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      Lipodystrophy syndrome associated with antiretroviral therapy in HIV patients: considerations for psychosocial aspects Translated title: Síndrome de la lipodistrofia asociado con la terapia antiretroviral en pacientes con VIH: consideraciones para los aspectos psicosociales Translated title: Sindrome da lipodistrofia associada com a terapia anti-retroviral em portadores do HIV: considerações para os aspectos psicossociais

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          Abstract

          Several side effects have been strongly associated with antiretroviral therapy in HIV patients. Among them, the lipodystrophy syndrome which presents alterations in body shape with central adipose hypertrophy and peripheral lipoatrophy, reported by patients as a visible marker identifying them as HIV patients. This manuscript presents an analysis of current literature regarding the psychosocial aspects of HIV patients with lipodystrophy associated with antiretroviral therapy. The results show that the alterations in body shape can be disturbing in terms of psychosocial well being, affecting quality of life and increasing the stigma associated with the disease, with consequent disturbances in social relations. This analysis provides a preliminary review of the psychosocial aspects of lipodystrophy and further studies are needed for a better understanding of this complex syndrome, which could provide new information to be used in nursing care for HIV patients affected by this problem.

          Translated abstract

          Varios efectos secundarios han sido fuertemente asociados con la terapia antiretroviral en pacientes con HIV. Entre ellos, el síndrome de la lipodistrofia se presenta con alteraciones en la forma del cuerpo con hipertrofia adiposa central y lipoatrofia periférica, las cuales son reportadas por pacientes como marcas visibles que los identifica como pacientes con VIH. En este manuscrito, presentamos un análisis de literatura actual con respecto a los aspectos psicosociales de pacientes con VIH presentándose con lipodistrofia asociado con la terapia antiretroviral. Los resultados demuestran que las alteraciones de la forma del cuerpo pueden ser inquietantes en lo que se refiere al bienestar psicosocial, afectando la calidad de vida y aumentando el estigma asociado con la enfermedad, con las consiguientes dificultades en las relaciones sociales. Este análisis provee un repaso preliminar de los aspectos psicosociales de la lipodistrofia; sin embargo, otros estudios son necesarios para entender mejor este complejo síndrome, proveyendo nueva información para ser utilizada en el cuidado de enfermería para pacientes con VIH que están afectados por este problema.

          Translated abstract

          Diversos efeitos colaterais têm sido associados à terapia anti-retroviral em portadores da infecção pelo HIV, dentre esses, a síndrome da lipodistrofia apresentando hiperlipidemia e alterações na forma do corpo, com hipertrofia adiposa central e lipoatrofia periférica, relatada pelos pacientes como um visível marcador para a identificação de portadores da infecção pelo HIV. Este estudo consiste em análise da produção científica sobre aspectos psicossociais em portadores da infecção pelo HIV que apresentam lipodistrofia associada à utilização da terapia anti-retroviral. Os resultados mostram que alterações corporais podem ser suficientemente perturbadoras para o bem-estar psicossocial, afetando a qualidade de vida e aumentando o estigma da doença, ocasionando perturbações nas relações sociais. Esta revisão possibilita uma análise preliminar dos aspectos psicossocias da lipodistrofia; entretanto, outros estudos são necessários para o melhor entendimento desta complexa síndrome, trazendo novas informações a serem utilizadas no cuidado de enfermagem a portadores da infecção pelo HIV afetados por este problema.

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          Most cited references17

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          HIV lipodystrophy: risk factors, pathogenesis, diagnosis and management.

          HIV lipodystrophy is a heterogeneous syndrome, which has yet to be objectively defined, comprising peripheral lipoatrophy, central fat accumulation and lipomata, along with hyperlipidaemia, insulin resistance and lactic acidaemia. Both nucleoside analogues and protease inhibitors are involved, but there are also host factors that probably place some patients at greater risk. The pathogenesis is increasingly understood, with evidence of interference of several regulatory proteins such as sterol regulatory enhancer binding protein-1, the proteasome, mitochondrial DNA polymerase gamma and GLUT-4. Along with the issues of cosmesis and stigmatization, a principal clinical concern that arises with lipodystrophy is a possible increased risk of accelerated atherosclerosis. A variety of therapeutic interventions, designed to limit these risks, are under evaluation, but none is conclusively shown to be of value.
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            Comparison of Medical Subject Headings and text-word searches in MEDLINE to retrieve studies on sleep in healthy individuals.

