Efeitos da HAART no estado nutricional de crianças e adolescentes infectados pelo HIV no Brasil: uma revisão sistemática

Gratão, Lucia Helena Almeida; Nascimento, Guilherme Nobre Lima do; Pereira, Renata Junqueira

doi:10.1590/1413-81232021264.13862018

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Sumário

REVIEW • Ciênc. saúde coletiva 26 (4) • Abr 2021 • https://doi.org/10.1590/1413-81232021264.13862018 copiar

Efeitos da HAART no estado nutricional de crianças e adolescentes infectados pelo HIV no Brasil: uma revisão sistemática

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumo

A verificação de fatores associados ao crescimento, composição corporal e aspectos alimentares e nutricionais, após a infecção pelo HIV em crianças ou adolescentes no Brasil é fundamental para avanços nesta área. Foram selecionados artigos publicados até 2018, disponibilizados nas plataformas PubMed e Lilacs, extraídas do MeSH: “Children”, “Adolescent”, “Anthropometry”, “Nutritional Assessment”, “HIV”, “Brazil” adicionadas do filtro “and” para as pesquisas. Foram encontrados 1.450 artigos e após seleção e leitura integral foram selecionados 19. Os estudos concordaram que crianças e adolescentes vivendo com HIV apresentam ou podem apresentar alterações no metabolismo ósseo, de lipídeos e na composição corporal devido à infecção ou associadas à terapia. Observou-se diferença significativa do peso e estatura em crianças infectadas em relação às não infectadas. Percebe-se que a avaliação e o monitoramento da qualidade da dieta, bem como o acompanhamento sérico de micronutrientes, são fundamentais para garantir as condições clínicas e de tratamento destes pacientes, bem como para prevenir desordens por baixo consumo de nutrientes.

Palavras-chave
Infecções por HIV; Síndrome de imunodeficiência adquirida; Transtornos da nutrição infantil; Fenômenos fisiológicos da nutrição do adolescente

Author, year	Target group	Study design	Diagnostic Methods	Main results
Carmo et al., 2017¹³13 Carmo FB, Terreri MT, Succi RCM, Beltrão SV, Gouvea AFTB, Paulino ERC, Machado DM. Bone mineral density and vitamin D concentration: the challenges in taking care of children and adolescents infected with HIV. Braz J Infect Dis 2017; 21(3):270-275..	58 children and adolescents (35 female, 23 male), aged between 5 and 20 years-old.	Cohort	Biochemical examinations, clinical data, DXA, degree of sexual maturation (Tanner), food frequency questionnaire.	Patients living with HIV are at increased risk for BMD changes. Lower serum levels of vitamin D in HIV-infected children.
Palchetti, et al. 2015⁸8 Palchetti CZ, Szejnfeld VL, Succi RCM, Patin RV, Teixeira PF, Machado DM, Oliveira FLC. Impaired bone mineral accrual in prepubertal HIV-infected children: a cohort study. Braz J Infect Dis. 2015; 19(6):623-630..	35 children (18 female, 17 male), aged 7 to 12 years-old.	Cohort	Weight, height, BMI, weight by age (WHO, 2007), DXA, biochemical tests, 24h recall of food intake, degree of sexual maturation (Tanner).	Bone mass involvement in children living with HIV. Adequate intake of calcium and fat helps in the accumulation of bone mass.
Lima et al., 2013⁷7 Lima LRA, Silva RCR, Giulianoc ICB, Sakunod T, Sérgio M. Brincase, Carvalho AP. Bone mass in children and adolescentes infected with human immunodefciency virus. J Pediatr. 2013; 89(1):91-99..	48 children and adolescents (24 females, 24 males), aged between 7 and 17 years-old.	Cross-sectional	Height, weight, anthropometric indices (WHO, 2007), DXA, clinical data, wrist and left hand radiographs, physical activity level (pedometer), food consumption frequency questionnaire.	Delay in skeletal maturation. Inadequate level of physical activity. Inadequate intake of calcium. DMO significantly lower in the group that used protease inhibitors. No significant difference was found between calcium intake, physical activity level and bone mass.
Schtscherbyna et al., 2012¹⁴14 Schtscherbyna A, Pinheiro MFMC, Mendonc LMC, Gouveia C, Luiz RR, Machado ES, Farias MLF. Factors associated with low bone mineral density in a Brazilian cohort of vertically HIV-infected adolescents. Inter J Infect Dis. 2012; 16(12):e872-e878..	74 adolescents (41 female, 33 male), with mean age of 17.3 years-old.	Cohort	Biochemical tests, DXA, weight, height, BMI, degree of sexual maturation (Tanner), 24h recall of food consumption.	Low BMD in the study population. Positive relationship between use of Tenofovir and low bone mass. Positive relationship between body composition, weight, BMI, body fat and BMD. Low intakes of vitamin D and calcium among adolescents living with HIV.

