were in the female group (p <0.01), aged> 50 years (p = 0.02) and in the male group (p <0.01), young adult (p <0.01), respectively. The final linear regression model for both free fat mass and fat mass had sex, age, smoking and nutritional diagnosis as relevant factors. The frequency of food consumption was inadequate for calories, carbohydrates, proteins and lipids was high, however it did not significantly influence body composition.

CONCLUSIONS

Gender, age, smoking and nutritional diagnosis by BMI significantly influence body composition.

Comparative analysis of MTP -493G/T and ABCG2 34G/A polymorphisms and theirs expression in HIV-associated lipodystrophy patients

HIV-associated lipodystrophy (HIVLD) is a metabolic condition with an irregularity in the production of lipoprotein particles, and its occurrence varies among HIV-infected patients. MTP and ABCG2 genes have a role in the transport of lipoproteins. The polymorphisms of MTP -493G/T and ABCG2 34G/A affect its expression and influence the secretion and transportation of lipoproteins. Hence, we investigated the MTP -493G/T and ABCG2 34G/A polymorphisms in 187 HIV-infected patients (64 with HIVLD and 123 without HIVLD) along with 139 healthy controls using polymerase chain reaction (PCR)-restriction fragment length polymorphism and expression analysis using real-time PCR. ABCG2 34A allele showed an insignificantly reduced risk of LDHIV severity [P = 0.07, odds ratio (OR) = 0.55]. MTP -493T allele exhibited a non-significantly reduced risk for the development of dyslipidemia (P = 0.08, OR = 0.71). In patients with HIVLD, the ABCG2 34GA genotype was linked with impaired low-density lipoprotein levels and showed a reduced risk for LDHIV severity (P = 0.04, OR = 0.17). In patients without HIVLD, the ABCG2 34GA genotype was associated with impaired triglyceride levels with marginal significance and showed an increased risk for the development of dyslipidemia (P = 0.07, OR = 2.76). The expression level of MTP gene was 1.22-fold decreased in patients without HIVLD compared with that in patients with HIVLD. ABCG2 gene was upregulated 2.16-fold in patients with HIVLD than in patients without HIVLD. In conclusion, MTP -493C/T polymorphism influences the expression level of MTP in patients without HIVLD. Individuals without HIVLD having ABCG2 34GA genotype with impaired triglyceride levels may facilitate dyslipidemia risk.

Association between lipid and glycemic profile and total body and trunk fat in children and adolescents diagnosed with HIV

INTRODUCTION

Metabolic alterations and body fat redistribution are common in people living with HIV using antiretroviral therapy and increase the risk of premature cardiovascular diseases.

AIM

To verify the presence of difference in the lipid and glycemic profile in relation to different total body and trunk fat phenotypes in children and adolescents diagnosed with HIV+.

METHOD

This is a cross-sectional study carried out with 62 children and adolescents diagnosed with HIV+. Lipid and glycemic profiles were obtained from blood samples. Total and trunk fat mass (FM) was obtained by DXA. Analysis of covariance was used to verify if there is difference in the lipid and glycemic profile between total body and trunk fat phenotypes.

RESULTS

In males, in the covariate-adjusted model, it was observed that boys with high total FM had higher triglyceride values (mean: 164.9 mg/dl^-1 ±31.2) compared to those with low and adequate total FM. In females, in adjusted models, it was observed that girls with high total FM had higher total cholesterol (mean: 181.6 mg/dl^-1 ±13.8) and LDL-C values (mean: 111.8 mg/dl^-1 ±12.0), compared to those with low and adequate total FM. Girls with trunk FM had higher total cholesterol (mean: 181.6 mg/dl^-1 ± 13.8), LDL-C (mean: 71.3 mg/dl^-1 ± 9.6) and blood glucose values (91.6 mg/dl^-1 ± 2.2).

CONCLUSION

Boys with high total FM had higher triglyceride levels, while in females, it was observed that girls with high total FM and high trunk FM had higher total cholesterol, LDL-C and blood glucose values. High body fat in children and adolescents living with HIV is related to metabolic changes in the lipid and glycemic profile, with specificities of sex and fat location.

