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Yu B, Wu D, Feng C, Xu P, Reinhardt JD, Yang S. Toward a Prognostic Model for Mortality Risk in Older People Living With HIV: A Prospective Cohort Study From Southwestern China. J Am Med Dir Assoc 2024; 25:243-251. [PMID: 37429452 DOI: 10.1016/j.jamda.2023.05.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 05/31/2023] [Accepted: 05/31/2023] [Indexed: 07/12/2023]
Abstract
OBJECTIVE The existing prognostic models for mortality risk in people living with HIV (PLWH) may not be applicable for older PLWH because the risk factors were confined to biomarkers and clinical variables. We developed and validated a nomogram for the prognosis of all-cause mortality in older PLWH based on comprehensive predictors. DESIGN Prospective cohort study. SETTING AND PARTICIPANTS We included 824 participants aged ≥50 years (mean age, 64.0 ± 7.6 years) from 30 study sites in Sichuan, China, and followed up from Nov 2018 to Mar 2021. METHODS Data on demographics, biomarkers, and clinical indicators were extracted from the registry; mental and social factors were assessed by a survey. Elastic net was used to select predictors. A nomogram was developed based on Cox proportional hazards regression model to visualize the relative effect size (points) of the selected predictors. The prognostic index (PI) was calculated by summing points of all predictors to quantify mortality risk. RESULTS Predictive performance of PI from the nomogram was good, with area under the curve of 0.76 for the training set, and 0.77 for the validation set. Change in CD4 count, virological failure in antiretroviral therapy, and living with comorbidities were robust predictors. Depressive symptoms were an important predictor in men, those aged ≥65 years, and those with time of diagnosis <1 year; low social capital was an additional predictor in people aged <65. Mortality risk increased approximately 10-fold among participants whose PI was in the fourth quartile compared with those in the first quartile (hazard ratio, 9.5; 95% CI, 2.9-31.5). CONCLUSION AND IMPLICATIONS Although biological and clinical factors are crucial predictors, mental and social predictors are essential for specific groups. The developed nomogram is useful for identifying risk factors and groups at risk of mortality in older PLWH.
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Affiliation(s)
- Bin Yu
- Institute for Disaster Management and Reconstruction, Sichuan University-The Hong Kong Polytechnic University, Chengdu, China; West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China; Sichuan Research Center of Sexual Sociology and Sex Education, Chengdu, China
| | - Dan Wu
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, China; Departmemt of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Chuanteng Feng
- Institute for Disaster Management and Reconstruction, Sichuan University-The Hong Kong Polytechnic University, Chengdu, China; West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Peng Xu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jan D Reinhardt
- Institute for Disaster Management and Reconstruction, Sichuan University-The Hong Kong Polytechnic University, Chengdu, China; Jiangsu Province Hospital/Nanjing University First Affiliated Hospital, Nanjing, China; Swiss Paraplegic Research, Nottwil, Switzerland; University of Lucerne, Switzerland.
| | - Shujuan Yang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China; Department of Health Management Center, Clinical Medical College & Affiliated Hospital, Chengdu University, Chengdu, China; International Institute of Spatial Lifecourse Epidemiology (ISLE), Wuhan, China.
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Hou Y, Cai C, Tang H, Jin Y, Chen F, Niu D, Lv F. Sexual Behavior and Perceived Loneliness in Elderly People Living with HIV in China during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2714. [PMID: 36768080 PMCID: PMC9915913 DOI: 10.3390/ijerph20032714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The proportion of elderly people living with HIV (PLHIV) is increasing in China. To advance targeted interventions and substantially improve their quality of life, we investigate indicators of loneliness and sexual behavior among elderly PLHIV in 10 districts/counties in China during the COVID-19 pandemic. METHODS The demographic information and laboratory test results of the potential respondents were initially collected from the China Information System for Disease Control and Prevention. A two-stage stratified cluster sampling was used. The questionnaire survey was individually provided to all PLHIV aged +60. RESULTS We recruited 1017 valid respondents with a median age of 66 years (interquartile range of 63-71), of which 776 (76.3%) were male. Overall, 341 respondents (33.5%) lived alone, and 304 (29.9%) felt lonely. A total of 726 respondents (71.4%) informed others of their HIV diagnosis. Among the 726 respondents, children were the most common group with whom the older people shared their HIV infection status, accounting for 82.9%. Approximately 20% of the older PLHIV engaged in sexual behavior in the last year, and 70% reported not using condoms. A significantly greater risk of loneliness was found among the females (AOR = 1.542, CI: 1.084, 2.193), those who suffered discrimination from informed people (AOR = 4.719, CI: 2.986, 7.459), were diagnosed <1 year prior (AOR = 2.061, CI: 1.345, 3.156), those living alone (AOR = 2.314, CI: 1.632, 3.280), those having no friends (AOR = 1.779, CI: 1.327, 2.386), and those who had a divorced or widowed marital status (AOR = 1.686, CI: 1.174, 2.421). CONCLUSIONS Compared with non-lonely participants, the lonely participants were more likely to have a rural registered residence, a lower education level, no friends, be divorced or widowed, live alone, and lack knowledge of smartphones and reproductive health. The influence of COVID-19 had caused social activities to be more confined to the community, which impacts elderly HIV patients suffering from severe discrimination within families and communities.
