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Milewska-Buzun M, Cybulski M, Baranowska A, Kózka M, Paradowska-Stankiewicz I. Quality of Life in HIV-Positive People in Poland Treated in the City of Bialystok: A Cross-Sectional Study. J Clin Med 2023; 12:5593. [PMID: 37685659 PMCID: PMC10488938 DOI: 10.3390/jcm12175593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/23/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
The quality of life is one of the key factors in assessing the health status of HIV-positive individuals, with its improvement considered an important goal of treatment. Assessment of the quality of life helps accurately evaluate the impact of diseases and treatment on the patient's life. The aim of this study was to assess the quality of life of HIV-positive people in Poland using the example of patients treated in the Observation and Infection Clinic with the Subunit for HIV/AIDS Patients of the University Clinical Hospital in Bialystok, based on the evaluation of HIV-positive status acceptance in HIV patients as well as sociometric variables such as age, gender and marital status. A total of 147 patients participated in this study, including 104 men (70.7%) and 43 women (29.3%). This study was conducted between May 2019 and January 2020 in the Observation and Infection Clinic with the Subunit for HIV/AIDS Patients with the Consultation and Diagnostic Centre at the Teaching Hospital of the Medical University of Bialystok. This study used a diagnostic survey method with a modified questionnaire "Psychosocial Situation of People Living with HIV/AIDS in Poland" by Dr. Magdalena Ankiersztejn-Bartczak and the following standardised psychometric tools: the World Health Organization Quality of Life (WHOQOL-BREF), Short-Form Health Survey (SF-36), Acceptance of Illness Scale (AIS) and Satisfaction with Life Scale (SWLS). The majority of respondents (60%) reported no significant changes in their lives as a result of HIV infection. Gender was not a differentiating factor in the quality of life of people living with HIV. The variation in psychometric measures within the female and male groups was far greater than the difference between them. Marital status clearly differentiated the quality of life. The following conclusions were drawn from this study: The surveyed HIV patients presented a moderate level of quality of life, which was mainly determined by marital status. Higher quality of life was presented by married persons. Duration of infection was not correlated with quality of life. The level of acceptance of HIV infection was relatively high among respondents. A higher level of HIV acceptance was associated with a higher quality of life. The respondents presented a relatively poor level of satisfaction with life. Changing jobs, going on disability, relationship breakdown, not having a family of their own and losing friends were the key HIV-related changes in the lives of the respondents.
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Affiliation(s)
- Marta Milewska-Buzun
- Department of Integrated Medical Care, Faculty of Health Sciences, Medical University of Bialystok, 15-096 Bialystok, Poland; (M.C.); (A.B.)
| | - Mateusz Cybulski
- Department of Integrated Medical Care, Faculty of Health Sciences, Medical University of Bialystok, 15-096 Bialystok, Poland; (M.C.); (A.B.)
| | - Anna Baranowska
- Department of Integrated Medical Care, Faculty of Health Sciences, Medical University of Bialystok, 15-096 Bialystok, Poland; (M.C.); (A.B.)
| | - Maria Kózka
- Department of Clinical Nursing, Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University Medical College, 31-501 Krakow, Poland;
| | - Iwona Paradowska-Stankiewicz
- Department of Epidemiology and Surveillance of Infectious Diseases, National Institute of Public Health NIH—National Research Institute, 00-791 Warsaw, Poland;
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Mabweazara SZ, Manne-Goehler J, Bibangambah P, Kim JH, Ruth S, Hemphill LC, Okello S, Hamer M, Siedner MJ. Correlates of physical activity among people living with and without HIV in rural Uganda. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1093298. [PMID: 37547804 PMCID: PMC10398393 DOI: 10.3389/frph.2023.1093298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 06/07/2023] [Indexed: 08/08/2023] Open
Abstract
Background Antiretroviral therapy (ART) has led to diminishing AIDS-related mortality but a concomitant increase in non-communicable diseases (NCDs) for people with HIV (PWH). Whereas physical activity (PA) has been shown to help prevent NCDs and NCD outcomes in other settings, there are few data on PA and its correlates among PWH in high-endemic settings. We aimed to compare PA by HIV serostatus in rural Uganda. Methods We analysed data from the UGANDAC study, an observational cohort including PWH in ambulatory HIV care in Mbarara, Uganda, and age- and gender-matched people without HIV (PWOH). Our primary outcome of interest was PA, which we assessed using the International Physical Activity Questionnaire and considered as a continuous measure of metabolic equivalents in minutes/week (MET-min/week). Our primary exposure of interest was HIV serostatus. We fit univariable and multivariable linear regression models to estimate the relationship between HIV and PA levels, with and without addition of sociodemographic and clinical correlates of PA (MET-min/week). In secondary analyses, we explored relationships restricted to rural residents, and interactions between gender and serostatus. Results We enrolled 309 participants, evenly divided by serostatus and gender. The mean age of PWH was 52 [standard deviation (SD) 7.2] and 52.6 (SD 7.3) for PWOH. In general, participants engaged in high levels of PA regardless of serostatus, with 81.2% (251/309) meeting criteria for high PA. However, PWOH reported higher mean levels of PA met-minutes/week than PWH (9,128 vs 7,152, p ≤ 0.001), and a greater proportion of PWOH (88.3%; 136/154) met the criteria for high PA compared to PWH (74.2%; 115/155). In adjusted models, lower levels of PA persisted among PWH (β = -1,734, 95% CI: -2,645, -824, p ≤ 0.001). Results were similar in a sensitivity analysis limited to people living in rural areas. Conclusion In a rural Ugandan cohort, PWOH had higher levels of PA than PWH. Interventions that encourage PA among PWH may have a role in improving NCD risk profiles among PWH in the region.
