Associação entre indicadores antropométricos e risco cardiovascular detectado pelo Escore de Risco de Framingham em pessoas vivendo com HIV

Abstract

The HIV virus can induce immunodeficiency, and antiretroviral therapy (ART) is an effective treatment for inhibiting the virus and preserving the immune function of people living with HIV (PLHIV). However, the viral action and adverse effects of pharmacological therapy can lead to metabolic and morphological alterations, increasing the risk of cardiovascular issues. In this context, the assessment of body composition through anthropometric indicators is crucial in clinical practice due to potential associations with morbidity and mortality in PLHIV. The aim of this study was to analyze the association between anthropometric indicators and cardiovascular risk in PLHIV. This was an analytical, cross-sectional observational study conducted in two infectious disease reference outpatient clinics in Alagoas, Brazil. The study included adults (≥18 years old), cisgender, of both sexes, with a diagnosis of HIV infection in outpatient care. Sociodemographic information, personal history, anthropometric measurements (body mass, height, neck, waist, and hip circumferences, from which 11 anthropometric indicators were calculated), viral load, CD4+ T lymphocytes, ART duration and regimen, time since diagnosis, biochemical data (glucose, total cholesterol, and high-density lipoprotein [HDL] cholesterol), and blood pressure were collected. Framingham score-calculated cardiovascular risk used variables such as sex, age, smoking, diabetes mellitus, and treatment for systemic arterial hypertension. Multivariate regression analyses, adjusted for education, physical activity level, income, CD4+ T lymphocytes, and ART, were performed using STATA® v. 13.0 (p<0.05). A total of 354 PLHIV participated in the study, with 41.2% (n=146) being female, with a mean age of 42.7 ± 13.0 years, 23.4% (n=81) using protease inhibitors (PI), 31.6% (n=107) with detectable viral load, and 24.3% (n=79) showing immunosuppression with CD4<350 cells/mm³. Among participants, 70.1% (n=248) had low cardiovascular risk, 16.7% (n=59) had moderate risk, and 13.3% (n=47) had high risk. Anthropometric indicators showed stronger correlations with cardiovascular risk compared to biochemical variables and blood pressure. HIV-positive men exhibited higher standardized β coefficients than HIV-positive women. Among the anthropometric indicators analyzed through multivariate regression, the conicity index (CI), waist-hip ratio (WHR), body shape index (BSI), waist-to-height ratio (WHtR), and body roundness index (BRI) were significantly associated with risk in male participants (β*=0.4985, β*=0.4861, β*=0.4645, β*=0.4320, β*=0.4204, respectively, are the standardized betas of the indicators). In female participants, none of the evaluated indicators were associated with cardiovascular risk. The anthropometric variables CI and WHR in males, but not females, independently related to cardiovascular risk, with WHR being the indicator with the greatest potential application in clinical practice.