Primary Validation of the Submandibular Skinfold as an Anthropometric Measurement of Cardiometabolic Risk in People with Intellectual Disabilities

The accumulation of body fat is an important cardiometabolic risk factor; however, there is no consensus about which measure is more reliable for the assessment of cardiometabolic risk in people with intellectual disabilities. The aim of the present study was to primarily validate the submandibular skinfold as an anthropometric measurement of cardiometabolic risk in children, adolescents, and adults with intellectual disabilities, using a cross-sectional study made up of 131 people (67.2% men) with mild and moderate intellectual disability. The cardiometabolic risk indicators used were: body mass index (kg/m2), neck circumference (cm), waist circumference (cm), calf circumference (cm) and waist-to-height ratio. Moderate correlations were demonstrated between the submandibular skinfold measure and the anthropometric measurements analyzed in the three age categories, showing the highest correlation (r = 0.70) between the submandibular skinfold and BMI in the adolescent group and waist-to-height ratio in adults. The implementation of the submandibular skinfold measurement is suggested as an easy, fast, and minimally invasive anthropometric measurement as part of the physical and nutritional evaluation for the assessment of cardiometabolic risk in people with intellectual disabilities.

Body image in children and adolescents diagnosed with the human immunodeficiency virus: a systematic review

CONTEXT

The relationship with body image, which is the way the body presents itself to each subject, can be aggravated in children and adolescents diagnosed with an human immunodeficiency virus (HIV) infection, since these patients use antiretroviral therapy and may suffer from the adverse effects of the treatment due to continuous use of medication.

OBJECTIVE

To estimate the prevalence of body image dissatisfaction, to describe the assessment methods, and to identify associated factors in children and adolescents diagnosed with HIV.

DESIGN AND SETTING

This is a systematic review. Department of Physical Education, Florianópolis - Brazil.

METHODS

We followed the procedures of the Preferred Reporting Items for Systematic Reviews (PRISMA) and the Cochrane recommendations in the selection of articles through a search performed in eight databases.

RESULTS

Prevalence of body image dissatisfaction due to thinness was between 36.7-52.0% in males and 28.1-36.4% in females, and body image dissatisfaction due to overweight was between 8.0-31.2% in males and 21.9-50.0% in females. Factors associated with body image dissatisfaction were as follows: female sex, older age, low levels of physical activity, low self-esteem, higher body fat, higher body weight, greater arm muscle area, triceps skinfold thickness, and higher body mass index.

CONCLUSION

Children and adolescents of both sexes diagnosed with HIV infection are dissatisfied by thinness and overweight of their body image.

REGISTRATION

https://www.crd.york.ac.uk/prospero/ (CRD42021257676).

Association Between Body Fat Distribution Assessed by Different Techniques and Body Image Perception in HIV-Infected Children and Adolescents

PURPOSE

verify whether there is difference in body fat values assessed by different methods according to the body image perception of HIV-infected children and adolescents.

DESIGN AND METHODS

This is a cross-sectional study with 65 HIV-infected children and adolescents (aged 8-15 years). Total fat mass, trunk fat mass, arm fat mass and leg fat mass were obtained through dual-energy X-ray absorptiometry (DXA). Anthropometric variables were measured according to international standardization. Body image was assessed using a scale of body silhouettes. Bone age covariates were assessed using carpal wrist X-rays and physical activity by accelerometers. Information regarding viral load and use of combined antiretroviral therapy was obtained from medical records. In males, no significant difference in body fat values and body image categories was observed.

RESULTS

In the model with covariates, girls who desired to reduce body weight had higher BMI (18.96 kg / m2 ± 2.47, R² adj: 0.613), total fat mass (14.25 kg ± 1.37, R² adj: 0.589), trunk fat mass (6.50 kg ± 0.66, R² adj: 0.611) and leg fat mass values (6.01Kg ± 0.57, R² adj: 0.503) in comparison to girls who were satisfied and to those who desired to increase body weight.

CONCLUSIONS

HIV + girls who desired to reduce body weight had greater amount of BMI, total fat mass, trunk fat mass and leg fat mass compared to those who were satisfied and those who desired to increase body weight.

PRACTICE IMPLICATIONS

These data can be used to assist in the process of coping and accepting body image.

