RESUMO
OBJECTIVE: Combination antiretroviral treatment (cART) allows for longer survival for people living with HIV and hence long-term complications of both disease and treatment are common. Our purpose was to evaluate bone alterations in men living with HIV (MLWH) and receiving cART and to identify associated factors that can be corrected or mitigated. PATIENTS AND DESIGN: Thirty MLWH and 36 healthy controls (≥50 years) were studied for areal bone mineral density (aBMD) and body composition (dual-energy X-ray absorptiometry), volumetric bone mineral density (vBMD) and bone microstructure (high-resolution peripheral quantitative computed tomography [HR-pQCT]), serum calcium, phosphate, parathyroid hormone, 25(OH)D, testosterone (T), estradiol (E2 ), glucose, creatinine, and albumin levels. RESULTS: The proportion of patients classified as osteoporosis (according to the lowest aBMD T-score) was higher among MLWH as compared to controls (17.9% vs. 5.9%, p = .011). The MLWH showed significant alterations in cortical and trabecular bone on HR-pQCT, which were not associated with the duration of HIV infection or cART. These differences in vBMD and bone microstructure seen in HR-pQCT persisted in the nonosteoporotic MLWH as compared to nonosteoporotic control subjects. Body mass index (BMI) and fat mass were lower in MLWH and positively associated with total vBMD, cortical bone area, and thickness. E2 and E2 /T ratios were lower in MLWH than in controls and significantly correlated with several cortical and trabecular bone parameters. Multivariate regression analysis entering simultaneously age, BMI, and E2 defined that E2 is an independent influence on bone parameters evaluated by HR-pQCT. CONCLUSION: MLWH have alterations in bone volumetric density and microstructure when compared with controls, irrespective of aBMD, which are associated with lower E2 and BMI.
Assuntos
Doenças Ósseas Metabólicas , Infecções por HIV , Absorciometria de Fóton/métodos , Idoso , Densidade Óssea , Brasil , Estradiol , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Rádio (Anatomia)RESUMO
Radioactive lightning rods were manufactured in Brazil until 1989, when the licenses for using radioactive sources in these products were lifted by the national nuclear authority. Since then, these rods have been replaced by the Franklin type and collected as radioactive waste. However, only 20% of the estimated total number of installed rods has been delivered to the Brazilian Nuclear Commission. This situation causes concern, since there is the possibility of the rods to be disposed as domestic waste. In Brazil, 64% of the municipal solid waste is disposed at garbage dumps without sufficient control. In addition, (241)Am, the radionuclide most commonly employed, is classified as a high-toxicity element, when incorporated. In the present study, (241)Am migration experiments were performed by means of a lysimeter system, in order to evaluate the risk of contamination caused by radioactive lightning rods disposed as common solid waste. (241)Am sources removed from lightning rods were placed inside lysimeters filled with organic waste that was collected at the restaurant of the Instituto de Pesquisas Energéticas e Nucleares. The generated leachate was periodically analyzed, and characteristics such as pH, redox potential, solid content and the concentration of the radioactive material were determined. The equivalent dose for members of the public was calculated considering ingestion of contaminated drinking water as the major path of exposure. Estimated doses were about 20-times below the effective dose limit of 1 mSv year(-1) for members of the public as recommended by the International Commission on Radiological Protection. This suggests the radiation risk caused by lightning rods disposed at uncontrolled garbage dumps to be low. It should be noted, however, that the number of investigated lightning rods was quite small. The results of this study might therefore not be entirely representative and should be interpreted with care. They provide, however, a very first basis for characterizing the transfer of (241)Am from lightning rods to the human food chain.