Academic journal article Journal of Health Population and Nutrition

Self-Reported Body Changes and Associated Factors in Persons Living with HIV

Academic journal article Journal of Health Population and Nutrition

Self-Reported Body Changes and Associated Factors in Persons Living with HIV

Article excerpt

INTRODUCTION

Brazil, being the most populated country in Latin America, also holds one-third of all AIDS cases in the region. During 1980-June 2009, 544,846 cases of AIDS were noticed, corresponding to an incidence rate of 18.2 per 100,000 inhabitants (1). Of the noticed cases, 65.4% were men, and 34.6% were women. According to the United Nations Joint Programme on HIV/AIDS (UNAIDS), the number of infected people in the country varies from 600,000 to 890,000 (2). Sao Paulo--the biggest city of Brazil--has the largest number of people living with HIV (PLHIV) in the country.

In developed countries, the tendency of reduction in mortality due to AIDS had been observed even before the appearance of the highly-active antiretroviral therapy (HAART), and this has been attributed to the prophylaxis and better clinical treatment of opportunistic infections. However, with the use of protease inhibitors, this phenomenon was accentuated (3).

Ever since universal access to HAART through the public-health system in Brazil (in 1996), the country has become an example for the treatment of those living with HIV. The public-healthcare programme for PLHIV also includes other initiatives aimed at reducing hospital admissions, such as specialized outpatient care, day hospitals, and home-based care (3). Consequently, the rate of HIV infection-related mortality has declined from 9.6 per 100,000 inhabitants in 1996 to 6.1 per 100,000 inhabitants in 2008, resulting in increases in survival (1).

With great progress in the clinical course, prognostic and survival of patients, HIV infection starts to be seen like a disease of chronic evolution and potentially controllable (4). The prolonged use of HAART has led to side-effects which have brought new demands to health services specialized in the care of PLHIV (5).

Lipodystrophy syndrome, defined as a set of changes that includes loss of fat in peripheral areas, such as face, buttocks, arms, and legs, and gain in fat in central portions of the body, such as abdomen, neck, and chest and in the arms, is currently considered one of the most important side-effects of the use of HAART that may lead to other problems relating to stigma towards PLHIV (6). In a study among HAART users, perceived body changes were significantly associated with the duration of the use of protease inhibitors and nucleoside reverse transcriptase inhibitors (6).

The fact that not all patients on HAART develop fat redistribution, dyslipidaemia, or impaired glucose homeostasis supports the hypothesis that the susceptibility to morphologic and metabolic changes varies by therapy, environment, and genetics (7). In a study on self-reported body changes, Santos et al. found a prevalence of 49.2% of self-perception of gain in abdominal fat in PLHIV in Brazil (6). Overweight and obesity are turning into a major public-health concern in the country, reaching 45% of Brazilian adults in 2003 (8). The rates of obesity among men and women increased by 92% and 63% between 1975 and 1989 respectively, and between 1989 and 2003, a further rise was observed--10% among women and 26% among men, even higher among lower-income groups (9).

The role of an adequate intake of fibres in the prevention of diseases is already well-known (10). Benefits, among others, included reduction of lipid concentrations in blood, better tolerance to glucose, reduction of hyperinsulinaemia, control of body-weight, better gastrointestinal function, and reduction in the risk of cardiovascular diseases. Therefore, this study aimed at verifying the associated factors relating to self-reported body changes in PLHIV receiving HAART in the city of Sao Paulo, Brazil.

MATERIALS AND METHODS

Sample

Data from participants of this cross-sectional study were collected in nine of 15 STD/AIDS Specialized Health Community Centres of the City Council STD/AIDS Programme. These health community centres were located at four different geographic regions of the city of Sao Paulo, and there were no differences in the socioeconomic characteristics when the included health centres were compared with those excluded due to infrastructural problems. …

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