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Affiliation(s)
| | | | | | | | | | | | - Fan Lv
- Correspondence: ; Tel./Fax: +86-010-58900906
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Dean LS, Chow DC, Ndhlovu LC, Boisvert WA, Chang SP, Shikuma CM, Park J. Characterization of Circulating Fibrocytes in People Living with HIV on Stable Antiretroviral Therapy. Immunohorizons 2022; 6:760-767. [PMID: 36445359 PMCID: PMC10402248 DOI: 10.4049/immunohorizons.2200085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 01/04/2023] Open
Abstract
Highly effective combination antiretroviral therapy has reduced HIV infection to a manageable chronic disease, shifting the clinical landscape toward management of noninfectious comorbidities in people living with HIV (PLWH). These comorbidities are diverse, generally associated with accelerated aging, and present within multiple organ systems. Mechanistically, immune dysregulation and chronic inflammation, both of which persist in PLWH with well-controlled virally suppressive HIV infection, are suggested to create and exacerbate noninfectious comorbidity development. Persistent inflammation often leads to fibrosis, which is the common end point pathologic feature associated with most comorbidities. Fibrocytes are bone marrow-derived fibroblast-like cells, which emerged as key effector cells in tissue repair and pathologic fibrotic diseases. Despite their relevance to fibrosis, the circulating fibrocyte concentration in PLWH remains poorly characterized, and an understanding of their functional role in chronic HIV is limited. In this study, utilizing PBMCs from a cross-sectional adult HIV cohort study with matched uninfected controls (HIV-), we aimed to identify and compare circulating fibrocytes in blood. Both the percentage and number of fibrocytes and α-smooth muscle actin+ fibrocytes in circulation did not differ between the HIV+ and HIV- groups. However, circulating fibrocyte levels were significantly associated with increasing age in both the HIV+ and HIV- groups (the percentage and number; r = 0.575, p ≤ 0.0001 and r = 0.558, p ≤ 0.0001, respectively). Our study demonstrates that circulating fibrocyte levels and their fibroblast-like phenotype defined as collagen I and α-smooth muscle actin+ expression are comparable between, and strongly associated with, age irrespective of HIV status.
