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Franco-Oliva A, Pinzón-Navarro BA, Martínez-Soto-Holguín MC, León-Lara X, Ordoñez-Ortega J, Pardo-Gutiérrez AL, Guevara-Cruz M, Avila-Nava A, García-Guzmán AD, Guevara-Pedraza L, Medina-Vera I. High resting energy expenditure, less fat-free mass, and less muscle strength in HIV-infected children: a matched, cross-sectional study. Front Nutr 2023; 10:1220013. [PMID: 37799766 PMCID: PMC10548389 DOI: 10.3389/fnut.2023.1220013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/28/2023] [Indexed: 10/07/2023] Open
Abstract
Background and aims Many improvements have been made in the treatment of human immunodeficiency virus (HIV) in pediatric patients; however, challenges remain in terms of achieving normal growth, body composition, and metabolism during treatment, etc. Current nutritional recommendations are based on studies performed in adults, with limited data on the HIV-infected pediatric population. Therefore, this study aimed to compare the resting energy expenditure (REE) of asymptomatic HIV-infected pediatric patients with healthy counterparts and to compare body composition, dietary intake, and physical activity between the two groups. Methods This was a cross-sectional study of asymptomatic HIV-infected children who were receiving antiretroviral therapy; the infected group was compared with the uninfected group, matched by age (± 6 months), sex, and body mass index (± 0.5 z-score). Participants were recruited between 2021 and 2022, as outpatients. In both groups, REE was determined by indirect calorimetry and body composition by bioelectrical impedance analysis and hand strength, measured using a hydraulic hand dynamometer. Results Seventy-eight participants were enrolled, where n = 39 HIV-infected children and n = 39 controls, with a mean age of 11.6 ± 3.4 years old. REE was significantly higher in the HIV group (1254.4 ± 334.7 kcal/day vs. 1124.7 ± 321 kcal/day, p = 0.013) than in the control group. Fat-free mass (FFM) was lower in the HIV group (28.2 ± 10.5 kg vs. 32 ± 11.2 kg, p = 0.001); this trend continued when the index skeletal muscle was evaluated (7.2 ± 1.2 vs. 7.6 ± 1.5, p = 0.04). The strength of the dominant hand was also lower in the HIV group (12 (8-18) kg vs. 20 (10.5-26) kg, p < 0.0001). Conclusions Children with asymptomatic HIV infection have higher REE than their uninfected peers. They also present decreased FFM, skeletal muscle mass index, and muscle strength. These parameters should be considered during nutritional assessment in this population to have a favorable impact on nutritional status and growth.
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Affiliation(s)
- Andrea Franco-Oliva
- Departamento de Metodología de la Investigación, Instituto Nacional de Pediatría, Ciudad de México, Mexico
- Maestría en Nutrición Clínica, Escuela de Dietética y Nutrición del ISSSTE, Ciudad de México, México
| | - Beatriz Adriana Pinzón-Navarro
- Servicio de Gastroenterología y Nutrición Pediátrica, Instituto Nacional de Pediatría, Ciudad de México, Mexico
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Ciudad de México, Mexico
| | | | - Ximena León-Lara
- Institute of Immunology, Hannover Medical School, Hannover, Germany
| | - Javier Ordoñez-Ortega
- Departamento de Infectología Pediátrica, Instituto Nacional de Pediatría, Ciudad de México, Mexico
| | - Ana Laura Pardo-Gutiérrez
- Departamento de Metodología de la Investigación, Instituto Nacional de Pediatría, Ciudad de México, Mexico
| | - Martha Guevara-Cruz
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Ciudad de México, Mexico
- Departamento de Fisiología de la Nutrición, Instituto Nacional de Nutrición y Ciencias Médicas Salvador Zubirán, Ciudad de México, Mexico
| | - Azalia Avila-Nava
- Unidad de Investigación, Hospital Regional de Alta Especialidad de la Península de Yucatán, Mérida, Yucatán, Mexico
| | - Alda Daniela García-Guzmán
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Ciudad de México, Mexico
- Servicio de Oncología Médica, Instituto Nacional de Pediatría, Ciudad de México, Mexico
| | | | - Isabel Medina-Vera
- Departamento de Metodología de la Investigación, Instituto Nacional de Pediatría, Ciudad de México, Mexico
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Ciudad de México, Mexico
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Wan Yusuf, WN, Tang, SP, Mohd Ashari, and NS, Abd Aziz CB. Use of Honey in Immune Disorders and Human Immunodeficiency Virus. HONEY 2023:235-249. [DOI: 10.1002/9781119113324.ch18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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3
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Chacha S, Hui J, Yuxin T, Wang Z, Ali S, Mbonile N, Msumari M, Msuya N, Malimu E, Revocatus B, Maokola W, Mtali G, Simon V, Dang S. Epidemiological profile of malnutrition status and spatial distribution of children and adolescents living with HIV/AIDS in Tanzania. Trop Med Int Health 2023; 28:203-214. [PMID: 36617637 DOI: 10.1111/tmi.13852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To determine the prevalence of malnutrition status, analyse the association between malnutrition status and individual-level factors, and explore the spatial variation among children and adolescents living with HIV/AIDS in Tanzania. METHODS The study is based on large-scale baseline routine data from the National AIDS Control Programme on people living with HIV from January 2016 to December 2021 in mainland Tanzania. 70,102 children and adolescents aged 5-19 years receiving active antiretroviral therapy were included in the analysis. Nutritional status of participants was assessed by anthropometric measurement. Pearson's Chi-square test was used to describe the association between individual-level factors with all malnutrition outcomes and spatial analysis was used to investigate spatial distribution of malnutrition. The excess risk of malnutrition for each region was calculated while Anselin Local Moran's I and Getis-Ord statistical tools were used to identify significant hot spots regions of malnutrition. RESULTS The mean age of participants was 11.1 (SD 4.7) years, with 71.7% in the 5-14-year age group and 58.4% being girls. 39.2% were attending care and treatment clinics services at hospital level with public ownership. 53.4% started using ARV at age 5-14 years and 55.5% had already switched to second- or third-line ARV with 61.1% using ARV for less than 3 years. 51.2% were in WHO HIV clinical stage III or IV. The prevalence of malnutrition was 36.0% for stunting, 28.9% for underweight, 13.0% for wasting, and 48.0% for anthropometric failure. Individual-level factors which accounted for a higher proportion of malnutrition based on anthropometric failure were male sex (56.3%), age 5-14 years (50.0%), being unmarried (52.9%), being on second- or third-line ARV treatment (51.4%), ART initiation at age 5-14 years (55.7%), ARV for more than 3 years (49.4%), and stage IV of WHO HIV clinical status (57.8%). There were regional hot spots (p < 0.05): the prevalence rate and excess risk of malnutrition for stunting and anthropometric failure were highest in the southern highlands regions, for underweight in the central regions, and for wasting in the northern regions. CONCLUSIONS Children and adolescents living with HIV/AIDS in Tanzania suffer from poor nutritional status. Malnutrition does not occur arbitrarily, and the regions identified as hot spots should be given priority for nutritional intervention. Effective nutritional interventions for children living with HIV/AIDS should incorporate multiple approaches by considering unique geographical factors.