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Affiliation(s)
- Smart Z. Mabweazara
- Clinical Research Department, Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Jennifer Manne-Goehler
- Department of Medicine, Harvard Medical School, Boston MA, United States
- Department of Medicine Brigham and Women's Hospital Boston, MA, United States
| | - Prossy Bibangambah
- Faculties of Medicine and Radiology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - June-Ho Kim
- Department of Medicine, Harvard Medical School, Boston MA, United States
- Ariadne Labs, Brigham and Women's Hospital, Boston, MA, United States
| | - Sentongo Ruth
- Faculties of Medicine and Radiology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Linda C. Hemphill
- Department of Medicine, Harvard Medical School, Boston MA, United States
| | - Samson Okello
- Faculties of Medicine and Radiology, Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, United States
| | - Mark Hamer
- Division of Surgery & Interventional Science, University College London, London, United Kingdom
| | - Mark J. Siedner
- Clinical Research Department, Africa Health Research Institute, KwaZulu-Natal, South Africa
- Department of Medicine, Harvard Medical School, Boston MA, United States
- Faculties of Medicine and Radiology, Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
- Faculty of Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
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Sivanandy P, Ng Yujie J, Chandirasekaran K, Hong Seng O, Azhari Wasi NA. Efficacy and Safety of Two-Drug Regimens That Are Approved from 2018 to 2022 for the Treatment of Human Immunodeficiency Virus (HIV) Disease and Its Opportunistic Infections. Microorganisms 2023; 11:1451. [PMID: 37374953 DOI: 10.3390/microorganisms11061451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/22/2023] [Accepted: 05/29/2023] [Indexed: 06/29/2023] Open
Abstract
The human immunodeficiency virus (HIV) is a type of virus that targets the body's immune cells. HIV infection can be divided into three phases: acute HIV infection, chronic HIV infection, and acquired immunodeficiency syndrome (AIDS). HIV-infected people are immunosuppressed and at risk of developing opportunistic infections such as pneumonia, tuberculosis, candidiasis, toxoplasmosis, and Salmonella infection. The two types of HIV are known as HIV-1 and HIV-2. HIV-1 is the predominant and more common cause of AIDS worldwide, with an estimated 38 million people living with HIV-1 while an estimated 1 to 2 million people live with HIV-2. No effective cures are currently available for HIV infection. Current treatments emphasise the drug's safety and tolerability, as lifelong management is needed to manage HIV infection. The goal of this review is to study the efficacy and safety of newly approved drugs from 2018 to 2022 for the treatment of HIV by the United States Food and Drug Administration (US-FDA). The drugs included Cabotegravir and Rilpivirine, Fostemsavir, Doravirine, and Ibalizumab. From the review, switching to doravirine/lamivudine/tenofovir disoproxil fumarate (DOR/3TC/TDF) was shown to be noninferior to the continuation of the previous regimen, efavirenz/emtricitabine/tenofovir disoproxil fumarate (EFV/FTC/TDF) in virologically suppressed adults with HIV-1. However, DOR/3TC/TDF had shown a preferable safety profile with lower discontinuations due to adverse events (AEs), lower neuropsychiatric AEs, and a preferable lipid profile. Ibalizumab was also safe, well tolerated, and had been proven effective against multiple drug-resistant strains of viruses.
