Lipoatrofia facial associada ao HIV/AIDS: do advento aosconhecimentos atuais

Abstract

Abstract:The advent of AIDS has brought new challenges to Dermatology. Antiretroviral therapy dramatically changed the morbidity and mortality associated with HIV / AIDS, but contributed to the emergence of other new situations that require adequate approach by the dermatologist. The HIV / AIDS Associated Lipodystrophy Syndrome is multifactorial in origin, but it is strongly associated with the use of antiretroviral drugs. It includes changes in body fat distribution, with or without metabolic changes. The loss of facial fat, called facial lipoatrophy, is one of the most stigmatizing signs of the syndrome. This condition, often revealing of the disease, brought back the stigma of AIDS. It is necessary that the specialists working with patients with HIV / AIDS identify these changes and seek treatment options, amongst which stands out the implant with polymethylmethacrylate, which is available for the treatment of HIV / AIDS facial lipoatrophy in the Brazilian Public Health System. Keywords: Ambulatory surgical procedures; HIV; HIV-associated lipodystrophy syndrome; Polymethyl methacrylate; Therapeutics Resumo: O advento da AIDS trouxe novos desafios para a Dermatologia. A terapia antirretroviral mudou drasticamente a morbimortalidade associada à infecção pelo HIV/AIDS, mas contribuiu para o surgimento de outras novas situações que exigem abordagem adequada do dermatologista. A Síndrome Lipodistrófica Associada ao HIV/AIDS tem origem multifatorial, mas está fortemente associada ao uso dos antirretrovirais. Compreende alterações na distribuição da gordura corporal, acompanhada ou não de alterações metabólicas. A perda da gordura da face, chamada lipoatrofia facial, é dos sinais mais estigmatizantes da síndrome. Esta condição, muitas vezes reveladora da doença, trouxe de volta o estigma da AIDS. É necessário que os especialistas que atuam com pacientes com HIV/AIDS identifiquem estas alterações e busquem opções de tratamento, dentre as quais se destaca o implante com polimetilmetacrilato, que é disponibilizado para tratamento da lipoatrofia facial associada ao HIV/AIDS no Sistema Único de Saúde.

The lipodystrophy syndrome as a risk marker for cardiovascular disease in patients with HIV / AIDS treated with HAART

“…The lipoatrophy and lipohypertrophy can occur separately or can occur together in the same patient [4,19]. In lipohypertrophy is observed accumulation of central fat.…”

“…The introduction of antiretroviral therapy in highpower highly active antiretroviral therapy (HAART) has resulted in the reduction of mortality associated with acquired immunodeficiency syndrome (AIDS) in developed countries and in Brazil, despite the increased number of individuals with AIDS in developing countries [1][2][3][4].…”

Atuação fonoaudiológica em pacientes com síndrome da imunodeficiência adquirida e queixa de deglutição – análise retrospectiva de prontuários

“…The virus can be transmitted through sexual relations, transfusion of blood or blood products, sharing of syringes, and vertical transmission. The infection is characterized by three stages: acute retroviral syndrome, chronic asymptomatic infection, and symptomatic infection/AIDS, where there is a large variation in the CD4 cell count in the individual HIV carrier (1,2) . This virus acts preferentially in T-lymphocyte CD4 cells, which control the body's immune response, and act on other susceptible cells such as monocytes/macrophages.…”

“…After its entry into the cell, the ribonucleic acid (RNA) virus is released. This begins the process of deoxyribonucleic acid (DNA) transcription, which afterwards migrates to the cell nucleus and integrates into the host DNA (2,3) . Laboratory diagnosis of HIV infection can be accomplished by direct methods such as culture and viral isolation, as well as detection of HIV antigen and HIV nucleic acids.…”

“…Laboratory diagnosis of HIV infection can be accomplished by direct methods such as culture and viral isolation, as well as detection of HIV antigen and HIV nucleic acids. Indirect methods that detect antibodies against HIV include enzyme-linked immunosorbent assay (ELISA), indirect immunofluorescence, and Western blot (2,4) . In 2003, the Brazilian Ministry of Health issued a document with definitions for AIDS cases in adults and children (5) .…”