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Affiliation(s)
- Samuel Chacha
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China.,Department of Molecular Diagnostics, Sumbwanga Regional Referral Hospital, Rukwa, Tanzania
| | - Jing Hui
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Teng Yuxin
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Ziping Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Saumu Ali
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Nicolaus Mbonile
- Department of Molecular Diagnostics, Sumbwanga Regional Referral Hospital, Rukwa, Tanzania
| | - Mary Msumari
- Department of Molecular Diagnostics, Sumbwanga Regional Referral Hospital, Rukwa, Tanzania
| | - Ndovera Msuya
- Department of Biochemistry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Emmanuel Malimu
- Global Fund, Ministry of Health, Dodoma, Tanzania.,Department of Parasitology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Baraka Revocatus
- Department of Data and Statistics, Bugando Medical Centre, Mwanza, Tanzania.,National AIDS Control Program, Ministry of Health, Dodoma, Tanzania
| | - Werner Maokola
- National AIDS Control Program, Ministry of Health, Dodoma, Tanzania
| | - Godwin Mtali
- Department of Oncology, Bugando Medical Centre, Mwanza, Tanzania
| | - Victor Simon
- Global Health Program, HJFMRI, U.S. Military HIV Research Program, Rukwa, Tanzania
| | - Shaonong Dang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
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Kynurenine/tryptophan ratio for detection of active tuberculosis in adults with HIV prior to antiretroviral therapy. AIDS 2022; 36:1245-1253. [PMID: 35703207 DOI: 10.1097/qad.0000000000003235] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to assess the performance of kynurenine/tryptophan ratio for tuberculosis (TB) case-finding among antiretroviral therapy (ART)-naive people with HIV (PWH), and to investigate other factors associated with kynurenine/tryptophan ratio in this population. DESIGN A nested case--control study based on a cohort of 812 ambulatory PWH in the Oromia region, Ethiopia. METHODS At enrolment, all participants submitted sputum samples for bacteriological TB investigations. Concentrations of kynurenine and tryptophan in plasma were quantified using liquid chromatography-mass spectrometry. Receiver operator characteristic curves were constructed to assess diagnostic performance (area under the curve; AUC) for kynurenine, tryptophan, and kynurenine/tryptophan ratio. Sensitivity, specificity, and predictive values were calculated. Kynurenine/tryptophan ratios were correlated to plasma levels of nine inflammation mediators, plasma HIV RNA levels, CD4+ cell count, BMI, and mid-upper arm circumference (MUAC). RESULTS We included 124 individuals with HIV-TB coinfection (HIV+/TB+) and 125 with HIV mono-infection (HIV+/TB-). Tryptophan levels were lower in HIV+/TB+ than in HIV+/TB- (median 19.5 vs. 29.8 μmol/l, P < 0.01), while kynurenine levels were similar between these groups (median 2.95 vs. 2.94 μmol/l, P = 0.62). Median kynurenine/tryptophan ratio was 0.15 in HIV+/TB+, significantly higher compared with HIV+/TB- (0.11; P < 0.01), with AUC 0.70 for TB detection. Kynurenine/tryptophan ratio was positively correlated to plasma HIV RNA levels, IP-10, IL-18, and IL-27, and negatively correlated to CD4+ cell count, BMI, and MUAC (all P < 0.01). CONCLUSION Among ART-naive PWH, kynurenine/tryptophan ratio has modest potential for TB discrimination, limiting its utility for TB case-finding in this population.
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Carpenter CL, Kapur K, Ramakrishna P, Pamujula S, Yadav K, Giovanni JE, Julian O, Ekstrand ML, Sinha S, Nyamathi AM. Lean Mass Improvement from Nutrition Education and Protein Supplementation among Rural Indian Women Living with HIV/AIDS: Results from Cluster Randomized Factorial Trial at 18-Month Follow-Up. Nutrients 2021; 14:179. [PMID: 35011054 PMCID: PMC8746930 DOI: 10.3390/nu14010179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 12/24/2021] [Accepted: 12/24/2021] [Indexed: 11/17/2022] Open
Abstract
Loss of lean muscle mass impairs immunity and increases mortality risk among individuals with HIV/AIDS. We evaluated the relative contributions of protein supplementation and nutrition education on body composition among 600 women living with HIV/AIDS in rural Andhra Pradesh, India. We conducted a cluster randomized controlled 2 × 2 factorial trial lasting six months with follow up at twelve and eighteen months. Interventions occurred in the Nellore and Prakasam regions of Andhra Pradesh by trained village women, ASHA (Accredited Social Health Activists), and included: (1) the usual supportive care from ASHA (UC); (2) UC plus nutrition education (NE); (3) UC plus nutritional protein supplementation (NS); (4) combined UC plus NE plus NS. A Bioimpedance Analyzer Model 310e measured body composition. SAS 9.4 analyzed all data. Mixed models using repeated measures evaluated lean mass change from baseline as primary and fat weight and total weight as secondary outcomes. Lean mass change was significantly associated with NS (p = 0.0001), NE (p = 0.0001), and combined NS plus NE (p = 0.0001), with similar associations for secondary outcomes. Stronger associations for total weight were observed with greater ART adherence. Nutritional interventions may improve physiologic response to HIV. Significant increases in lean mass resulted from independent and combined protein supplementation and nutrition education.