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Affiliation(s)
- Palanisamy Sivanandy
- Department of Pharmacy Practice, School of Pharmacy, International Medical University, Kuala Lumpur 57000, Malaysia
| | - Jess Ng Yujie
- School of Pharmacy, International Medical University, Kuala Lumpur 57000, Malaysia
| | | | - Ooi Hong Seng
- School of Pharmacy, International Medical University, Kuala Lumpur 57000, Malaysia
| | - Nur Azrida Azhari Wasi
- Department of Pharmacy, University of Malaya Medical Centre, Kuala Lumpur 59100, Malaysia
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Inflammatory and Cardiovascular Correlates of Physical Activity and Sedentary Behavior in Older Adults Living With HIV. J Phys Act Health 2023; 20:149-156. [PMID: 36640774 DOI: 10.1123/jpah.2022-0304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 10/07/2022] [Accepted: 11/11/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Inflammation is an indicator of oxidative stress that may contribute to cardiovascular diseases in older people living with HIV (OPWH). Physical activity (PA) may reduce these biomarkers in OPWH, but little is known about the association of PA with inflammatory and cardiovascular biomarkers. We sought to examine the inflammatory and cardiovascular biomarker correlates of PA and sedentary behavior in OPWH. METHODS We included 101 OPWH with complete assessments of PA, sedentary behavior, and biomarker data to examine the association between the volume of PA and inflammatory and cardiovascular biomarkers. RESULTS In this cohort of OPWH (mean age 55.9 y), 68% were male and 83% were African American/Black. Among OPWH, greater volume of PA (ie, walking, moderate, vigorous, and/or total) was associated with lower systolic (P < .05) and diastolic blood pressure (P < .05), pulse pressure (P < .05), and tumor necrosis factor-alpha (P < .05). Greater duration of sitting was associated with greater triglycerides, interleukin-6, and tumor necrosis factor-alpha (P < .05). CONCLUSIONS Although adherence to regular PA among OPWH is low and sedentary behavior is high, the associations between biomarkers and PA suggest a greater volume of PA could attenuate the inflammatory and cardiovascular derangements experienced by OPWH.
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Role of Environment on Physical Activity Patterns of Older Adults Living With HIV in New York City. J Assoc Nurses AIDS Care 2023; 34:31-44. [PMID: 35622464 DOI: 10.1097/jnc.0000000000000340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
ABSTRACT The purpose of this study was to survey the physical activity (PA) patterns of older adults with HIV and investigate the relationship between environmental factors and PA in this population. This study was a secondary data analysis from 100 adults, ages 50 years and older, living with HIV in New York City. Descriptive statistics assessed PA patterns. Linear regression assessed the association between environmental factors and time spent in PA. All participants had been living with HIV for 21 years on average, were on antiretroviral therapy, ranged in age from 50 to 71 years, and were 50% female. Participants performed at 75% of their functional capacity ( p < .0001), and females walked less than males ( p < .05). Traffic hazards were the sole environmental predictor of PA participation. Targeted interventions are needed to increase PA in this growing population. Interventions at the policy level should reduce traffic hazards to support PA.
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Dos Santos ECM, de Lima LRA, Yoong S, Guerra PH, Segurado AC. Home-based interventions to promote physical activity for people living with HIV - a systematic review. AIDS Care 2023; 35:25-34. [PMID: 35735412 DOI: 10.1080/09540121.2022.2091102] [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: 10/17/2022]
Abstract
Although physical activity (PA) improves the physical, mental, and social outcomes of people living with HIV (PLH), multiple barriers prevent them from exercising. In this systematic review, we investigated the effect of home-based interventions to promote physical activity (HBI) among PLH. Randomised trials and quasi-experimental studies published in English until March 2020 were sought in five databases. Independent reviewers performed data extraction, risk of bias assessment and pragmatic-explanatory (PRECIS-2) evaluation of study characteristics. Outcomes included engagement in PA, body composition, cardiorespiratory fitness, strength, metabolic disturbances, and quality of life (QoL). Out of 480 retrieved references, six studies met inclusion criteria. Interventions lasted 12-48 weeks and involved 400 individuals (57.8% women). Ninety-eight (24.5%) participants completed interventions, but dropout rates varied considerably (5.0-54.5%). Resulted showed increased PA (two studies) and improved cardiorespiratory fitness or strength (three and two studies, respectively). Four studies demonstrated reduction of waist circumference and increase in lean body mass. QoL improved in two of three studies. We conclude HBI (aerobic and/or resistance exercises) may contribute to improve PA and/or cardiorespiratory fitness, body composition, strength and QoL of PLH. Further investigation using multi-centre standardised protocols is warranted to provide stronger evidence of their effectiveness in health promotion for PLH.
