Risco cardiovascular e avaliação de parâmetros metabólicos em coorte de pacientes adultos HIV soropositivos

• Autor(a) principal: Nery, Max Weyler
• Data de Publicação: 2013
• Tipo de documento: Tese
• Idioma: por
• Título da fonte: Repositório Institucional da UFG
• Texto Completo: http://repositorio.bc.ufg.br/tede/handle/tede/7984
• topic: HIV; Aids; Risco cardiovascular; Dislipidemia; Framingham; Fatores agravantes; PROCAM; DAD; Coorte; Dyslipidemia; Cardiovascular risk; Framingham; Aggravating factors; Cohort; SAUDE COLETIVA::EPIDEMIOLOGIA

A highly active antiretroviral therapy (HAART) has significantly reduced the morbidity and mortality of HIV infection. The greatest survival, chronic inflammation and metabolic changes resulting from HAART are associated with increased cardiovascular disease (CVD). Objectives: To evaluate the correlation between CVD risk scores; estimate the frequency of evaluating the metabolic and obtaining lipid targets in HIV-positive patients. Method: Cohort of seropositive individuals recruited at a referral center for HIV, in Goiás, 2009-2011. 294 participants aged >19 years were followed with clinical and laboratory evaluations performed at baseline, after 3 and 6 months. We analyzed the correlation between Framingham with and without aggravating factors; PROCAM and DAD (Kappa). We estimated the frequency of metabolic changes and obtaining lipid targets, post-intervention, according to Guidelines of the Brazilian Society of Cardiology. According to clinical and laboratory criteria, patients received rosuvastina and/or ciprofibrate. The level of significance was set at p<5%. SPSS 18.0 software was used. Results: predominantly male population (76.9%); with a mean age of 36.8 years (SD=10.3); 66.3% on HAART, of whom 50.0% for less than two years. High risk of CVD ranged from 0.4 to 5.7%. Intermediate risk for CVD was seen in 3.2, according to the Framingham score and 39.9% of the participants, considering the presence of aggravating factors. At baseline, 72.8% of participants had some type of dyslipidemia. There was a significant reduction in the percentage of individuals with mixed dyslipidemia and low HDL, post-deployment lipid targets (p<0.05). Conclusions: Framingham with aggravating factors seems to overestimate cardiovascular risk in HIV positive patients. One third of patients with dyslipidemia reached lipid treatment targets in six months. Further studies are needed to assess the predictive power of different risk scores, as well as to assess the benefits of medium and long-term use of statins in this population.