Caracterização e fatores associados à sarcopenia em pessoas vivendo com o vírus da imunodeficiência humana

Abstract

Sarcopenia is a disease characterized by low muscle strength and low muscle mass, its severity being determined by impaired physical performance. Studies that assessed the prevalence of sarcopenia among people living with the human immunodeficiency virus (PVHIV) used consensus and very heterogeneous criteria, which resulted in discrepant prevalence rates, between 1% and 35%. Mechanisms responsible for the reduction in muscle strength and mass may include low-grade inflammation, mitochondrial dysfunction secondary to antiretroviral therapy (ART), chronic immune activation and HIV-related metabolic disorders that can result in proteolysis, in addition harmful lifestyle habits and malnutrition that occurs especially due to inadequate dietary intake of energy and/or proteins. There are few studies in the literature after the publication of the European Working Group on Sarcopenia in Older People revised consensus (EWGSOP2). Thus, there is a need to explore and contribute to the literature with factors associated with redesigned sarcopenia. Furthermore, it may assist in clinical-nutritional management and early interventions that may have an impact on improving the prognosis of these individuals. Objectives: To characterize sarcopenia and its associated factors in individuals with the human immunodeficiency virus. Methods: This is a cross-sectional study. The study period was from April 2023 to January 2024. PLHIV attending the medical clinic and infectious disease outpatient clinic of the UFGD University Hospital, in the outpatient clinic of the Specialized Assistance Service/Testing and Counseling Center (SAE) of the municipality of Dourados-MS, using ART, aged ≥20 years, of both sexes, literate or not, who had the cognitive and physical capacity to understand and perform the tests. Sociodemographic, clinical factors related to the disease, lifestyle and anthropometric factors were collected through interviews and electronic and/or physical records. To characterize sarcopenia, the algorithm proposed by EWGSOP2 was used. Statistical analyzes conducted at the 5% significance level. Results: The sample consisted of 44 patients (42.1±12.4 years), predominantly men (62.1%), adults (95.5%) and outpatient treatment (68.2%). The prevalence of sarcopenia (confirmed and severe) was 20.5%. Associations were found between sarcopenia and the variables economic level (p=0.007), disease status (p=0.036), service level (p=0.040), body mass index (BMI) (p=0.002), muscle strength (p<0.001), skeletal muscle mass (calf circumference, CC) (p<0.001) and gait speed (GS) (p=0.004). Conclusion: In this study, the prevalence of sarcopenia (confirmed and severe) was significant. PLWH individuals with sarcopenia had lower BMI, CC and GS compared to individuals without sarcopenia and with sarcopenia probable. PLHIV individuals with a lower economic level, with the disease (AIDS) and hospitalization are factors related to sarcopenia, and it is recommended that they be investigated in clinical-nutritional care. The assessment of muscular health, linked to routine anthropometry, deserves more attention in PLHIV, especially in public hospitals.