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Affiliation(s)
| | | | - Serene Yoong
- Faculty of Health, Art and Design, Swinburne University of Technology, Hawthorn, Australia
| | | | - Aluisio Cotrim Segurado
- Department/Division of Infectious Diseases (LIM-49), Faculdade de Medicina, Hospital das Clinicas, Universidade de São Paulo, São Paulo, Brazil
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Aminde JA, Harris N, Thng C, Desbrow B. Effectiveness of self-managed home and community exercise interventions in improving physical activity, body adiposity and related health indices in adults living with HIV: a protocol for a systematic review. Syst Rev 2022; 11:37. [PMID: 35241154 PMCID: PMC8895643 DOI: 10.1186/s13643-022-01908-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 02/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Disorders of adipose tissue distribution in people living with the human immunodeficiency virus (HIV) have been associated with significant metabolic derangements that increase their risk of cardiometabolic and other chronic diseases. Systematic reviews focusing on supervised laboratory-based exercise interventions demonstrate that these interventions improve adipose tissue distribution and related health outcomes in people living with HIV (PLWH). However, there is a need to examine the effectiveness of more pragmatic home or community exercise programmes. The aim of this review will be to synthesize existing evidence on the effectiveness of self-managed home or community exercise interventions to improve physical activity levels, adipose tissue distribution and associated health indices in PLWH. METHODS This review will encompass interventional studies that evaluate the effect of prescribed exercise programmes performed in the home or community with minimal supervision, by adults living with HIV. The following will be searched from inception: PubMed, Embase, Scopus, Cumulative Index to Nursing and Allied Health Literature, Physiotherapy Evidence Database, SPORTDiscus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and Clinicaltrials.gov. Screening of studies and data extraction will be conducted by two independent reviewers. The risk of bias in included studies will be assessed using version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2) and the Risk of Bias In Non-Randomized Studies-of Interventions (ROBINS-I) tool for non-randomized concurrently controlled and single-arm interventional studies. A random effects meta-analysis will be used to pool effect estimates for outcomes of interest (measures of physical activity and body adiposity). However, if pooling is deemed inappropriate due to substantial differences between studies, a narrative synthesis will be performed. This protocol is written according to the Preferred Reporting Items for Systematic reviews and Meta-analysis Protocols 2015 statement (see Additional file 1). DISCUSSION This review shall provide evidence to support or disapprove the prescription of self-managed exercise interventions in a particularly vulnerable population. We will equally explore the potential impact of technology in improving physical activity outcomes. Our findings could help guide clinicians involved in the care of PLWH in prescribing exercise and inform the design of future trials and research. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021223357 .
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Affiliation(s)
- Jeannine Anyingu Aminde
- School of Health Sciences and Social Work (SHS), Griffith University, Gold Coast, Queensland, 4222, Australia.
| | - Neil Harris
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Caroline Thng
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Ben Desbrow
- School of Health Sciences and Social Work (SHS), Griffith University, Gold Coast, Queensland, 4222, Australia
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8
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Ramos SR, O’Hare OM, Colon AH, Jacobs SK, Campbell B, Kershaw T, Vorderstrasse A, Reynolds HR. Purely Behavioral: A Scoping Review of Nonpharmacological Behavioral and Lifestyle Interventions to Prevent Cardiovascular Disease in Persons Living With HIV. J Assoc Nurses AIDS Care 2021; 32:536-547. [PMID: 33481464 PMCID: PMC8289919 DOI: 10.1097/jnc.0000000000000230] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Cardiovascular disease (CVD) is the leading cause of death in the United States, accounting for 900,000 deaths annually. People living with HIV are at a higher risk of developing CVD. We conducted a scoping review guided by the Joanna Briggs Institute Manual for Evidence Synthesis. In July 2020, six databases were searched: PubMed, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Web of Science, Embase, and The Cochrane Central Register of Controlled Trials, as well as reference lists of relevant studies and key journals. Our review identified 18 studies that addressed nonpharmacological behavioral interventions into the following: physical activity (n = 6), weight loss (n = 2), dietary interventions (n = 1), and multicomponent interventions (n = 9). In the past 10 years, there has been an increased emphasis on nonpharmacological behavioral approaches, including the incorporation of multicomponent interventions, to reduce cardiovascular risk in people living with HIV. The extant literature is limited by underrepresentation of geographic regions and populations that disproportionately experience CVD.
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Affiliation(s)
- S. Raquel Ramos
- Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - Olivia M. O’Hare
- Rory Meyers College of Nursing, New York University, New York, New York, USA
| | | | - Susan Kaplan Jacobs
- Health Sciences Librarian/Curator, New York University, New York, New York, USA
| | - Brynne Campbell
- Health Sciences Reference Associate, New York University, New York, New York, USA
| | - Trace Kershaw
- Department of Social and Behavioral Sciences, and Director, P30 Center for Interdisciplinary Research on AIDS and R25 REIDS HIV Training Programs, School of Public Health, Yale, University, New Haven, Connecticut, USA
| | | | - Harmony R. Reynolds
- Sarah Ross, Soter Center for Women’s Cardiovascular Research, Leon H. Charney Division of Cardiology, and Associate Professor, Department of Medicine, NYU School of Medicine, NYU LangoneHealth, New York, New York, USA
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9
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Abstract
PURPOSE OF REVIEW Systemic inflammation increases as a consequence of aging (inflammaging) and contributes to age-related morbidities. Inflammation in people living with HIV is elevated compared with the general population even after prolonged suppression of viremia with anti-retroviral therapy. Mechanisms that contribute to inflammation during aging and in treated HIV disease are potentially interactive, leading to an exaggerated inflammatory phenotype in people with HIV. RECENT FINDINGS Recent studies highlight roles for anti-retroviral therapy, co-infections, immune system alterations, and microbiome perturbations as important contributors to HIV-associated inflammation. These factors likely contribute to increased risk of age-related morbidities in people living with HIV. Understanding mechanisms that exaggerate the inflammaging process in people with HIV may lead to improved intervention strategies, ultimately, extending both lifespan and healthspan.