            The objective was to investigate the performance of two search strategies in the retrieval of primary research papers containing descriptive information on the sleep of healthy people from MEDLINE. Two search strategies-one based on the use of only Medical Subject Headings (MeSH), the second based on text-word searching-were evaluated as to their specificity and sensitivity in retrieving a set of relevant research papers published in the journal Sleep from 1996 to 2001 that were preselected by a hand search. The subject search provided higher specificity than the text-word search (66% and 47%, respectively) but lower sensitivity (78% for the subject search versus 88% for the text-word search). Each search strategy gave some unique relevant hits. The two search strategies complemented each other and should be used together for maximal retrieval. No combination of MeSH terms could provide comprehensive yet reasonably precise retrieval of relevant articles. The text-word searching had sensitivity and specificity comparable to the subject search. In addition, use of text words "normal," "healthy," and "control" in the title or abstract fields to limit the final sets provided an efficient way to increase the specificity of both search strategies.
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              Relationship between HAART adherence and adipose tissue alterations.

              Adipose tissue alterations (ATA), which are common among persons treated with highly active antiretroviral therapy (HAART), can have substantial psychologic repercussions, with a subsequent negative impact on the patient's quality of life and on HAART adherence. However, the cross-sectional nature of the studies precludes establishing the direction and causality of the relationship. The authors evaluated the longitudinal relationship between ATA and adherence to HAART. The analysis included all participants in the AdICoNA and the LipolCoNA substudies of the Italian Cohort Naive Antiretrovirals (ICoNA). Adherence was assessed using a 16-item self-administered questionnaire, which also included a question on self-perceived fat accumulation experienced during the past 4 weeks. ATA was diagnosed by physicians at enrollment and evaluated every 6 months thereafter. There were 207 patients, with a median age of 35 years; 73% were men; and 34% acquired HIV through injection drug use. At baseline, nonadherence was reported by 63% of participants, and ATA was self-perceived by 15% and clinically diagnosed in 25%. Using Cox regression analysis, patients with good adherence at baseline were more likely to develop ATA (RH = 2.58; 95% CI, 1.09-6.11) and developed it sooner. Self-perceived ATA at baseline was independently related to subsequent nonadherence (OR, 4.67; 95% CI, 1.01-22.4), but clinically diagnosed ATA was not (OR, 0.77; 95% CI, 0.37-1.61). Patients' adherence to HAART is a dynamic process that interacts with ATA. Better adherence is associated with a higher risk of subsequent occurrence of ATA, while patient-perceived onset of morphologic alterations can reduce adherence to antiretroviral therapy.
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                Author and article information

                Journal
                rlae
                Revista Latino-Americana de Enfermagem
                Rev. Latino-Am. Enfermagem
                Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo (, SP, Brazil )
                0104-1169
                1518-8345
                October 2007
                : 15
                : 5
                : 1041-1045
                Affiliations
                [01] orgnameUniversity of São Paulo orgdiv1Ribeirão Preto College of Nursing Brazil anapaula@ 123456eerp.usp.br
                [02] orgnameUniversity of Alberta orgdiv1Faculty of Nursing Canada
                Article
                S0104-11692007000500024 S0104-1169(07)01500524
                10.1590/S0104-11692007000500024
                356fa167-8445-46c8-95e9-f06ccc7bb6f6

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 24 November 2006
                : 25 May 2007
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 18, Pages: 5
                Product

                SciELO Revista de Enfermagem

                Categories
                Review Articles

                HIV,enfermagem,lipodistrofia,síndrome de imunodeficiência adquirida,enfermería,síndrome de inmunodeficiencia adquirida,VIH,nursing,lipodystrophy,acquired immunodeficiency syndrome

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