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Affiliation(s)
| | | | | | - Suresh Pamujula
- People’s Health Society, Nellore 524137, India; (P.R.); (S.P.)
| | - Kartik Yadav
- Sue & Bill Gross School of Nursing, University of California, Irvine, CA 92697, USA; (K.Y.); (A.M.N.)
| | - Jennifer E. Giovanni
- Center for Human Nutrition, University of California, Los Angeles, CA 90024, USA;
| | - Olivia Julian
- College of Medicine, Drexel University, Philadelphia, PA 19129, USA;
| | - Maria L. Ekstrand
- Center for AIDS Prevention, Department of Medicine, University of California, San Francisco, CA 94158, USA;
| | - Sanjeev Sinha
- All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India;
| | - Adeline M. Nyamathi
- Sue & Bill Gross School of Nursing, University of California, Irvine, CA 92697, USA; (K.Y.); (A.M.N.)
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Osuna-Padilla I, Aguilar-Vargas A, Rodríguez-Moguel NC, Villazón-De la Rosa A, Osuna-Ramírez I, Ormsby CE, Reyes-Terán G. Resting energy expenditure in HIV/AIDS patients: Development and validation of a predictive equation. Clin Nutr ESPEN 2020; 40:288-292. [PMID: 33183552 DOI: 10.1016/j.clnesp.2020.09.004] [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: 07/25/2020] [Revised: 08/23/2020] [Accepted: 09/02/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Accurate measurements of resting energy expenditure (REE) are important for determining nutritional needs in HIV patients. Indirect calorimetry (IC) is a noninvasive method that reflects REE but can be costly and is frequently calculated with predictive equations. Research suggests that REE obtained by predictive equations in people living with HIV/AIDS (PLWH) is inaccurate. The aim of the study is to develop and validate a new predictive equation of REE based on a population of PLWH. METHODS Cross-sectional study including 164 PLWH (82 to develop and 82 to validate the equation). Multiple linear regression was used to determine the relationship between variables and to develop the new predictive equation. Intraclass correlation coefficient (ICC) and Bland-Altman methods were used to evaluate agreement between the new predictive equation and indirect calorimetry. RESULTS A new predictive equation with an accuracy of 67% when compared with IC was developed. This equation included as covariates: fat free mass, antiretroviral therapy status and age. CONCLUSION A new equation to predict energy expenditure in PLWH was developed and validated. This formula can be used to estimate REE if IC is not available.
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Affiliation(s)
- Iván Osuna-Padilla
- Centro de Investigaciones en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Adriana Aguilar-Vargas
- Centro de Investigaciones en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico.
| | - Nadia C Rodríguez-Moguel
- Centro de Investigaciones en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Andrea Villazón-De la Rosa
- Centro de Investigaciones en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Ignacio Osuna-Ramírez
- Facultad de Ciencias Químico Biológicas, Universidad Autónoma de Sinaloa, Culiacán, Sinaloa, Mexico
| | - Christopher E Ormsby
- Centro de Investigaciones en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Gustavo Reyes-Terán
- Centro de Investigaciones en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
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Sivalingam K, Cirino TJ, McLaughlin JP, Samikkannu T. HIV-Tat and Cocaine Impact Brain Energy Metabolism: Redox Modification and Mitochondrial Biogenesis Influence NRF Transcription-Mediated Neurodegeneration. Mol Neurobiol 2020; 58:490-504. [PMID: 32978730 DOI: 10.1007/s12035-020-02131-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/14/2020] [Indexed: 02/07/2023]
Abstract
HIV infection and drugs of abuse induce oxidative stress and redox imbalance, which cause neurodegeneration. The mechanisms by which HIV infection and cocaine consumption affect astrocyte energy metabolism, and how this leads to neurodegenerative dysfunction, remain poorly understood. Presently, we investigated how oxidative injury causes the depletion of energy resources and glutathione synthetase (GSS), which in turn activates 5' AMP-activated protein kinase (AMPK), glycolytic enzymes, and mitochondrial biogenesis, finally resulting in nuclear factor erythroid (NRF) transcription in astrocytes. Both human primary astrocytes incubated with HIV-1 Tat protein in vitro and HIV-inducible Tat (iTat) mice exposed to cocaine showed decreased levels of GSS and increased superoxide dismutase (SOD) levels. These changes, in turn, significantly activated AMPK and raised the concentrations of several glycolytic enzymes, along with oxidative phosphorylation, the mitochondrial biogenesis of peroxisome proliferator-activated receptor-γ coactivator (PGC-1α) and mitochondrial transcription factor (TFAM), and Nrf1 and Nrf2 gene transcription and protein expression. Moreover, neurons exposed to HIV-1Tat/cocaine-conditioned media showed reductions in dendritic formation, spine density, and neuroplasticity compared with control neurons. These results suggest that redox inhibition of GSS altered AMPK activation and mitochondrial biogenesis to influence Nrf transcription. These processes are important components of the astrocyte signaling network regulating brain energy metabolism in HIV-positive cocaine users. In conclusion, HIV-1 Tat alters redox inhibition, thus increasing glycolytic metabolic profiles and mitochondrial biogenesis, leading to Nrf transcription, and ultimately impacting astrocyte energy resource and metabolism. Cocaine exacerbated these effects, leading to a worsening of neurodegeneration.
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Affiliation(s)
- Kalaiselvi Sivalingam
- Department of Pharmaceutical Sciences, Irma Lerma Rangel College of Pharmacy, Texas A&M University, 1010 W Avenue B, Kingsville, TX, 78363, USA
| | - Thomas J Cirino
- Department of Pharmacodynamics, College of Pharmacy, University of Florida, Gainesville, FL, 32611, USA
| | - Jay P McLaughlin
- Department of Pharmacodynamics, College of Pharmacy, University of Florida, Gainesville, FL, 32611, USA
| | - Thangavel Samikkannu
- Department of Pharmaceutical Sciences, Irma Lerma Rangel College of Pharmacy, Texas A&M University, 1010 W Avenue B, Kingsville, TX, 78363, USA.