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Affiliation(s)
- Logan S. Dean
- Department of Tropical Medicine, Medical Microbiology, and Pharmacology, University of Hawaii at Manoa, Honolulu, HI
- Hawaii Center for AIDS, John A. Burns School Medicine, University of Hawaii at Manoa, Honolulu, HI
| | - Dominic C. Chow
- Department of Tropical Medicine, Medical Microbiology, and Pharmacology, University of Hawaii at Manoa, Honolulu, HI
- Hawaii Center for AIDS, John A. Burns School Medicine, University of Hawaii at Manoa, Honolulu, HI
| | - Lishomwa C. Ndhlovu
- Department of Tropical Medicine, Medical Microbiology, and Pharmacology, University of Hawaii at Manoa, Honolulu, HI
| | - William A. Boisvert
- Center for Cardiovascular Research, University of Hawaii at Manoa, Honolulu, HI
| | - Sandra P. Chang
- Department of Tropical Medicine, Medical Microbiology, and Pharmacology, University of Hawaii at Manoa, Honolulu, HI
| | - Cecilia M. Shikuma
- Department of Tropical Medicine, Medical Microbiology, and Pharmacology, University of Hawaii at Manoa, Honolulu, HI
- Hawaii Center for AIDS, John A. Burns School Medicine, University of Hawaii at Manoa, Honolulu, HI
| | - Juwon Park
- Department of Tropical Medicine, Medical Microbiology, and Pharmacology, University of Hawaii at Manoa, Honolulu, HI
- Hawaii Center for AIDS, John A. Burns School Medicine, University of Hawaii at Manoa, Honolulu, HI
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Li J, Chen X, Lin H, Yuan S, Shi R, Xu L, Qiao S, He C, Shen W, He N, Ding Y. Associations between
HIV
infection and frailty status and its individual components: Are frailty components disproportionally affected? HIV Med 2022; 24:533-543. [PMID: 36288971 DOI: 10.1111/hiv.13429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/10/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE We aimed to examine whether HIV infection was independently associated with frailty status and its individual components. METHODS This cross-sectional investigation included people living with HIV (PLWH) and HIV-negative individuals from the baseline survey of the Comparative HIV and Aging Research in Taizhou (CHART) cohort, China. Frailty phenotype was based on five components: weight loss, low physical activity, exhaustion, weak grip strength and slow gait speed. Frailty was defined as the presence of at least three components, and prefrailty was defined as one or two components. Logistic regression models were used to analyse the factors associated with frailty and its components. RESULTS In all, 2475 people living with HIV (age 45.5 ± 14.9 years; 76.2% male) and 4948 HIV-negative individuals (age 45.5 ± 14.8 years; 76.3% male) were included. Among PLWH, median CD4 count was 395 cells/μL and 78% were currently on antiretroviral therapy (ART). Frailty and prefrailty were significantly more prevalent in PLWH (3.2% vs 1.9% and 32.9% vs 27.9%) overall and at ages 18-39 (1.4% vs 0.2% and 22.7% vs 19.0%), 40-59 (2.5% vs 0.9% and 30.9% vs 27.9%) and 60-90 years (8.4% vs 7.4% and 57.1% vs 45.8%). HIV infection was associated with frailty and prefrailty [adjusted odds ratio (aOR) = 1.48, 95% confidence interval (CI): 1.06-2.08; and aOR = 1.18, 95% CI: 1.05-1.33, respectively] after adjusting for confounding variables, but were strengthened with further adjustment for multimorbidity (aOR = 1.62, 95% CI: 1.14-2.28; and aOR = 1.22, 95% CI: 1.09-1.37), and were no longer significant with further adjustment for depressive symptoms and sleep disorders (aOR = 1.02, 95% CI: 0.71-1.46; and aOR = 1.06, 95% CI: 0.94-1.20). Among individual components, HIV infection was positively associated with weak grip strength and slow gait speed, but negatively associated with low physical activity and exhaustion in all the adjusted models described. CONCLUSIONS Frailty and prefrailty occur more often and earlier in PLWH. However, grip strength and gait speed are affected to a greater extent, highlighting their potential as screening and intervention targets to prevent or slow frailty among PLWH.