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10
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Choi H, Dey AK, Sharma G, Bhoite R, Burkholder G, Fedson S, Jneid H. Etiology and pathophysiology of heart failure in people with HIV. Heart Fail Rev 2021; 26:497-505. [PMID: 33619685 DOI: 10.1007/s10741-020-10048-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2020] [Indexed: 11/25/2022]
Abstract
HIV-associated cardiomyopathy is a well-established sequela in people infected with HIV (PHIV). Despite significant advances in HIV management through the use of highly active anti-retroviral therapy (HAART), PHIV on HAART continue to have elevated risk of cardiomyopathy and heart failure, even when accounting for known cardiovascular risk factors. This review article will explore the proposed mechanisms by which chronic HIV infection induces cardiomyopathy and heart failure in the setting of HAART. Evaluation, work-up, and management of cardiomyopathy in PHIV will also be briefly discussed. The advent of HAART has altered the pathophysiology HIV-associated cardiomyopathy from a rapidly progressive cardiomyopathy, often with pericardial involvement, into a chronic process involving inflammation and persistent immune dysregulation. With the significant decrease in AIDS-related deaths, the prevalence of cardiomyopathy and the mortality associated with heart failure in PHIV have increased. Multiple immune-related and inflammatory mechanisms have been proposed, which may provide insight into evaluation and management of cardiomyopathy in PHIV.
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Affiliation(s)
- Harry Choi
- Section of Inflammation and Cardiometabolic Diseases, National Institute of Health, Bethesda, MD, USA
| | - Amit K Dey
- Section of Inflammation and Cardiometabolic Diseases, National Institute of Health, Bethesda, MD, USA
| | - Gaurav Sharma
- Division of Medicine, University of South Alabama, Mobile, AL, USA
| | - Rahul Bhoite
- Division of Medicine, MedStar Union Memorial Hospital and Good Samaritan Hospital, Baltimore, MD, USA
| | - Greer Burkholder
- Division of Infectious Diseases, University of Alabama, Birmingham, AL, USA
| | - Savitri Fedson
- Section of Cardiology, Baylor College of Medicine and the Michael E. DeBakey VA Hospital, Houston, TX, 77030, USA
| | - Hani Jneid
- Section of Cardiology, Baylor College of Medicine and the Michael E. DeBakey VA Hospital, Houston, TX, 77030, USA.
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11
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Testa C, DI Lorenzo A, Parlato A, D'Ambrosio G, Merolla A, Pacileo M, Iannuzzo G, Gentile M, Nugara C, Sarullo FM, DE Gregorio C, D'Andrea A, Vigorito C, Venturini E, Giallauria F. Exercise for slowing the progression of atherosclerotic process: effects on inflammatory markers. Panminerva Med 2021; 63:122-132. [PMID: 33565757 DOI: 10.23736/s0031-0808.21.04266-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Atherosclerosis is a dynamic process driven by all cardiovascular risk factors that can be briefly divided into an early and a late phase. Inflammation is one of the fundamental substrates that initiates the atherosclerotic process in the early stages and promotes and maintains it in the final stages. In the last decades, clinical and experimental data have shown that inflammation is supported by mediators that respond to physical activity. The present review aimed at investigating the effect of physical exercise on inflammatory mediators, both the positive ones that have a proinflammatory effect (interleukin 6, c-reactive protein and tumor necrosis factor α, interferon γ, high-mobility group box-1), and the negative ones which have an anti-inflammatory effect (interleukin 10). Pooled data support the evidence that physical exercise can directly modulate the activity of inflammatory cytokines slowing down or preventing the formation of the atherosclerotic stage.