Effect of lipodystrophy on self-esteem and adherence to antiretroviral therapy in people living with HIV

The aim of this study was to determine the effect of lipodystrophy on self-esteem and adherence to antiretroviral therapy (ART) in people living with HIV (PLHIV). A cross-sectional and comparative study was carried out in an infection clinic, with 125 patients with lipodystrophy and 125 without lipodystrophy. Sociodemographic, clinical and epidemiological data were collected, using the Rosenberg Self-Esteem Scale and Assessment of Adherence to Antiretroviral Treatment Questionnaire (CEAT-VIH). Descriptive statistics and univariate and multivariate logistic regression analysis were used. Of the total sample, 57.2% had unsatisfactory self-esteem and 57.6% adequate adherence to ART. Self-esteem was lower in PLHIV with lipodystrophy (66.4%). PLHIV with monthly income less than or equal to two minimum wages (P < 0.001) and those with lipodystrophy had more unsatisfactory self-esteem (P < 0.001). Catholics had better self-esteem (P = 0.012), when compared to those without religion. Patients with monthly income less than or equal to two minimum wages (P = 0.021) and people with unsatisfactory self-esteem had more inadequate adherence to ART (P = 0.001). Catholics had better adherence to antiretrovirals (P = 0.007). In conclusion, lipodystrophy and low income negatively affect the self-esteem of PLHIV. Low income and unsatisfactory self-esteem make adherence to ART difficult. Religion is a protective factor for satisfactory self-esteem and adherence to antiretrovirals.

"We are becoming older women and then we have two stigmas": voicing women's biopsychosocial health issues as they age with HIV

In April 2019, nine older women (age 50+) living with HIV in Palm Springs, California, participated in a 90-minute focus group to identify their major health issues, strengths, and HIV and aging-related health priorities. Using the rigorous and accelerated data reduction (RADaR) technique, we identified four major themes: (1) mental health, (2) HIV comorbidities, (3) social determinants of health, and (4) resiliencies. These results reinforce the need to conduct additional research focused on women aging with HIV, an understudied population that requires more effective, tailored interventions to promote better quality of life and healthy aging.

Association between changes in body fat distribution, biochemical profile, time of HIV diagnosis, and antiretroviral treatment in adults living with and without virus infection

OBJECTIVES

Individuals living with HIV seem to be more prone to changes in the redistribution of body fat, characterized as lipodystrophy, which may occur in conjunction with metabolic diseases. In the present study, such impacts were assessed in adults with and without HIV and associated with the time of virus diagnosis and treatment with antiretroviral.

METHODS

A cross-sectional study with 123 adults, in which 87 had HIV and 36 without HIV, of both sexes, in outpatient follow-up at the Specialized Care Service (SAE) in Macaé-RJ. The following were made: 1) Alteration in body fat distribution, measured by anthropometric parameters and self-reported lipodystrophy; 2) Biochemical profile; 3) Association between HIV diagnosis time and antiretroviral treatment.

RESULTS

54.47% (n = 67) males, 45.52% (n = 56) females, mean age 37 years. Of these 87 were people living with HIV, 29% (n = 25) had self-reported lipodystrophy, mean time of virus infection, and antiretroviral treatment (5.80 ± 4.56 and 5.14 ± 3.82 years), respectively. Patients with self-reported lipodystrophy had a greater change in body fat distribution between 3-6 years of HIV diagnosis and a negative cholesterol profile. The antiretroviral treatment time influenced total cholesterol and triglycerides, even for patients without self-reported lipodystrophy, with a further nine years under treatment.

CONCLUSION

In this study, the negative cholesterol profile was mainly related to antiretroviral treatment time, even for patients without self-reported lipodystrophy, and changes in body fat distribution, measured by anthropometry, was especially associated with time for HIV infection in those with lipodystrophy self-reported.

Self-reported lipodystrophy, nutritional, lipemic profile and its impact on the body image of HIV-1-infected persons, with and without antiretroviral therapy

A cross-sectional study was conducted with 227 adults, 162 using antiretroviral therapy (ART), both sexes, in Secondary Immunodeficiency Outpatient Clinic of the Department of Dermatology of the Hospital das Clínicas of the Faculty of Medicine of University of São Paulo. The patients were grouped into 92 under ART and self-reported lipodystrophy (G1); 70 under ART and without self-reported lipodystrophy (G2); 65 without ART (G3). We evaluated: (1) self-reported lipodystrophy, self-perception and feeling about body image; (2) Anthropometric and lipemic profile. We included 67% (n = 152) male; 33% (n = 77) female. There was a negative impact of self-reported lipodystrophy on body image, where female was more critical, although it was significant for male (p = 0.014). BMI revealed excess weight in female (p = 0.058). Hip waist ratio was shown to be a better parameter than abdominal perimeter when measuring fat in central region of male and lipohypertrophy was characterized in both sexes. There was lipoatrophy in upper and lower limbs for individuals of the (G1) and the male of this group presented hypertriglyceridemia, (p = 0.012). There was a difference in sex, pattern of self - perceived morphologic alterations and feeling in relation to body image when associated with self - reported lipodystrophy, ART use, anthropometric and lipemic profile.