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Affiliation(s)
- Jing Li
- Department of Epidemiology, School of Public Health Fudan University, and The Key Laboratory of Public Health Safety of Ministry of Education Shanghai China
| | - Xiaoxiao Chen
- Taizhou City Center for Disease Control and Prevention Zhejiang China
| | - Haijiang Lin
- Taizhou City Center for Disease Control and Prevention Zhejiang China
| | - Shiying Yuan
- Department of Epidemiology, School of Public Health Fudan University, and The Key Laboratory of Public Health Safety of Ministry of Education Shanghai China
| | - Ruizi Shi
- Department of Epidemiology, School of Public Health Fudan University, and The Key Laboratory of Public Health Safety of Ministry of Education Shanghai China
| | - Lulu Xu
- Department of Epidemiology, School of Public Health Fudan University, and The Key Laboratory of Public Health Safety of Ministry of Education Shanghai China
| | - Shijie Qiao
- Department of Epidemiology, School of Public Health Fudan University, and The Key Laboratory of Public Health Safety of Ministry of Education Shanghai China
| | - Chunyan He
- Department of Epidemiology, School of Public Health Fudan University, and The Key Laboratory of Public Health Safety of Ministry of Education Shanghai China
| | - Weiwei Shen
- Taizhou City Center for Disease Control and Prevention Zhejiang China
| | - Na He
- Department of Epidemiology, School of Public Health Fudan University, and The Key Laboratory of Public Health Safety of Ministry of Education Shanghai China
| | - Yingying Ding
- Department of Epidemiology, School of Public Health Fudan University, and The Key Laboratory of Public Health Safety of Ministry of Education Shanghai China
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He J, Shi R, Duan S, Ye R, Yang Y, Wang J, Zu Z, Tang R, Gao J, Liu X, He N. Microbial translocation is associated with advanced liver fibrosis among people with HIV. HIV Med 2022; 23:947-958. [PMID: 35301782 DOI: 10.1111/hiv.13279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 02/03/2022] [Accepted: 02/08/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND The prevalence of liver complications is increasing among people living with HIV, and microbial translocation (MT) might play a vital role. We conducted a prospective cohort study to evaluate the association between plasma biomarkers of MT and liver fibrosis (LF) among people living with HIV in southwest China. METHOD A total of 665 people living with HIV were enrolled at baseline and had at least one follow-up visit during the 3-year study period. We calculated the Liver Fibrosis Index (FIB-4) to evaluate LF and measured plasma soluble CD14 (sCD14) and lipopolysaccharide-binding protein (LBP) as surrogate biomarkers for MT. We used ordinal logistic regression to investigate correlates of LF at baseline and used a linear mixed model to examine the association between dynamic changes in MT biomarkers and LF. RESULTS Of the participants, 61 (9.17%) had advanced LF (FIB-4 >3.25), and 193 (29.02%) had moderate LF (1.45 ≤ FIB-4 ≤ 3.25). Patients with advanced LF had higher plasma levels of sCD14 and LBP than those with moderate or no LF, both at baseline and at follow-up. The following factors were significantly associated with advanced LF: the highest quartile of LBP (adjusted odds ratio [aOR] = 1.69; 95% confidence interval [CI] 1.02~2.81), current intravenous drug use (aOR = 1.82; 95% CI 1.06~3.12), baseline CD4 <200 cells/μl (aOR = 3.25; 95% CI 2.13~4.95), hepatitis C virus coinfection (aOR = 2.52; 95% CI 1.41~4.51) and age >50 years (aOR = 32.66; 95% CI 15.89~66.36). LF progression (increasing FIB-4) was significantly associated with increasing sCD14 level (β = 1.11; 95% CI 0.97~1.26; p < 0.001) with covariate adjustment. CONCLUSION The significant relationship between MT and LF may reveal pathogenic mechanisms and potential intervention targets of liver complications among people living with HIV in China.
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Affiliation(s)
- Jiayu He
- Department of Epidemiology, School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
- Shanghai Institute of Infectious Diseases and Biosecurity, Fudan University, Shanghai, China
| | - Ruizi Shi
- Department of Epidemiology, School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
- Shanghai Institute of Infectious Diseases and Biosecurity, Fudan University, Shanghai, China
| | - Song Duan
- Dehong Prefecture Center for Disease Control and Prevention, Shanghai, China
| | - Runhua Ye
- Dehong Prefecture Center for Disease Control and Prevention, Shanghai, China
| | - Yuecheng Yang
- Dehong Prefecture Center for Disease Control and Prevention, Shanghai, China
| | - Jibao Wang
- Dehong Prefecture Center for Disease Control and Prevention, Shanghai, China
| | - Zhipeng Zu
- Department of Epidemiology, School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
- Shanghai Institute of Infectious Diseases and Biosecurity, Fudan University, Shanghai, China
| | - Renhai Tang
- Dehong Prefecture Center for Disease Control and Prevention, Shanghai, China
| | - Jie Gao
- Dehong Prefecture Center for Disease Control and Prevention, Shanghai, China
| | - Xing Liu
- Department of Epidemiology, School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Na He
- Department of Epidemiology, School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
- Shanghai Institute of Infectious Diseases and Biosecurity, Fudan University, Shanghai, China
- Yi-Wu Research Institute, Fudan University, Shanghai, China
