RESUMO
ABSTRACT Background: The increase in life expectancy for patients living with human immunodeficiency virus (HIV) infection has resulted in health complications related to a chronic disease. Objectives: To evaluate the prevalence of bone mineral density (BMD) alterations and vitamin D concentrations in HIV-infected children and adolescents and to verify the variations in those parameters during a 12-month interval. Methods: A prospective cohort study with a dual period of evaluation was conducted in 57 patients perinatally HIV-infected and one patient with sexual abuse in early infancy. Demographic, anthropometric, pubertal stage, viral load, T CD4+ cell count and antiretroviral therapy were evaluated. Biochemical tests and total body (TB) and lumbar spine (L1-L4) bone density evaluations by dual X-ray absorptiometry (DXA) were performed. Calcium or vitamin D supplements were prescribed if reduction in BMD or deficiency for vitamin D was detected. Results: 58 patients (ages 5.4-18.3 years; 60.3% girls) were included (T0); 55 patients were reevaluated after 12 (±3) months (T1). Low bone mass for chronological age was found in 6/58 (10.4%) and 6/55(10.9%) patients at T0 and at T1, respectively. There was no statistical relationship between z-scores for BMD (BMD z-score) and the variables sex, fracture history, family history of osteoporosis, physical activity and pubertal stage. There was a relation between BMD z-score alterations for TB and HIV viral load at T1 (p = 0.016). There was no association between duration or classes of antiretroviral therapy and bone density. The mean value of vitamin D in T0 was 23.43 ng/mL ± 2.015 and in T1 22.1 ng/mL ± 0.707 and considered insufficient levels for this population. Conclusion: Patients infected with HIV are at risk for BMD alterations and lower vitamin D serum concentrations; both of these variables should be evaluated at routine examinations in order to improve both prevention and therapeutic planning.
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Vitamina D/sangue , Densidade Óssea/fisiologia , Infecções por HIV/complicações , Cálcio/administração & dosagem , Vitamina D/administração & dosagem , Absorciometria de Fóton , Infecções por HIV/fisiopatologia , Infecções por HIV/sangue , Prevalência , Estudos Prospectivos , Contagem de Linfócito CD4 , Carga ViralRESUMO
BACKGROUND: The increase in life expectancy for patients living with human immunodeficiency virus (HIV) infection has resulted in health complications related to a chronic disease. OBJECTIVES: To evaluate the prevalence of bone mineral density (BMD) alterations and vitamin D concentrations in HIV-infected children and adolescents and to verify the variations in those parameters during a 12-month interval. METHODS: A prospective cohort study with a dual period of evaluation was conducted in 57 patients perinatally HIV-infected and one patient with sexual abuse in early infancy. Demographic, anthropometric, pubertal stage, viral load, T CD4+ cell count and antiretroviral therapy were evaluated. Biochemical tests and total body (TB) and lumbar spine (L1-L4) bone density evaluations by dual X-ray absorptiometry (DXA) were performed. Calcium or vitamin D supplements were prescribed if reduction in BMD or deficiency for vitamin D was detected. RESULTS: 58 patients (ages 5.4-18.3 years; 60.3% girls) were included (T0); 55 patients were reevaluated after 12 (±3) months (T1). Low bone mass for chronological age was found in 6/58 (10.4%) and 6/55(10.9%) patients at T0 and at T1, respectively. There was no statistical relationship between z-scores for BMD (BMD z-score) and the variables sex, fracture history, family history of osteoporosis, physical activity and pubertal stage. There was a relation between BMD z-score alterations for TB and HIV viral load at T1 (p=0.016). There was no association between duration or classes of antiretroviral therapy and bone density. The mean value of vitamin D in T0 was 23.43ng/mL±2.015 and in T1 22.1ng/mL±0.707 and considered insufficient levels for this population. CONCLUSION: Patients infected with HIV are at risk for BMD alterations and lower vitamin D serum concentrations; both of these variables should be evaluated at routine examinations in order to improve both prevention and therapeutic planning.
Assuntos
Densidade Óssea/fisiologia , Cálcio/administração & dosagem , Infecções por HIV/complicações , Vitamina D/sangue , Absorciometria de Fóton , Adolescente , Contagem de Linfócito CD4 , Criança , Feminino , Infecções por HIV/sangue , Infecções por HIV/fisiopatologia , Humanos , Masculino , Prevalência , Estudos Prospectivos , Carga Viral , Vitamina D/administração & dosagemRESUMO
Risk perception of acquiring vaccine preventable diseases and the immune status of 187 health care workers (HCW) from a high-complexity university hospital in São Paulo, Brazil, were assessed. The vaccine preventable diseases more cited as at risk for acquisition were hepatitis B (94.1%), influenza (92.5%), meningococcal disease (90.3%), tuberculosis (85.0%), and varicella (72.7%). Previous disease or vaccination reported by HCW were hepatitis B (82.4%), tetanus (87.7%), diphtheria (81.8%), measles (86.6%), mumps (85.6%), rubella (85.0%), varicella (82.9%), and influenza (35.8%). One third of HCW reported previous percutaneous or mucosal occupational accidents, and 83.6% had notified the event to the Hospital Infection Control Committee. Despite good risk perception of acquiring vaccine preventable diseases, only 35.8% of individuals were fully immunized. Efforts should be made to increase influenza vaccination coverage among all professionals and to reduce the number of nonreported accidents, especially among physicians.