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Aouizerat BE, Byun E, Pullinger CR, Gay C, Lerdal A, Lee KA. Sleep disruption and duration are associated with variants in genes involved in energy homeostasis in adults with HIV/AIDS. Sleep Med 2020; 82:84-95. [PMID: 33906044 DOI: 10.1016/j.sleep.2020.08.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 07/21/2020] [Accepted: 08/25/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine whether selected genes and plasma markers involved in energy homeostasis are associated with sleep disruption or duration in adults with HIV/AIDS. METHODS A sample of 289 adults with HIV/AIDS wore a wrist actigraph for 72 h to estimate total sleep time (TST) and wake after sleep onset (WASO). Twenty-three single nucleotide polymorphisms (SNP) spanning 5 energy homeostasis genes (adiponectin [ADIPOQ], ghrelin [GHRL], leptin [LEP], peroxisome proliferator-activated receptor-alpha [PPARA], and -gamma [PPARG]) were genotyped using a custom array. Plasma markers of energy homeostasis (adiponectin, ghrelin, leptin) were measured by commercial multiplex assay. RESULTS After adjusting for demographic and clinical characteristics (race/ethnicity, gender, CD4 cell count, waist circumference, medications), both WASO and TST were associated with SNPs in ADIPOQ (rs182052), LEP (rs10244329, rs3828942), PPARA (rs135551, rs4253655), and PPARG (rs709151). Additional SNPs in ADIPOQ were associated with WASO (rs1501299, rs3821799, rs6773957) and TST (rs2241766). TST was also associated with SNPs in GHRL (rs26802), LEP (rs11760956), PPARA (rs135547, rs8138102, rs4253776), and PPARG (rs12490265, rs796313). Many covariate-adjusted associations involved a significant interaction with markers of HIV (viral load, years since diagnosis). Among plasma markers, higher adiponectin was associated with less WASO, higher ghrelin and glucose levels with shorter TST, and higher leptin with longer TST. CONCLUSIONS Replication of SNPs in all five genes and three plasma markers of energy homeostasis were associated with objective sleep measures. HIV disease influenced many of the associations. Findings strengthen evidence for associations between energy homeostasis genetics and poor sleep, and provide direction for pharmacological intervention research.
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Affiliation(s)
- Bradley E Aouizerat
- Bluestone Center for Clinical Research, New York University, NY, USA; Department of Oral and Maxillofacial Surgery, New York University, NY, USA.
| | - Eeeseung Byun
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, USA
| | - Clive R Pullinger
- Cardiovascular Research Institute, University of California at San Francisco, San Francisco, CA, USA; Department of Physiological Nursing, University of California at San Francisco, San Francisco, CA, USA
| | - Caryl Gay
- Department of Family Health Care Nursing, University of California at San Francisco, San Francisco, CA, USA; Department of Patient Safety and Research, Lovisenberg Diakonale Hospital, Oslo, Norway
| | - Anners Lerdal
- Department of Patient Safety and Research, Lovisenberg Diakonale Hospital, Oslo, Norway; Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Norway
| | - Kathryn A Lee
- Department of Family Health Care Nursing, University of California at San Francisco, San Francisco, CA, USA
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Apornpong T, Han WM, Chattranukulchai P, Siwamogsatham S, Wattanachanya L, Gatechompol S, Ueaphongsukkit T, Phonphithak S, Sakulrak S, Sangarlangkarn A, Kerr SJ, Ruxrungtham K, Avihingsanon A. Higher Proportion of Abnormal Nutritional Status Among Well-Suppressed HIV-Infected Elderly Asians Compared to HIV-Negative Individuals. AIDS Res Hum Retroviruses 2020; 36:590-596. [PMID: 32093485 DOI: 10.1089/aid.2019.0285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Older adults face physiological, psychological, social, and economic changes, which may impair nutritional status, making the body vulnerable to illness and adverse clinical outcomes. Little is known regarding the nutritional status among elderly people living with HIV (PLHIV). We aimed to study the prevalence of malnutrition and the associated factors in a Thai aging cohort. A cross-sectional study was conducted among PLHIV >50 years of age on long-term antiretroviral therapy and HIV-negative controls, frequency matched by sex and age in Bangkok, Thailand. Nutritional status was assessed by the Mini Nutrition Assessment (MNA) tool. Abnormal nutritional status was defined as MNA score <24 (malnutrition and at risk of malnutrition). Body composition was measured by bioelectrical impedance analysis using Body Composition Analyzer. Demographic and disease-related factors were assessed for their association with abnormal nutrition status using multivariable logistic regression. There were 349 PLHIV and 103 HIV-uninfected controls, with median age 55 years. The majority were male (63%) with median body mass index (BMI) of 23.4 kg/m2. PLHIV had lower BMI [median, 23.1 (IQR, 20.8-25.2) vs. 25.3 (22.3-28.7) kg/m2, p < .001], lower fat percent [22.8% vs. 26.3%, p < .001] and lower fat mass [14.2 vs. 16.9 kg, p < .001] and higher abnormal nutritional status (18.05% vs. 6.8%, p = .005) than controls. In the multivariate model, older age (adjusted odds ratio [aOR], 1.06, 95% confident interval [CI]: 1.01-1.12, p = .03), positive HIV status (aOR, 2.67, 95% CI: 1.07-6.65, p = .036), diabetes mellitus (aOR, 2.21, 95% CI: 1.003-4.87, p = .049), lower fat mass (aOR, 0.70, 95%CI: 0.57-0.86, p < .001), and lower BMI (aOR, 0.63, 95% CI: 0.51-0.78, p < .001) were independently associated with abnormal nutritional status. PLHIV had higher risks for abnormal nutritional status compared with HIV-uninfected individuals. Regular screening and monitoring of nutritional status among PLHIV may promote better health outcomes.