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Zhu B, Chen X, Shen W, Ding Y, Lin H, He N. Association between inflammation and coagulation biomarkers and carotid atherosclerosis among treated people with HIV. Open Forum Infect Dis 2022; 9:ofac208. [PMID: 35794947 PMCID: PMC9253881 DOI: 10.1093/ofid/ofac208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/14/2022] [Indexed: 11/20/2022] Open
Abstract
Background Atherosclerotic cardiovascular disease (CVD) is a common cause of morbidity among people with human immunodeficiency virus (PWH) who initiate antiretroviral therapy (ART). Little is known about the roles of inflammation in atherosclerotic CVD among PWH. Methods This cross-sectional evaluation included 178 PWH between 40 and 70 years on stable (>3 months) ART who were derived from the ongoing, prospective cohort for Comparative HIV and Aging Research in Taizhou (CHART), China, from February 2017 to August 2018. Carotid intima-media thickness (cIMT) ≥1 mm was considered as cIMT thickening indicative of atherosclerotic CVD. Plasma inflammation and coagulation biomarkers were quantified by a multiplex bead cytokine assay for 27 cytokines and enzyme-linked immunosorbent assay (ELISA) for soluble CD14 and D-dimer, respectively. We performed a series of multiparametric analyses of biomarkers and developed a composite score for atherosclerotic CVD assessment among PWH. Results Of 178 PWH, 53 (30.9%) had cIMT thickening. In multivariable logistic analysis adjusting for CVD and human immunodeficiency virus-specific risk factors, interleukin (IL)-4 (odds ratio [OR] = 19.0; 95% confidence interval [CI], 1.6–226.5), IL-7 (OR = 16.7; 95% CI, 1.8–151.7), IL-10 (OR = 11.9; 95% CI, 2.0–72.1), and D-dimer (OR = 3.1; 95% CI, 1.0–10.1) were significantly associated with cIMT thickening. We also developed a composite score incorporating markers (IL-7, IL-10, D-dimer, and hypertension) that accurately evaluated atherosclerotic CVD. Conclusions The associations of IL-4, IL-7, IL-10, and D-dimer with atherosclerosis underscores research needs to further understand the inflammatory mechanisms in the pathogenesis of atherosclerosis CVD among treated PWH. The composite score for atherosclerotic CVD assessment could be useful for risk stratification in PWH.
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Affiliation(s)
- Bowen Zhu
- School of Public Health, Fudan University, Shanghai, China; and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
- Yiwu Research Institute of Fudan University, Shanghai, China
| | - Xiaoxiao Chen
- Taizhou City Center for Disease Control and Prevention, Zhejiang Province, China
| | - Weiwei Shen
- Taizhou City Center for Disease Control and Prevention, Zhejiang Province, China
| | - Yingying Ding
- School of Public Health, Fudan University, Shanghai, China; and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
- Yiwu Research Institute of Fudan University, Shanghai, China
| | - Haijiang Lin
- School of Public Health, Fudan University, Shanghai, China; and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
- Taizhou City Center for Disease Control and Prevention, Zhejiang Province, China
| | - Na He
- School of Public Health, Fudan University, Shanghai, China; and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
- Yiwu Research Institute of Fudan University, Shanghai, China
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Liu X, Cao J, Zhu Z, Zhao X, Zhou J, Deng Q, Zhang L, Wang H. Nutritional risk and nutritional status in hospitalized older adults living with HIV in Shenzhen, China: a cross-sectional study. BMC Infect Dis 2021; 21:618. [PMID: 34187374 PMCID: PMC8244224 DOI: 10.1186/s12879-021-06322-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 06/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nutrition is a crucial factor that can impact morbidity and mortality in older people living with HIV (PLWH). Studies on nutritional risk and nutritional status in all age groups in PLWH have been conducted. However, few studies have focused on nutritional risk in older PLWH. This study aimed to describe the nutritional risk and nutritional status in older PLWH, and explore factors associated with nutritional risk and undernutrition status. METHODS We conducted a cross-sectional study. We recruited participants aged 50 years or older from the Third People's Hospital of Shenzhen from January 2016 to May 2019. Nutritional risk and nutritional status were evaluated by the Nutritional Risk Screening 2002 (NRS 2002) tool, body mass index (BMI), albumin level, and prealbumin level on the first day of admission. Logistic regression models were used to identify the factors associated with undernutrition based on the BMI, albumin, and prealbumin criteria. RESULTS A total of 196 older PLWH were included in the analysis. We found that 36% of hospitalized older PLWH had nutritional risk, and 12-56% of them had undernutrition based on the BMI, albumin, and prealbumin criteria. An increased nutritional risk score was associated with older age (β = 0.265 CI [0.021, 0.096], P = 0.002), a higher viral load (β = - 0.186 CI [- 0.620, - 0.037], P = 0.028), a lower BMI (β = - 0.287 CI [- 0.217, - 0.058], P = 0.001), and a lower albumin level (β = - 0.324 CI [- 8.896, - 1.230], P = 0.010). The CD4 count was associated with the prevalence of undernutrition based on the albumin criterion (OR = 15.637 CI [2.742, 89.178], P = 0.002). CONCLUSION Our study indicated that nutritional screening, assessment, and management should be routinely performed in hospitalized older PLWH. HIV-specific measures should be used to assess nutritional risk, and albumin, BMI, and other assessments should be used in combination to identify undernutrition in older PLWH.