Author, year	Target group	Study design	Diagnostic Methods	Main results
Papi et al., 2014¹⁰10 Papi L, Menezes ACGB, Rocha H, Abreu TF, Oliveira RH, Frota ACC, Evangelista LA, Hofer CB. Prevalence of lipodystrophy and risk factors for dyslipidemia in HIV-infected children in Brazil. Braz J Infect Dis. 2014; 18(4):394-399..	90 children (52 female, 38 male), with age from 3 to 16 years-old.	Cross-sectional	Weight, height, skinfolds (triceps, subscapular and brachial), waist and arm circumference, anthropometric indices (NCHS, 1977), biochemical tests.	Lipodystrophy in 51% of the sample. Low intake of vegetables and fruits was associated with dyslipidemia. Inadequate intake of sugar and fat. Lopinavir and ritonavir were associated with dyslipidemia.
Palchetti et al., 2013¹⁵15 Palchetti CZ, Patin RV, Gouvêa AFTB, Szejnfeld VL, Succi RCM, Oliveira FLC. Body composition and lipodystrophy in prepubertal HIV-infected children. Braz J Infect Dis. 2013; 17(1):1-6..	52 prepubertal children, aged 7 to 12 years old of both sexes.	Cross-sectional		Clinical lipodystrophy was identified in 27,5% of the sample. 33 (82.5%) were eutrophic, 6 (15%) overweight/obese and 34 (85%) showed proper height. Dyslipidemia was found in 70% of children. The trunk to arm ratio showed a strong association with the presence of lipodystrophy.
Werner et al., 2010⁹9 Werner ML, Pone MV, Fonseca VM, Chaves CR. Lipodystrophy syndrome and cardiovascular risk factors in children and adolescents infected with HIV/AIDS receiving highly active antiretroviral therapy. J Pediatr (Rio J). 2010; 86(1):27-32..	43 (24 children and 19 adolescents) aged 2 to 16 years-old of both sexes.	Cross-sectional descriptive	Biochemical tests, degree of sexual maturation (Tanner diagrams), BMI, subscapular and triceps skinfold, clinical evaluation, family history, physical activity level, semi-quantitative food frequency questionnaire.	Lipid change by 88.3%. Body shape in 13.9%. Adequate nutritional status in 81.3%. Cholesterol intake above recommended.
Sarni et al., 2009¹⁶16 Sarni ROS, Souza FIS, Battistini TRB, Pitta TS, Fernandes AP, Tardini PC, Fonseca FLA, Santos VP, Lopez FA. Lipodystrophy in children and adolescentes with acquired immunodefciency syndrome and its relationship with the antiretroviral therapy employed. J Pediatr (Rio J). 2009; 85(4):329-334..	30 children and adolescents with age between 4 and 14 years-old of both sexes (14 male and 16 female).	Cross-sectional	Weight, height, biochemical tests, degree of sexual maturation (Tanner diagrams), anthropometric indices (WHO, 1995), physical examination by qualified professional.	Dyslipidemia was found in 60% of children and adolescents evaluated. Clinical lipodystrophy was observed in 53.3% of sample, showing a relationship with the antiretroviral regimen employed.