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Affiliation(s)
| | - Win Min Han
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Pairoj Chattranukulchai
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sarawut Siwamogsatham
- Chula Clinical Research Center, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Lalita Wattanachanya
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Excellence Center for Diabetes, Hormone, and Metabolism, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Sivaporn Gatechompol
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
- Tuberculosis Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | | | - Salila Sakulrak
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | | | - Stephen J. Kerr
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
- Biostatistics Excellence Center, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Kiat Ruxrungtham
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Anchalee Avihingsanon
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
- Tuberculosis Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Spencer DC, Krause R, Rossouw T, Moosa MYS, Browde S, Maramba E, Jankelowitz L, Mulaudzi MB, Ratishikana-Moloko M, Modupe OF, Mahomed A. Palliative care guidelines for the management of HIV-infected people in South Africa. South Afr J HIV Med 2019; 20:1013. [PMID: 31956436 PMCID: PMC6956685 DOI: 10.4102/sajhivmed.v20i1.1013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 07/15/2019] [Indexed: 11/01/2022] Open
Affiliation(s)
- David C Spencer
- Division of Infectious Diseases, Department of Medicine, Helen Joseph Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - René Krause
- Department of Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Theresa Rossouw
- Department of Immunology, University of Pretoria, Pretoria, South Africa
| | - Mahomed-Yunus S Moosa
- Department of Infectious Diseases, Nelson Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Selma Browde
- Community Action NGO/NPO, Johannesburg, South Africa
| | - Esnath Maramba
- Clinical Unit, Council for Medical Schemes, Pretoria, South Africa
| | | | | | - Mpho Ratishikana-Moloko
- Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Adam Mahomed
- Department of Internal Medicine, Charlotte Maxake Johannesburg Academic Hospital, Johannesburg, South Africa
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Osuna-Padilla IA, Aguilar-Vargas A, Villazón-De la Rosa A, Ablanedo-Terrazas Y, Vargas-Infante Y, Reyes-Terán G. Accuracy of Predictive Equations for Energy Expenditure in Mexicans Living With HIV/AIDS With and Without Antiretroviral Therapy. JPEN J Parenter Enteral Nutr 2017; 42:380-386. [PMID: 29187061 DOI: 10.1177/0148607117695250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 01/31/2017] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Determination of the resting energy expenditure (REE) is essential for planning nutrition therapy in patients with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) to help to improve their nutrition status. We aim to evaluate the agreement and accuracy of prediction equations that estimate the REE in a Mexican population with a diagnosis of HIV/AIDS with and without antiretroviral therapy (ART). METHODS A cross-sectional study in Mexican patients with HIV/AIDS with and without ART. Weight, height, and body composition measured with dual-energy x-ray absorptiometry were evaluated. The REE was determined with indirect calorimetry and estimated using the Mifflin-St Jeor (MSJ), Harris-Benedict (HB), Schofield 1 and 2, Cunningham, Melchior 91, Melchior 93, and Batterham equations. The Bland-Altman method assessed agreement between the real and estimated values, and the percent difference between these values was used to assess the prediction accuracy. RESULTS Sixty-five adults without ART and 102 adults with ART were included. The mean REE (kcal/kg) was 24.8 ± 2.4 and 23.8 ± 3.6 in patients without and with ART, respectively. Good agreement and reliability were observed in the HB (intraclass correlation coefficient [ICC], 0.75; P < .05), Batterham (ICC, 0.79; P < .05), Schofield 1 (ICC, 0.74; P < .05), and Schofield 2 (ICC, 0.78; P < .05) results in individuals without ART. In individuals with ART, good agreement and reliability were observed with the HB equation (ICC, 0.76; P < .05). The MSJ equation showed good agreement with poor reliability (ICC, 0.05; P < .05). CONCLUSION The equations with the best agreement and accuracy were Schofield 2, Batterham, and HB in individuals without ART and HB and MSJ in the population with ART.
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Affiliation(s)
- Iván Armando Osuna-Padilla
- Center for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico
| | - Adriana Aguilar-Vargas
- Center for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico
| | - Andrea Villazón-De la Rosa
- Center for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico
| | - Yuria Ablanedo-Terrazas
- Center for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico
| | - Yetlanezi Vargas-Infante
- Center for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico
| | - Gustavo Reyes-Terán
- Center for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico
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Cerebrospinal fluid metabolomics implicate bioenergetic adaptation as a neural mechanism regulating shifts in cognitive states of HIV-infected patients. AIDS 2015; 29:559-69. [PMID: 25611149 DOI: 10.1097/qad.0000000000000580] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To identify prognostic surrogate markers for change in cognitive states of HIV-infected patients. DESIGN Longitudinal cerebrospinal fluid (CSF) samples were collected from 98 HIV-infected patients identified by temporal change in cognitive states classified as normal, stably impaired, improving and worsening. METHODS The metabolic composition of CSF was analysed using H nuclear magnetic resonance (H NMR) spectroscopy that focused on energy metabolites. Metabolic biomarkers for cognitive states were identified using multivariate partial least squares regression modelling of the acquired spectra, combined with nonparametric analyses of metabolites with clinical features. RESULTS Multivariate modelling and cross-validated recursive partitioning identified several energy metabolites that, when combined with clinical variables, classified patients based on change in neurocognitive states. Prognostic identification for worsening was achieved with four features that included no change in a detectable plasma viral load, elevated citrate and acetate; decreased creatine, to produce a model with a predictive accuracy of 92%, sensitivity of 88% and 96% specificity. Prognosis for improvement contained seven features that included first visit age less than 47 years, new or continued use of antiretrovirals, elevated glutamine and glucose; decreased myo-inositol, β-glucose and creatinine to generate a model with a predictive accuracy of 92%, sensitivity of 100% and specificity of 84%. CONCLUSION These CSF metabolic results suggest that worsening cognitive status in HIV-infected patients is associated with increased aerobic glycolysis, and improvements in cognitive status are associated with a shift to anaerobic glycolysis. Dietary, lifestyle and pharmacologic interventions that promote anaerobic glycolysis could protect the brain in setting of HIV infection with combined antiretroviral therapy.