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Affiliation(s)
- Crescenzo Testa
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Anna DI Lorenzo
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Alessandro Parlato
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Giuseppe D'Ambrosio
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Aurora Merolla
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Mario Pacileo
- Unit of Cardiology and Intensive Care, "Umberto I" Hospital, Nocera Inferiore, Salerno, Italy
| | - Gabriella Iannuzzo
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Marco Gentile
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Cinzia Nugara
- Unit of Cardiovascular Rehabilitation, Buccheri La Ferla Fatebenefratelli Hospital, Palermo, Italy
| | - Filippo M Sarullo
- Unit of Cardiovascular Rehabilitation, Buccheri La Ferla Fatebenefratelli Hospital, Palermo, Italy
| | - Cesare DE Gregorio
- Unit of Cardiology, Department of Clinical and Experimental Medicine, University Hospital of Messina, Messina, Italy.,Post-graduate Residency School in Cardiovascular Diseases, Department of Clinical and Experimental Medicine, University Hospital of Messina, Messina, Italy
| | - Antonello D'Andrea
- Unit of Cardiology and Intensive Care, "Umberto I" Hospital, Nocera Inferiore, Salerno, Italy
| | - Carlo Vigorito
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Elio Venturini
- Cardiac Rehabilitation Unit, AUSL Toscana Nord-Ovest, Cecina Civil Hospital, Cecina, Livorno, Italy
| | - Francesco Giallauria
- Department of Translational Medical Sciences, Federico II University, Naples, Italy - .,Faculty of Sciences and Technology, University of New England, Armidale, Australia
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Abstract
Approximately 30-50% of persons living with HIV manifest some degree of neurocognitive impairment. Even mild-to-moderate forms of HIV-associated neurocognitive disorders (HAND) can result in difficulties with everyday functioning, such as suboptimal medication adherence and impaired driving. Despite the pervasive presence and consequences of HAND, there is a significant unmet need to develop effective behavioral strategies to reduce the incidence and consequences of HAND. Although there is an absence of evidence-based behavioral interventions specific to HAND, the literature reviewed in this chapter suggest the following modifiable lifestyle factors as intervention targets: physical activity, diet, sleep, and antiretroviral medication adherence. Adoption and maintenance of these healthy lifestyle factors may reduce inflammation and oxidative stress, which, in turn, may reduce the incidence and/or severity of HAND.
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Affiliation(s)
- Jessica L Montoya
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Brook Henry
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - David J Moore
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.
- HIV Neurobehavioral Research Program, San Diego, CA, USA.
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13
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Pencina KM, Li Z, Montano M. Objectively Measured Physical Activity in Asymptomatic Middle-Aged Men Is Associated With Routine Blood-Based Biomarkers. J Gerontol A Biol Sci Med Sci 2020; 74:S32-S37. [PMID: 31724056 DOI: 10.1093/gerona/glz151] [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] [Received: 02/15/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The use of circulating clinically routine biomarkers and volitional physical activity using wristband accelerometry in preclinical middle-aged adults may provide sensitive measures of physical function and predict sooner the onset of age- and HIV-related physical decline. METHODS Nested cross-sectional cohort study of adult men 50-65 years old with HIV infection on potent antiretroviral therapy and uninfected control participants within the Boston metropolitan area. Gait speed derived from wristband accelerometry, gait speed derived from a standardized 6-minute walk test, cellular immune biomarker levels (CD4 T cell, CD8 T cell), and serum anabolic biomarker levels (total and free testosterone, and sex-hormone-binding globulin) were measured. RESULTS Of the five measured biomarkers, four were significantly associated with volitional gait speed based on accelerometry, whereas only one was associated with gait speed based on the 6-minute walk test collected in a laboratory environment. CONCLUSION Levels of selected immune and anabolic biomarkers were associated with volitional physical activity in middle-aged individuals. Digital and circulating biomarkers may be useful in future studies designed to identify presymptomatic individuals at increased risk for age- and HIV-associated functional decline.
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Affiliation(s)
- Karol M Pencina
- Harvard Medical School, Boston, Massachusetts.,Brigham and Women's Hospital, Boston, Massachusetts
| | - Zhuoying Li
- Brigham and Women's Hospital, Boston, Massachusetts
| | - Monty Montano
- Harvard Medical School, Boston, Massachusetts.,Brigham and Women's Hospital, Boston, Massachusetts
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14
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Stabell AC, Wilson M, Jankowski CM, MaWhinney S, Erlandson KM. The Impact of a Structured, Supervised Exercise Program on Daily Step Count in Sedentary Older Adults With and Without HIV. J Acquir Immune Defic Syndr 2020; 84:228-233. [PMID: 32084050 PMCID: PMC7228846 DOI: 10.1097/qai.0000000000002326] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND People with HIV (PWH) may have lower daily activity levels compared with persons without HIV. We sought to determine the impact of initiating a supervised exercise program on the daily step count of sedentary PWH and uninfected controls. METHODS PWH and controls, aged 50-75, were enrolled in a 24-week supervised exercise program. All individuals were given a pedometer and instructed in regular use. A linear mixed model taking into account random effects was used to model daily step count. RESULTS Of 69 participants that began the study, 55 completed and 38 (21 PWH, 17 controls) had complete pedometer data. Baseline daily step count on nonsupervised exercise day was (estimated geometric mean, 95% confidence interval) 3543 (1306 to 9099) for PWH and 4182 (1632 to 10,187) for controls. Both groups increased daily steps on supervised [43% (20 to 69)%, P < 0.001] but not unsupervised exercise days [-12% (-24 to 1)%, P = 0.071]. Compared with controls, PWH had 26% [(-47 to 4)%, P = 0.08] fewer daily steps on days with supervised exercise and 35% [-53 to -10)%, P = 0.011] fewer daily steps on days without supervised exercise. Higher body mass index (per 1 unit) and smoking were associated with fewer daily steps [-5% (-9 to -1)%; -49% (-67 to -23)%; P ≤ 0.012]. Days with precipitation [-8% (-13 to -3)%, P = 0.002] or below freezing [-10% [-15 to -4)%, P < 0.001] were associated with fewer steps. CONCLUSION Supervised exercise increased daily step counts in sedentary individuals, but at the expense of fewer steps on nonsupervised exercise days.
