Consequências clínicas e metabólicas da insegurança alimentar familiar em pessoas vivendo com HIV/AIDS: um estudo coorte

Abstract

Food insecurity (FI) reaches 22.6% of the Brazilian population, but its prevalence and consequence in people living with HIV/Aids (PLWHA) are little known in Brazil. The consequences were studied in PLWHA, considering its effect on clinical morbidity associated with HIV/Aids, on the metabolic changes of HIV Lipodistrophic Syndrome, cardiovascular risk (CVR) and adherence to treatment. A cohort of 400 PLWHA accompanied on a reference service in the State of Paraíba, between March 2015 to May 2016, which were classified in two groups for exposure to FI, obtained by Brazilian Range of food insecurity and accompanied by a year to evaluate the outcomes. Described if the frequencies of socio-demographic variables, clinical, laboratory and the CVR; through its association with FI, using the Chi square and Mann-Whitney tests. Instrument devised to assess adherence to antiretroviral therapy (ART). Using Kaplan-Meier estimators and Nelson-Aalen to estimate survival. The Logrank test compared the curves for variable, and we used Cox regression model to estimate the risk associated with each outcome. Devised decision tree model to identify individuals with viral load (VL) detectable. The sample was characterized by most male (61.5%), race/color brown (54.8%), mean and median age of 44 years, 57.1% education; incomplete elementary school, 48.5% were retired, 32.8% with per capita incomes between 1/3 to 1/2 minimum wage in force. The average time to diagnosis was 7.8 years and use of HAART was 6.9 years. The prevalence of was 70.7% 399 of PLWHA, being higher in households with children under 18 years old, and FI afflicted 19.5 percent of these people. Moderate or severe FI (MFI/SFI) was associated with female sex, race/color; white, low education, low income per capita, being unemployed, not being adherent to HAART and have undetectable VL. There was no difference between the groups for levels of hemoglobin, hematocrit, serum proteins, glucose, lipid profile and body mass index. Individuals in MFI/SFI were more smokers, sedentary and with higher levels of ultra sensitive protein C. The CVR was classified as high 7.9, 40.7% of PLWHA and when used, respectively, the Framingham risk score and the Overall risk score, and not related to MFI/SFI. The Accession score 42 presented 63% of accuracy to detect the PLWHA with undetectable VL and 58.5 percent ranked as adherents. Poor adherence to HAART increased by 1.6 times the risk for care in the hospital, at 1.7 times the risk to introduce infectious diseases associated with HIV/Aids and immunodeficiencies in 1.9 times the risk to submit to undetectable VL after 12 months. The MFI/SFI was associated with worse survival to seek care at the hospital, introduce infectious diseases associated with HIV/Aids immunodeficiency and have CD4 count less than 350 cells/mm3, during the following 12 months. Individuals adhering to treatment in food safety or FI take had better survival for present undetectable VL. Being in MFI/SFI increased by 1.7 times the risk to seek care at the hospital, 1.9 times the risk for infectious disease associated with HIV/Aids immunodeficiency and 1.7 times the risk for HIV/Aids related diseases not associated with immunodeficiency, during the following 12 months. At the end of this period the VL was undetectable in 76.7 percent of 322 individuals, each with their own new tests. The evaluation of VL, CD4 cell count and treatment adherence was able to predict correctly 80.0% of PLWHA regarding detectable after 12 months VL from rules obtained by the decision tree model. The FI is a stressor that worsens the clinical evolution of PLWHA in the following 12 months, such as vulnerability to be better investigated and valued for the effective control of the Aids epidemic.