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Yuh B, Tate J, Butt AA, Crothers K, Freiberg M, Leaf D, Logeais M, Rimland D, Rodriguez-Barradas MC, Ruser C, Justice AC. Weight change after antiretroviral therapy and mortality. Clin Infect Dis 2015; 60:1852-9. [PMID: 25761868 DOI: 10.1093/cid/civ192] [Citation(s) in RCA: 137] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 03/04/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Weight gain after antiretroviral therapy (ART) initiation is common, but its implication for mortality is unknown. We evaluated weight change in the first year after ART initiation and its association with subsequent mortality. METHODS Human immunodeficiency virus-infected patients from the Veterans Aging Cohort Study (VACS) who initiated ART between 2000 and 2008, with weight recorded at baseline and 1 year later, were followed another 5 years for mortality. Baseline body mass index (BMI) was classified as underweight (<18.5 kg/m(2)), normal (18.5-24.9 kg/m(2)), overweight (25-29.9 kg/m(2)), and obese (≥30 kg/m(2)). We used multivariable Cox models to assess mortality risk with adjustment for disease severity using the VACS Index. RESULTS The sample consisted of 4184 men and 127 women with a mean age of 47.9 ± 10.0 years. After 1 year of ART, median weight change was 5.9 pounds (2.7 kg) (interquartile range, -2.9 to 17.0 pounds, -1.3 to 7.7 kg). Weight gain after ART initiation was associated with lower mortality among underweight and normal-weight patients. A minimum threshold of 10- to 19.9-pound (4.5 to 9.0 kg) weight gain was beneficial for normal-weight patients (hazard ratio, 0.56; 95% confidence interval, .41-.78), but there was no clear benefit to weight gain for overweight/obese patients. Baseline weight, CD4 cell count status, and hemoglobin level were strongly associated with weight gain. Risk for weight gain was higher among those with greater disease severity, regardless of weight at initiation. CONCLUSIONS The survival benefits of weight gain after ART initiation are dependent on starting BMI. Weight gain after ART is associated with lower mortality for those who are not initially overweight.
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Affiliation(s)
- Bianca Yuh
- Yale University School of Medicine, New Haven
| | - Janet Tate
- Yale University School of Medicine, New Haven Veterans Affairs (VA) Connecticut Healthcare System, West Haven
| | - Adeel A Butt
- VA Pittsburgh Healthcare System University of Pittsburgh School of Medicine, Pennsylvania
| | | | - Matthew Freiberg
- VA Pittsburgh Healthcare System University of Pittsburgh School of Medicine, Pennsylvania
| | - David Leaf
- UCLA School of Medicine Greater Los Angeles VA Healthcare System, California
| | - Mary Logeais
- University of Minnesota Medical School, Minneapolis
| | - David Rimland
- Atlanta VA Medical Center Emory University School of Medicine, Atlanta, Georgia
| | | | - Christopher Ruser
- Yale University School of Medicine, New Haven Veterans Affairs (VA) Connecticut Healthcare System, West Haven
| | - Amy C Justice
- Yale University School of Medicine, New Haven Veterans Affairs (VA) Connecticut Healthcare System, West Haven
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Nell TA, Kruger MJ, Beukes DC, Calitz E, Essop R, Essop MF. Distinct gender differences in anthropometric profiles of a peri-urban South African HIV population: a cross sectional study. BMC Infect Dis 2015; 15:85. [PMID: 25887844 PMCID: PMC4340112 DOI: 10.1186/s12879-015-0836-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 02/13/2015] [Indexed: 11/28/2022] Open
Abstract
Background Highly active antiretroviral therapy (HAART) has extended life expectancy and enhanced the well-being of HIV-positive individuals. Since there are concerns regarding HAART-mediated onset of cardio-metabolic diseases in the long-term, we evaluated the anthropometric profile of black HIV-infected individuals in a peri-urban setting (Western Cape, South Africa). Methods A cross sectional study design was followed to describe the gender differences in different HAART treatment groups. HIV-positive patients (n = 44 males, n = 102 females; 20–40 years) were recruited for three groups: 1) control (HIV-positive, HAART-naïve), 2) HIV-positive (<3 years HAART), and 3) HIV-positive (>3 years HAART). Results All participants underwent comprehensive anthropometric and bio-electrical impedance analyses. No significant differences were observed in the male treatment groups. HAART-naïve females are mostly overweight (73.90 ± 2.79). This is followed by a period of muscle wasting seen in the triceps skinfold (29.30 ± 2.19 vs 20.63 ± 1.83; p < 0.01), muscle mass (22.23 ± 0.46 vs 19.82 ± 0.54; p < 0.01), and fat free mass (49.40 ± 1.08 vs 44.16 ± 1.21; p < 0.01) upon HAART initiation (<3 years HAART). Thereafter all parameters measured had levels similar to that seen for the female HAART-naïve group. Females on <3 years HAART exhibited significantly decreased body cell mass (p < 0.01), protein mass (p < 0.01), muscle mass (p < 0.01), fat free mass (p < 0.01), and fat mass (p < 0.001) versus matched HAART-naïve controls. The W:H ratio for the female treatment groups placed the females overall at a higher risk for developing cardiovascular disease compared to the males. Conclusions This study found striking gender-based anthropometric differences in black South African HIV-positive individuals on HAART. We also conclude from this observational study that no significant differences were found in the different male treatment groups. All female body composition parameters initially showed lower values (<3 years HAART). The female treatment group (>3 years HAART) displayed values similar to that seen in the HAART-naïve group. Higher W:H ratios in females receiving longer-term HAART potentially increases their risk for the future onset of cardio-metabolic complications.
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Affiliation(s)
- Theodore A Nell
- Cardio-Metabolic Research Group (CMRG), Department of Physiological Sciences, Stellenbosch University, Mike De Vries Building, Merriman Avenue, Stellenbosch, 7600, South Africa. .,Division of Community Health, Tygerberg Campus, Stellenbosch, 7600, South Africa.
| | - Maritza J Kruger
- Cardio-Metabolic Research Group (CMRG), Department of Physiological Sciences, Stellenbosch University, Mike De Vries Building, Merriman Avenue, Stellenbosch, 7600, South Africa.
| | - Dillan C Beukes
- Cardio-Metabolic Research Group (CMRG), Department of Physiological Sciences, Stellenbosch University, Mike De Vries Building, Merriman Avenue, Stellenbosch, 7600, South Africa.
| | - Esme Calitz
- TC Newman Community Day Care Centre, Paarl, 7646, South Africa.
| | - Rehana Essop
- ANOVA Health Institute, Kohler Street, Paarl, 7646, South Africa.
| | - M Faadiel Essop
- Cardio-Metabolic Research Group (CMRG), Department of Physiological Sciences, Stellenbosch University, Mike De Vries Building, Merriman Avenue, Stellenbosch, 7600, South Africa.