End-of-Life Care and Bereavement Issues in Human Immunodeficiency Virus-AIDS

This review article addresses end-of-life care issues characterizing human immunodeficiency virus progression by delineating associated stages of medical and nursing care. The initial progression from primary medical and nursing care aimed at functional cure to palliative care is discussed. This transition is considered in accord with the major symptoms experienced, including fatigue, pain, insomnia; decreased libido, hypogonadism, memory, and concentration; depression; and distorted body image. From the stage of palliative care, progression is delineated onward through the stages of hospice care, death and dying, and the subsequent bereavement process.

Lipodystrophic syndrome of HIV and associated factors: a study in a university hospital

The use of antiretroviral drugs has increased the survival of HIV patients, but may have side effects, such as lipodystrophic syndrome. This article aims to identify the frequency of the lipodystrophic syndrome and its associated factors in patients with HIV using antiretroviral therapy. It involved a cross-sectional study with HIV patients, monitored on an outpatient basis. The syndrome was evaluated by the association of two parameters: peripheral weight loss through the lipodystrophy severity scale and central fat accumulation, measured by the hip waist ratio. Poisson regression analysis was performed to identify the associated variables. Of the 104 patients evaluated, 27.9% presented the syndrome. After adjustment, the female sex (PRadjusted = 2.16 CI95% 1.43-3.39), being overweight (PRadjusted = 2.23 CI95% 1.35-2.65) and a longer period of use of antiretrovirals (PRadjusted = 1.64 CI95% 1.16-2.78), remained positively associated with the syndrome. On the other hand, a negative association with CD4 count £ 350 (PRadjusted = 0.39 CI95% 0.10-0.97) was observed The high prevalence of the syndrome and its association with specific groups reinforce the need for adequate follow-up and early identification to intervene in modifiable factors.

Lipodystrophy diagnosis in people living with HIV/AIDS: prediction and validation of sex-specific anthropometric models

BACKGROUND

Body composition alterations, or lipodystrophy, can lead to serious health problems in people living with HIV/AIDS (PLWHA). The objectives of this study are to predict and validate sex-specific anthropometric predictive models for the diagnosis of lipodystrophy in PLWHA.

METHODS

A cross-sectional design was employed to recruit 106 PLWHA (men = 65 and women = 41) in Brazil during 2013-2014. They were evaluated using dual-energy X-ray absorptiometry, and 19 regions of body perimeters and 6 skinfold thicknesses were taken. Sex-specific predictive models for lipodystrophy diagnosis were developed through stepwise linear regression analysis. Cross-validations using predicted residual error sum of squares was performed to validate each predictive model.

RESULTS

Results support the use of anthropometry for the diagnosis of lipodystrophy in men and women living with HIV/AIDS. A high power of determination with a small degree of error was observed for lipodystrophy diagnosis for men in model six (r² = 0.77, SEE = 0.14, r²_PRESS = 0.73, SEE _PRESS = 0.15), that included ratio of skinfold thickness of subscapular to medial calf, skinfold thickness of thigh, body circumference of waist, formal education _years, time of diagnosis to HIV _months, and type of combined antiretroviral therapy (cART) (with protease inhibitor "WI/PI = 1" or without protease inhibitor "WO/PI = 0"); and model five for women (r² = 0.78, SEE = 0.11, r²_PRESS = 0.71, SEE _PRESS = 0.12), that included skinfold thickness of thigh, skinfold thickness of subscapular, time of exposure to cART _months, body circumference of chest, and race _(Asian) ("Yes" for Asian race = 1; "No" = 0).

CONCLUSIONS

The proposed anthropometric models advance the field of public health by facilitating early diagnosis and better management of lipodystrophy, a serious adverse health effect experienced by PLWHA.