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Affiliation(s)
- Xiaoning Liu
- The Third People's Hospital of Shenzhen, Shenzhen, China
| | - Jing Cao
- The Third People's Hospital of Shenzhen, Shenzhen, China
| | - Zheng Zhu
- Fudan University School of Nursing, Shanghai, China. .,Fudan University Centre for Evidence-based Nursing: A Joanna Briggs Institute Centre of Excellence, Shanghai, China.
| | - Xia Zhao
- Peking Union Medical College Hospital, Beijing, China
| | - Jing Zhou
- The Third People's Hospital of Shenzhen, Shenzhen, China
| | - Qiuxia Deng
- The Third People's Hospital of Shenzhen, Shenzhen, China
| | - Liyuan Zhang
- The Third People's Hospital of Shenzhen, Shenzhen, China
| | - Hui Wang
- The Third People's Hospital of Shenzhen, Shenzhen, China.
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Oduro JK, Kissah-Korsah K. Aged Persons Living with HIV and Nutritional Wellness: Analysis of 2013 South Africa-SAGE Well-Being of Older People Study (WOPS) Wave 2. J Aging Res 2021; 2021:6635814. [PMID: 34258065 PMCID: PMC8249153 DOI: 10.1155/2021/6635814] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 05/11/2021] [Accepted: 06/09/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION This study sought to examine the nutritional wellness among aged persons living with HIV in Somkhele, South Africa. METHODS Data were extracted from the 2013 South Africa-SAGE Well-Being of Older People Study (WOPS) Wave 2. The study sampled 440 aged persons (50 years and above). The proportion of the aged persons with high nutritional wellness by key covariates was reported with chi-square and p-values (p < 0.05). Two-level binary logistic regression models were fitted. RESULTS Results show that there were more aged women (79.8%) than men (20.2%) and the younger old (50-64) dominated (65.7%) in the ages, among the respondents. A higher percent of the aged persons were widows (39.5%) and had no formal education (46.1%). Six in 10 aged persons were HIV infected (59.5%). Percentage distribution of men with high nutrition was higher (78.7%). Regression results show that having nutritional wellness was low for aged persons who were infected by HIV (OR = 0.74, 95% CI = 0.69, 1.26) when compared to those who were not infected. Regarding ages of respondents, having high nutritional wellness was higher for young old (65-74 years) (OR = 1.21, 95% CI = 0.65, 2.25) compared to younger old (50-64 years). CONCLUSION This study suggests that age, education, source of drinking water, household source of income, and financial situation are important for nutritional wellness of aged persons who are HIV infected in South Africa. Moreover, having HIV infection is associated with low nutritional wellness. Being a young old (65-74 years) and receiving government grants and with better financial situation is associated with high nutritional wellness. Stakeholders and agencies who have interest in aged persons affected by HIV must understand the socioeconomic status in relation to their nutritional wellness. The results are of great importance to ageing policies, specifically in health and nutrition.