Author, year	Target group	Study design	Diagnostic Methods	Main results
Lima et al., 2018¹⁷17 Lima LRA, Petroski EL, Moreno YMF, Silva DAS, Trindade EBMS, Carvalho AP, Back IC. Dyslipidemia, chronic inflammation, and subclinical atherosclerosis in children and adolescents infected with HIV: The PositHIVe Health Study. PLoS ONE. 2018; 13(1):e0190785..	65 children and adolescents between 8.0 and 15.2 years of age (30 male and 35 female)	Cross-sectional	DXA, weight, height, BMI, biochemical tests.	The z-score of stature for age lower and profiles potentially associated with premature atherosclerosis due to inflammation, elevated IMTc, higher atherogenic lipid levels, and higher blood glucose levels.
Schtscherbyna et al., 2016¹⁸18 Schtscherbyna A, Gouveia C, Pinheiro MFMC, Luiz RR, Farias MLF, Machado ES. Vitamin D status in a Brazilian cohort of adolescents and young adults with perinatally acquired human immunodeficiency virus infection. Mem Inst Oswaldo Cruz. 2016; 111(2):128-133..	65 adolescents and young adults with 17.6 ± 2 years old of both genders.	Cross-sectional	Weight, height, BMI, degree of sexual maturation (Tanner diagrams) anthropometric indices (WHO, 2007), dietary assessment was based on a 24-h recall, International Physical Activity Questionnaire (IPAQ), biochemical tests.	Found 29.2% were Vitamin D insufficiency and 23,1% of adolescents were severe thinness or thinness.
Pugliese et al., 2014¹⁹19 Pugliese C, Patin RV, Cecilia Zanin Palchetti CZ, Claudio CC, Gouvêa AFTB, Succi RCM, Amancio OMS, Cozzolino SMF, Oliveira FLC. Assessment of antioxidants status and superoxide dismutase activity in HIV-infected children. Braz J Infect Dis. 2014; 18(5):481-486..	83 prepubertal children of both genders.	Cross-sectional	Weight, height, anthropometric indices (WHO, 2007), clinical evaluations, biochemical tests, 24h recall of food consumption.	HIV-infected children had lower Z-score height / age and high prevalence of short stature (11.8%). Low levels of selenium and high levels of copper were found in biochemical tests.
Bassichetto et al., 2013²⁰20 Bassichetto KC, Bergamasch DP, Frainer DES, Garcia VRS, Trovões EAT. Weight and height of people living with HIV/AIDS attended by the Brazilian National Health System. Rev Bras Epidemiol. 2013; 16(3):622-632..	142 [71 children (< 10 years old), 71 adolescents (10 to 19 years old)] of both genders.	Cross-sectional	Weight (kg), length and height (cm), anthropometric indices (WHO, 2007).	Growth among children and adolescents was similar to patterns of growth in the general population, with an increase in weight and height with age.
Contri et al., 2011⁶6 Contri PV, Berchielli EM, Tremeschin MH, Negrini BVM, Salomão RG, Monteiro JP. Nutritional status and lipid profile of HIV-positive children and adolescents using antiretroviral therapy. Clinics. 2011; 66(6):997-1002..	59 children and adolescents of both sexes, aged between 3 and 17 years old.	Descriptive longitudinal	Weight, height, anthropometric indices (WHO, 2007), waist circumference, arm circumference, subscapular and tricipital fold, BIA, habitual intake questionnaire, biochemical tests.	The use of protease inhibitors does not significantly interfere with anthropometry, body composition and dietary intake but is associated with increased triglyceride and LDL-c.
Diniz, et al., 2011²¹21 Diniz LMO, Maia MMM, Camargos LS, Amara LC, Goulart EMA, Pinto JA. Impacto da terapia antirretroviral combinada no crescimento e nas taxas de hospitalização de crianças infectadas pelo HIV. J Pediatr (Rio J). 2011; 87(2):131-137..	196 children (95 female, 101 male) aged 0 to 12 years-old.	Retrospective cohort	Anthropometric indices (NCHS, 1977), clinical data, biochemical tests.	HAART resulted in a significant increase in weight / age and height / age indices.
Fausto et al., 2011⁴4 Fausto MA, Mariângela Carneiro M, Antunes CMF, Colosimo EA, Pinto JA. Longitudinal anthropometric assessment of infants born to HIV-1-infected mothers, Belo Horizonte, Southeastern Brazil. Rev Saude Publica. 2011; 45(4):652-660..	33 infants (< 3 months).	Cohort	Weight, height, anthropometric indices (WHO, 2007).	There was an observed decrease over time in the anthropometric indices.
Carvalho et al., 2009²²22 Carvalho IR, Pinto JA, Cardoso CA, Candiani TM, Kakehasi FM. Evaluation of hematological, virologic and anthropometric parameters as progression markers in HIV-1 infected children. J Pediatr (Rio J). 2009; 85(2):149-156..	120 children of both sexes, aged 0-60 months.	Retrospective Cohort	Anthropometric data, results of laboratory tests and clinical evaluations.	Values of LT-CD4, Z-score of weight / age and height / age and median hemoglobin were significantly lower in the group of progressors.
Centeville et al., 2005²³23 Centeville M, Morcillo AM, Filho AAB,Silva MTN, Dalbo AA, Toro C, Vilela MMS. Lack of association between nutritional status and change in clinical category among HIV infected children in Brazil. Sao Paulo Med J. 2005; 123(2):62-65..	127 children (56 females, 71 males).	Retrospective longitudinal	Anthropometric indices (NCHS, 1977), birth weight, age of onset of symptoms, weight, height.	40.2% of the children presented malnutrition, 31.5% with height impairment.
Leandro-Merhi et al., 2000¹1 Leandro-Merhi VA, Vilela MMS, Silva MN, Lopez FA, Barros Filho AA. Evaluation of nutritional status of infants infected with the human immunodeficiency vírus. São Paulo Med J. 2000; 118(5):148-153..	124 (71 infected and 53 uninfected children) of both sexes, aged 3 to 21 months.	Longitudinal	Gestational age at birth, birth weight, weight and height during the study follow-up, anthropometric indices (NCHS, 1977).	Significant difference in weight and height between groups. Changes in growth arise soon after birth.

Author, year	Target group	Study design	Diagnostic Methods	Main results
Tanaka et al., 2015¹¹11 Tanaka LF, Latorre MR, Silva AM, Konstantyner TC, Mendes EC, Marques HH. Poor diet quality among Brazilian adolescents with HIV/AIDS. J Pediatr (Rio J). 2015; 91(2):152-159..	88 adolescents aged 10 to 19 years of both sexes (40 males and 48 females).	Cross-sectional nested in a cohort	Weight, height, waist circumference, anthropometric index (WHO, 2007), 24h recall.	Food pattern similar to that of the general population (high consumption of sugar, saturated fat and sodium, and insufficient intake of whole grains and fruits).

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[1] Collaborations

LHA Gratão worked on the conception and design, analysis, interpretation of data and drafting the article; RJ Pereira and GNL Nascimento worked on design, analysis, interpretation of data and revising it critically. All the authors have approved of the version to be published.