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Puett C, Salpéteur C, Lacroix E, Zimunya SD, Israël AD, Aït-Aïssa M. Cost-effectiveness of community vegetable gardens for people living with HIV in Zimbabwe. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2014; 12:11. [PMID: 24834014 PMCID: PMC4022439 DOI: 10.1186/1478-7547-12-11] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 04/21/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is little evidence to date of the potential impact of vegetable gardens on people living with HIV (PLHIV), who often suffer from social and economic losses due to the disease. From 2008 through 2011, Action Contre la Faim France (ACF) implemented a project in Chipinge District, eastern Zimbabwe, providing low-input vegetable gardens (LIGs) to households of PLHIV. Program partners included Médecins du Monde, which provided medical support, and Zimbabwe's Agricultural Extension Service, which supported vegetable cultivation. A survey conducted at the end of the program found LIG participants to have higher Food Consumption Scores (FCS) and Household Dietary Diversity Scores (HDDS) relative to comparator households of PLHIV receiving other support programs. This study assessed the incremental cost-effectiveness of LIGs to improve FCS and HDDS of PLHIV compared to other support programs. METHODS This analysis used an activity-based cost model, and combined ACF accounting data with estimates of partner and beneficiary costs derived using an ingredients approach to build an estimate of total program resource use. A societal perspective was adopted to encompass costs to beneficiary households, including their opportunity costs and an estimate of their income earned from vegetable sales. Qualitative methods were used to assess program benefits to beneficiary households. Effectiveness data was taken from a previously-conducted survey. RESULTS Providing LIGs to PLHIV cost an additional 8,299 EUR per household with adequate FCS and 12,456 EUR per household with HDDS in the upper tertile, relative to comparator households of PLHIV receiving other support programs. Beneficiaries cited multiple tangible and intangible benefits from LIGs, and over 80% of gardens observed were still functioning more than one year after the program had finished. CONCLUSIONS Cost outcomes were 20-30 times Zimbabwe's per capita GDP, and unlikely to be affordable within government services. This analysis concludes that LIGs are not cost-effective or affordable relative to other interventions for improving health and nutrition status of PLHIV. Nonetheless, given the myriad benefits acquired by participant households, such programs hold important potential to improve quality of life and reduce stigma against PLHIV.
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Affiliation(s)
- Chloe Puett
- Action Against Hunger, 247 West 37th Street, New York, NY 10018, USA
| | - Cécile Salpéteur
- Action contre la Faim - France, 4 rue Niepce, 75 662 Paris Cedex 14, France
| | - Elisabeth Lacroix
- Action contre la Faim - France, 78-D Thanlwin Road, Bahan Township, Yangon, Myanmar
| | | | | | - Myriam Aït-Aïssa
- Action contre la Faim - France, 4 rue Niepce, 75 662 Paris Cedex 14, France
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Hillesheim E, Lima LRA, Silva RCR, Trindade EBSM. Dietary intake and nutritional status of HIV-1-infected children and adolescents in Florianopolis, Brazil. Int J STD AIDS 2013; 25:439-47. [PMID: 24352121 DOI: 10.1177/0956462413512808] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This cross-sectional study aimed to investigate the nutritional status and dietary intake of HIV-infected children and adolescents and the relationship between nutritional status and dietary intake and CD4(+) T-cell count and viral load. The sample was composed of 49 subjects aged 7-17 years and living in Florianópolis, Brazil. Nutritional status was assessed by height-for-age and body mass index-for-age. Dietary intake was assessed by a food frequency questionnaire. Spearman correlations and multiple linear regressions were used to determine the relationship between energy, nutrient intake and body mass index-for-age and CD4(+) T-cell count and viral load. The mean body mass index-for-age and height-for-age values were -0.26 ± 0.86 and -0.56 ± 0.92, respectively. The energy intake was 50.8% above the estimated energy requirement and inadequate intake of polyunsaturated fat, cholesterol, fibre, calcium and vitamin C was present in 100%, 57.1%, 40.8%, 61.2% and 26.5% of the sample, respectively. Multiple linear regression analyses revealed that energy intake was correlated with CD4+ T-cell count (r = 0.33; p = 0.028) and viral load (r = -0.35; p = 0.019). These data showed low body mass index-for-age and height-for-age z-scores, high energy intake and inadequate intake of important nutrients for immune function, growth and control of chronic diseases. A lower energy intake was correlated with viral suppression and immune preservation.
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Affiliation(s)
- Elaine Hillesheim
- Department of Nutrition, Federal University of Santa Catarina, Florianópolis, Brazil
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Nyamathi A, Sinha S, Ganguly KK, Ramakrishna P, Suresh P, Carpenter CL. Impact of protein supplementation and care and support on body composition and CD4 count among HIV-infected women living in rural India: results from a randomized pilot clinical trial. AIDS Behav 2013; 17:2011-21. [PMID: 23370835 DOI: 10.1007/s10461-013-0420-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Body composition in HIV-infected individuals is subject to many influences. We conducted a pilot 6-month randomized trial of 68 women living with AIDS (WLA) from rural India. High protein intervention combined with education and supportive care delivered by HIV-trained village women (activated social health activist [Asha] life [AL]) was compared to standard protein with usual care delivered by village community assistants (usual care [UC]). Measurements included CD4 counts, ART adherence, socio-demographics, disease characteristics (questionnaires); and anthropometry (bioimpedance analyzer). Repeated measures analysis of variance modeled associations. AL significantly gained in BMI, muscle mass, fat mass, ART adherence, and CD4 counts compared to UC, with higher weight and muscle mass gains among ART adherent (≥66%) participants who had healthier immunity (CD4 ≥450). BMI of WLA improved through high protein supplementation combined with education and supportive care. Future research is needed to determine which intervention aspect was most responsible.
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Affiliation(s)
- Adeline Nyamathi
- School of Nursing, University of California at Los Angeles, Room 2-250, Factor Building, Los Angeles, CA 90095-1702, USA.