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Affiliation(s)
- Joseph Kojo Oduro
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
| | - Kwaku Kissah-Korsah
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
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Fang EF, Xie C, Schenkel JA, Wu C, Long Q, Cui H, Aman Y, Frank J, Liao J, Zou H, Wang NY, Wu J, Liu X, Li T, Fang Y, Niu Z, Yang G, Hong J, Wang Q, Chen G, Li J, Chen HZ, Kang L, Su H, Gilmour BC, Zhu X, Jiang H, He N, Tao J, Leng SX, Tong T, Woo J. A research agenda for ageing in China in the 21st century (2nd edition): Focusing on basic and translational research, long-term care, policy and social networks. Ageing Res Rev 2020; 64:101174. [PMID: 32971255 PMCID: PMC7505078 DOI: 10.1016/j.arr.2020.101174] [Citation(s) in RCA: 231] [Impact Index Per Article: 57.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 08/13/2020] [Accepted: 09/03/2020] [Indexed: 12/18/2022]
Abstract
One of the key issues facing public healthcare is the global trend of an increasingly ageing society which continues to present policy makers and caregivers with formidable healthcare and socio-economic challenges. Ageing is the primary contributor to a broad spectrum of chronic disorders all associated with a lower quality of life in the elderly. In 2019, the Chinese population constituted 18 % of the world population, with 164.5 million Chinese citizens aged 65 and above (65+), and 26 million aged 80 or above (80+). China has become an ageing society, and as it continues to age it will continue to exacerbate the burden borne by current family and public healthcare systems. Major healthcare challenges involved with caring for the elderly in China include the management of chronic non-communicable diseases (CNCDs), physical frailty, neurodegenerative diseases, cardiovascular diseases, with emerging challenges such as providing sufficient dental care, combating the rising prevalence of sexually transmitted diseases among nursing home communities, providing support for increased incidences of immune diseases, and the growing necessity to provide palliative care for the elderly. At the governmental level, it is necessary to make long-term strategic plans to respond to the pressures of an ageing society, especially to establish a nationwide, affordable, annual health check system to facilitate early diagnosis and provide access to affordable treatments. China has begun work on several activities to address these issues including the recent completion of the of the Ten-year Health-Care Reform project, the implementation of the Healthy China 2030 Action Plan, and the opening of the National Clinical Research Center for Geriatric Disorders. There are also societal challenges, namely the shift from an extended family system in which the younger provide home care for their elderly family members, to the current trend in which young people are increasingly migrating towards major cities for work, increasing reliance on nursing homes to compensate, especially following the outcomes of the 'one child policy' and the 'empty-nest elderly' phenomenon. At the individual level, it is important to provide avenues for people to seek and improve their own knowledge of health and disease, to encourage them to seek medical check-ups to prevent/manage illness, and to find ways to promote modifiable health-related behaviors (social activity, exercise, healthy diets, reasonable diet supplements) to enable healthier, happier, longer, and more productive lives in the elderly. Finally, at the technological or treatment level, there is a focus on modern technologies to counteract the negative effects of ageing. Researchers are striving to produce drugs that can mimic the effects of 'exercising more, eating less', while other anti-ageing molecules from molecular gerontologists could help to improve 'healthspan' in the elderly. Machine learning, 'Big Data', and other novel technologies can also be used to monitor disease patterns at the population level and may be used to inform policy design in the future. Collectively, synergies across disciplines on policies, geriatric care, drug development, personal awareness, the use of big data, machine learning and personalized medicine will transform China into a country that enables the most for its elderly, maximizing and celebrating their longevity in the coming decades. This is the 2nd edition of the review paper (Fang EF et al., Ageing Re. Rev. 2015).
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Affiliation(s)
- Evandro F Fang
- Department of Clinical Molecular Biology, University of Oslo and Akershus University Hospital, 1478 Lørenskog, Norway; The Norwegian Centre on Healthy Ageing (NO-Age), Oslo, Norway; Department of Hypertension and Vascular Disease, The First Affiliated Hospital, Sun Yat-Sen University, 510080, Guangzhou, China; Institute of Geriatric Immunology, School of Medicine, Jinan University, 510632, Guangzhou, China; Department of Geriatrics, The First Affiliated Hospital, Zhengzhou University, 450052, Zhengzhou, China.
| | - Chenglong Xie
- Department of Clinical Molecular Biology, University of Oslo and Akershus University Hospital, 1478 Lørenskog, Norway; Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
| | - Joseph A Schenkel
- Durham University Department of Sports and Exercise Sciences, Durham, United Kingdom.