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Affiliation(s)
- Alex C. Stabell
- University of Colorado, School of Medicine, Aurora, CO
- New York Presbyterian Hospital-Columbia University, New York, NY (current position)
| | - Melissa Wilson
- University of Colorado, School of Public Health, Department of Biostatistics and Informatics, Aurora, CO
| | | | - Samantha MaWhinney
- University of Colorado, School of Public Health, Department of Biostatistics and Informatics, Aurora, CO
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15
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Effect of Structured Physical Activity on Inflammation and Immune Activation Profile of Antiretroviral Therapy-Experienced Children Living With HIV. Pediatr Exerc Sci 2020; 32:73-80. [PMID: 31881531 DOI: 10.1123/pes.2019-0126] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 10/07/2019] [Accepted: 10/14/2019] [Indexed: 11/18/2022]
Abstract
AIM To compare the markers of inflammation and immune activation in virally suppressed HIV-infected children on antiretroviral therapy, who practiced regular structured exercise comprising running and yoga to those who did not over a 2-year period. METHODS This retrospective cohort study included 72 children aged 8 to 16 years divided into 2 groups, exercisers (n = 36) and the nonexercisers (n = 36) based on their intentional physical activity. The analyses were carried out at baseline and after 2 years (Y2) for the soluble biomarkers of inflammation and immune activation (tumor necrosis factor alpha, interleukin-6, interleukin-10, interferon gamma, sCD14, and sCD163). In addition, cell-associated biomarker (CD38), lipopolysaccharides, and the gene expression of interleukin-2 and brain-derived neurotrophic factor were also measured at Y2. RESULTS Reduction in levels of sCD14 (effect size [ES], -0.6; 95% confidence interval [CI], -1.08 to -0.14), tumor necrosis factor alpha (ES, -0.7; 95% CI, -1.18 to -0.23), interferon gamma (ES, -0.7; 95% CI, -1.17 to -0.22), and interleukin-10 (ES, -0.6; 95% CI, -1.08 to -0.14) was observed among exercisers as compared with nonexercisers at Y2. In addition, CD38+ expressing CD4+ T cells were found to be lower among exercisers (P = .01) at Y2. However, the differences in levels of interleukin-6, sCD163, lipopolysaccharides, interleukin-2, and brain-derived neurotrophic factor were not significantly different among the 2 groups. CONCLUSION The study result suggests that regular structured physical activity improves the inflammatory profile of antiretroviral therapy-treated HIV-infected children.
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16
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COMT Val158Met Polymorphism, Cardiometabolic Risk, and Nadir CD4 Synergistically Increase Risk of Neurocognitive Impairment in Men Living With HIV. J Acquir Immune Defic Syndr 2020; 81:e148-e157. [PMID: 31107306 DOI: 10.1097/qai.0000000000002083] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The Val allele of the Val158Met single-nucleotide polymorphism of the catechol-o-methyltransferase gene (COMT) results in faster metabolism and reduced bioavailability of dopamine (DA). Among persons living with HIV, Val carriers display neurocognitive deficits relative to Met carriers, presumably due to exacerbation of HIV-related depletion of DA. COMT may also impact neurocognition by modulating cardiometabolic function, which is often dysregulated among persons living with HIV. We examined the interaction of COMT, cardiometabolic risk, and nadir CD4 on neurocognitive impairment (NCI) among HIV+ men. METHODS Three hundred twenty-nine HIV+ men underwent COMT genotyping and neurocognitive and neuromedical assessments. Cohort-standardized z scores for body mass index, systolic blood pressure, glucose, triglycerides, and high-density lipoprotein cholesterol were averaged to derive a cardiometabolic risk score (CMRS). NCI was defined as demographically adjusted global deficit score of ≥0.5. Logistic regression modeled NCI as a function of COMT, CMRS, and their interaction, covarying for estimated premorbid function, race/ethnicity, and HIV-specific characteristics. Follow-up analysis included the 3-way interaction of COMT, CMRS, and nadir CD4. RESULTS Genotypes were 81 (24.6%) Met/Met, 147 (44.7%) Val/Met, and 101 (30.7%) Val/Val. COMT interacted with CMRS (P = 0.02) such that higher CMRS increased risk of NCI among Val/Val [odds ratio (OR) = 2.13, P < 0.01], but not Val/Met (OR = 0.93, P > 0.05) or Met/Met (OR = 0.92, P > 0.05) carriers. Among Val/Val, nadir CD4 moderated the effect of CMRS (P < 0.01) such that higher CMRS increased likelihood of NCI only when nadir CD4 <180. DISCUSSION Results suggest a tripartite model by which genetically driven low DA reserve, cardiometabolic dysfunction, and historical immunosuppression synergistically enhance risk of NCI among HIV+ men, possibly due to neuroinflammation and oxidative stress.