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Glover DA, Garcia-Aracena EF, Lester P, Rice E, Rothram-Borus MJ. Stress biomarkers as outcomes for HIV+ prevention: participation, feasibility and findings among HIV+ Latina and African American mothers. AIDS Behav 2010; 14:339-50. [PMID: 19350378 PMCID: PMC2834765 DOI: 10.1007/s10461-009-9549-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2008] [Accepted: 03/16/2009] [Indexed: 12/03/2022]
Abstract
Mothers living with HIV (MLH) are at high risk for acute and chronic stress, given challenges related to their HIV status, ethnicity, economic and urban living conditions. Biomarkers combined into a composite index show promise in quantifying psychosocial stress in healthy people, but have not yet been examined among MLH. According, we examined potential biomarker correlates of stress [cortisol and catecholamines from home-collected urine and basic health indicators (blood pressure, height and weight, waist-to-hip ratio) measured during an interview] among 100 poor African American and Latina mothers MLH and demographic-matched control mothers without HIV (n = 50). Participants had been enrolled in a randomized controlled trial about 18 months earlier and had either received (MLH-I) or were awaiting (MLH-W) the psychosocial intervention. Participation was high, biomarkers were correctly collected for 93% of cases, and a complete composite biomarker index (CBI) calculated for 133 mothers (mean age = 42). As predicted, MLH had a significantly higher CBI than controls, but there was no CBI difference across ethnicity or intervention group. CBI predicted CD4 counts independently after controlling for age, years since diagnosis, prior CD4 counts, medication adherence, and depression symptoms. The study demonstrates acceptability, feasibility and potential utility of community-based biomarker collections in evaluating individual differences in psychosocial stress.
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Affiliation(s)
- Dorie A Glover
- Semel Institute, Child Division, Department of Psychiatry and Biobehavioral Sciences, University of California, 760 Westwood Blvd., Los Angeles, CA 90024, USA.
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Fitch KV, Guggina LM, Keough HM, Dolan Looby SE, Hadigan C, Anderson EJ, Hubbard J, Liebau JG, Johnsen S, Wei J, Makimura H, Stanley TL, Lo J, Grinspoon SK. Decreased respiratory quotient in relation to resting energy expenditure in HIV-infected and noninfected subjects. Metabolism 2009; 58:608-15. [PMID: 19375582 PMCID: PMC2691476 DOI: 10.1016/j.metabol.2008.12.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2008] [Accepted: 12/04/2008] [Indexed: 10/20/2022]
Abstract
The purpose of this study was to evaluate the relationship of respiratory quotient (RQ), a surrogate marker of substrate oxidation, as well as body composition and dietary intake to resting energy expenditure (REE) among HIV-infected patients in the current era of highly active antiretroviral therapy and among non-HIV-infected control subjects. Resting energy expenditure is increased in HIV-infected patients; but little is known regarding the potential contribution of altered substrate metabolism, body composition, and dietary intake to increased energy expenditure in this population. Respiratory quotient, REE, body composition, and dietary intake parameters were assessed in 283 HIV-infected patients and 146 community-derived HIV-negative controls who were evaluated for metabolic studies between 1998 and 2005. Respiratory quotient was lower (0.83 +/- 0.00 vs 0.85 +/- 0.01, P = .005), whereas REE adjusted for fat-free mass (FFM) was higher (31.8 +/- 0.3 vs 29.8 +/- 0.3 kcal/[d kg], P < or = .0001), in HIV-infected compared with control subjects. In multivariate modeling among HIV-infected patients, including age, sex, and parameters of immune function, FFM (beta = 24.811334, P < .0001), visceral adiposity (beta = .7182746, P = .008), and total body fat (beta = 8.0506839, P = .041) were positively associated with REE, whereas RQ was negatively associated with REE (beta = -528.4808, P = .024). Overall r(2) was equal to 0.705 and P was less than .0001 for the model. In control subjects, by contrast, only visceral adiposity (beta = 1.0612073, P = .004), total body fat (beta = 15.805547, P = .010), and FFM (beta = 22.613005, P < .0001) were significant predictors of REE; and there was no relationship with RQ. Overall r(2) was equal to 0.825 and P was less than .0001 for the model. These data suggest that alterations in substrate metabolism may contribute to increased REE in HIV-infected patients compared with control subjects.
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Affiliation(s)
- Kathleen V. Fitch
- Program in Nutritional Metabolism, Massachusetts General Hospital, Boston, Massachusetts
| | - Lauren M. Guggina
- Program in Nutritional Metabolism, Massachusetts General Hospital, Boston, Massachusetts
| | - Hester M. Keough
- Program in Nutritional Metabolism, Massachusetts General Hospital, Boston, Massachusetts
| | - Sara E. Dolan Looby
- Program in Nutritional Metabolism, Massachusetts General Hospital, Boston, Massachusetts
| | - Colleen Hadigan
- Program in Nutritional Metabolism, Massachusetts General Hospital, Boston, Massachusetts
- National Institute of Health, National Institute of Allergy and Infectious Disease, Bethesda, Maryland, USA
| | - Ellen J. Anderson
- General Clinical Research Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Jane Hubbard
- General Clinical Research Center, Massachusetts General Hospital, Boston, Massachusetts
| | - James G. Liebau
- Program in Nutritional Metabolism, Massachusetts General Hospital, Boston, Massachusetts
| | - Stine Johnsen
- Program in Nutritional Metabolism, Massachusetts General Hospital, Boston, Massachusetts
| | - Jeffery Wei
- Program in Nutritional Metabolism, Massachusetts General Hospital, Boston, Massachusetts
| | - Hideo Makimura
- Program in Nutritional Metabolism, Massachusetts General Hospital, Boston, Massachusetts
| | - Takara L. Stanley
- Program in Nutritional Metabolism, Massachusetts General Hospital, Boston, Massachusetts
| | - Janet Lo
- Program in Nutritional Metabolism, Massachusetts General Hospital, Boston, Massachusetts
| | - Steven K. Grinspoon
- Program in Nutritional Metabolism, Massachusetts General Hospital, Boston, Massachusetts
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