Department of Anatomy, University of Nigeria, Enugu Campus, Enugu, Enugu State, Nigeria.
Department of Physiotherapy, Enugu State University Teaching Hospital Park Lane, Enugu, Enugu State, Nigeria.
Gait Posture. 2021 May;86:101-105. doi: 10.1016/j.gaitpost.2021.02.015. Epub 2021 Feb 17.
Chronic inflammation in HIV infection and antiretroviral therapy have been shown to cause balance disorders due to neuromusculoskeletal damage, sensorimotor deficits, failure of foot mechanoreceptors and/or plantar lipoatrophy. However, despite evidence of plantar lipoatrophy in HIV patients, there is a dearth of information on how this relates to walking balance. This study sought to investigate how plantar fat thickness affects dynamic balance in HIV infected persons.
Can plantar lipoatrophy significantly affect walking balance in HIV infected persons?
This is a cross sectional study of 367 persons (106 HIV seronegative control subjects, 211 HIV seropositive subjects on antiretroviral therapy (HIV_ART) and 50 HIV ART naïve subjects (HIV_NonART)). Plantar fat thickness (PFT) was measured using diagnostic ultrasound. Subjects were asked to walk at 5 self-selected speeds, from very slow to very fast on a level 15-meter walkway. Average number of steps and time taken to complete the study distance were obtained, used to calculate gait parameters and plot the velocity field diagram for gait analysis.
Findings from this study showed significant reduction in plantar fat thickness, velocity of travel, stride frequency and a significant increase in stride and double support duration (p < 0.01) in HIV-seropositive individuals compared to healthy controls but none were observed between HIV_ART and NonART groups.
HIV infection significantly affects dynamic balance and increases the risk of falls, fracture and mobility impairment in this patient population.
This study will help clinicians to recognize plantar lipoatrophy as a significant cause of gait pathology in HIV infected persons and thus, make targeted interventions to minimize deformity and impairment, promote functional independence and improve quality of life.
HIV 感染和抗逆转录病毒治疗中的慢性炎症已被证明会因神经肌肉骨骼损伤、感觉运动缺陷、足部机械感受器和/或足底脂肪萎缩而导致平衡障碍。然而，尽管 HIV 患者存在足底脂肪萎缩的证据，但关于这如何与步行平衡相关的信息却很少。本研究旨在探讨足底脂肪厚度如何影响 HIV 感染者的动态平衡。
足底脂肪萎缩是否会显著影响 HIV 感染者的步行平衡？
这是一项横断面研究，共纳入 367 人（106 名 HIV 阴性对照者、211 名接受抗逆转录病毒治疗的 HIV 阳性者和 50 名未接受抗逆转录病毒治疗的 HIV 阳性者）。使用诊断超声测量足底脂肪厚度。要求受试者在 15 米水平步道上以 5 种自我选择的速度（从非常慢到非常快）行走。获得平均步数和完成研究距离所需的时间，用于计算步态参数并绘制步态分析的速度场图。
本研究发现，与健康对照组相比，HIV 阳性个体的足底脂肪厚度、行进速度、步频显著降低，步幅和双支撑时间显著延长（p<0.01），但在接受抗逆转录病毒治疗和未接受抗逆转录病毒治疗的两组之间未观察到差异。
HIV 感染显著影响动态平衡，增加了该患者人群跌倒、骨折和活动能力受损的风险。
本研究将帮助临床医生认识到足底脂肪萎缩是 HIV 感染者步态异常的重要原因，并因此采取有针对性的干预措施，以最小化畸形和功能障碍，促进功能独立性并提高生活质量。