| | - Chenkai Wu
- Global Health Research Center, Duke Kunshan University, 215316, Kunshan, China; Duke Global Health Institute, Duke University, Durham, 27710, North Carolina, USA.
| | - Qian Long
- Global Health Research Center, Duke Kunshan University, 215316, Kunshan, China.
| | - Honghua Cui
- Department of Endodontics, Shanghai Stomatological Hospital, Fudan University, China; Oral Biomedical Engineering Laboratory, Shanghai Stomatological Hospital, Fudan University, China.
| | - Yahyah Aman
- Department of Clinical Molecular Biology, University of Oslo and Akershus University Hospital, 1478 Lørenskog, Norway.
| | - Johannes Frank
- Department of Clinical Molecular Biology, University of Oslo and Akershus University Hospital, 1478 Lørenskog, Norway.
| | - Jing Liao
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 510275, Guangzhou, China; Sun Yat-sen Global Health Institute, Institute of State Governance, Sun Yat-sen University, 510275, Guangzhou, China.
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China; Kirby Institute, University of New South Wales, Sydney, Australia.
| | - Ninie Y Wang
- Pinetree Care Group, 515 Tower A, Guomen Plaza, Chaoyang District, 100028, Beijing, China.
| | - Jing Wu
- Department of Sociology and Work Science, University of Gothenburg, SE-405 30, Gothenburg, Sweden.
| | - Xiaoting Liu
- School of Public Affairs, Zhejiang University, Hangzhou, 310058, Zhejiang, China.
| | - Tao Li
- BGI-Shenzhen, Beishan Industrial Zone, 518083, Shenzhen, China; China National GeneBank, BGI-Shenzhen, 518120, Shenzhen, China.
| | - Yuan Fang
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, the Netherlands.
| | - Zhangming Niu
- Aladdin Healthcare Technologies Ltd., 25 City Rd, Shoreditch, London EC1Y 1AA, UK.
| | - Guang Yang
- Cardiovascular Research Centre, Royal Brompton Hospital, London, SW3 6NP, UK; and National Heart and Lung Institute, Imperial College London, London, SW7 2AZ, United Kingdom.
| | | | - Qian Wang
- Department of Geriatrics, The First Affiliated Hospital, Zhengzhou University, 450052, Zhengzhou, China.
| | - Guobing Chen
- Institute of Geriatric Immunology, School of Medicine, Jinan University, 510632, Guangzhou, China.
| | - Jun Li
- Department of Biochemistry and Molecular Biology, The Institute of Basic Medical Sciences, The Chinese Academy of Medical Sciences (CAMS)& Peking Union Medical University (PUMC), 5 Dondan Santiao Road, Beijing, 100730, China.
| | - Hou-Zao Chen
- Department of Biochemistry and Molecular Biology, The Institute of Basic Medical Sciences, The Chinese Academy of Medical Sciences (CAMS)& Peking Union Medical University (PUMC), 5 Dondan Santiao Road, Beijing, 100730, China.
| | - Lin Kang
- Department of Geriatrics, Peking Union Medical College Hospital, Beijing, 100730, China.
| | - Huanxing Su
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao.
| | - Brian C Gilmour
- The Norwegian Centre on Healthy Ageing (NO-Age), Oslo, Norway.
| | - Xinqiang Zhu
- Department of Toxicology, Zhejiang University School of Public Health, Hangzhou, 310058, Zhejiang, China; The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, 322000, Zhejiang, China.
| | - Hong Jiang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China; Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China.
| | - Na He
- School of Public Health, Fudan University, 200032, Shanghai, China; Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, 200032, Shanghai, China; Key Laboratory of Health Technology Assessment of Ministry of Health, Fudan University, 200032, Shanghai, China.
| | - Jun Tao
- Department of Hypertension and Vascular Disease, The First Affiliated Hospital, Sun Yat-Sen University, 510080, Guangzhou, China.
| | - Sean Xiao Leng
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, 5505 Hopkins Bayview Circle, Baltimore, MD 21224, USA.
| | - Tanjun Tong
- Research Center on Ageing, Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Peking University Health Science Center, Beijing Key Laboratory of Protein Posttranslational Modifications and Cell Function, Beijing, China.
| | - Jean Woo
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.
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