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17
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Jeremiah K, Filteau S, Faurholt-Jepsen D, Kitilya B, Kavishe BB, Krogh-Madsen R, Olsen MF, Changalucha J, Rehman AM, Range N, Kamwela J, Ramaiya K, Andersen AB, Friis H, Heimburger DC, PrayGod G. Diabetes prevalence by HbA1c and oral glucose tolerance test among HIV-infected and uninfected Tanzanian adults. PLoS One 2020; 15:e0230723. [PMID: 32267855 PMCID: PMC7141607 DOI: 10.1371/journal.pone.0230723] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 03/06/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The burden of diabetes is increasing in sub-Saharan Africa, including among people living with HIV. We assessed the prevalence of diabetes and the roles of HIV, antiretroviral therapy (ART) and traditional risk factors among adults in Tanzania. METHODS We analysed diabetes-relevant baseline data from 1,947 adult participants in the CICADA study in Mwanza, Tanzania: 655 HIV-uninfected, 956 HIV-infected ART-naïve, and 336 HIV-infected persons on ART. WHO guidelines for haemoglobin A1c (HbA1c) and oral glucose tolerance test (OGTT) were used to define diabetes and prediabetes. Risk factors were evaluated using multinomial logistic regression analysis. Relative risk ratios (RRR) were generated comparing participants with diabetes and prediabetes against the reference of those with no diabetes. RESULTS Mean age was 41 (SD 12) years; 59% were women. The prevalence of diabetes was 13% by HbA1c and 6% by OGTT, with partial overlap among participants identified by the two tests. Relative to HIV-uninfected, HIV-infected ART-naïve persons had increased relative risks of diabetes (HbA1c: RRR = 1.95, 95% CI 1.25-3.03; OGTT: RRR = 1.90, 95% CI 0.96-3.73) and prediabetes (HbA1c: RRR = 2.89, 95% CI 1.93-4.34; OGTT: RRR = 1.61, 95% CI 1.22-2.13). HIV-infected participants on ART showed increased risk of prediabetes (RRR 1.80, 95% CI 1.09, 2.94) by HbA1c, but not diabetes. CD4 count < 200 cell/μL at recruitment increased risk and physical activity decreased risk of diabetes by both HbA1c and OGTT. CONCLUSIONS The prevalence of diabetes was high, especially among HIV-infected ART-naïve adults. Being more physically active was associated with lower risk of diabetes. HbA1c and OGTT identified different participants as having diabetes or prediabetes. Overall, the finding of high burden of diabetes among HIV-infected persons suggests that health systems should consider integrating diabetes screening and treatment in HIV clinics to optimize the care of HIV patients and improve their health outcomes.
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Affiliation(s)
- Kidola Jeremiah
- Mwanza Research Centre, National Institute for Medical Research, Mwanza, Tanzania
| | - Suzanne Filteau
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Brenda Kitilya
- Mwanza Research Centre, National Institute for Medical Research, Mwanza, Tanzania
| | - Bazil B. Kavishe
- Mwanza Research Centre, National Institute for Medical Research, Mwanza, Tanzania
| | - Rikke Krogh-Madsen
- Centre of Inflammation and Metabolism and Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Mette F. Olsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - John Changalucha
- Mwanza Research Centre, National Institute for Medical Research, Mwanza, Tanzania
| | - Andrea M. Rehman
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Nyagosya Range
- Muhimbili Medical Research Centre, National Institute for Medical Research, Dar es Salaam, Tanzania
| | | | | | - Aase B. Andersen
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Douglas C. Heimburger
- Vanderbilt Institute for Global Health and Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - George PrayGod
- Mwanza Research Centre, National Institute for Medical Research, Mwanza, Tanzania
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18
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Ceccarelli G, Pinacchio C, Santinelli L, Adami PE, Borrazzo C, Cavallari EN, Vullo A, Innocenti GP, Mezzaroma I, Mastroianni CM, d’Ettorre G. Physical Activity and HIV: Effects on Fitness Status, Metabolism, Inflammation and Immune-Activation. AIDS Behav 2020; 24:1042-1050. [PMID: 31016505 DOI: 10.1007/s10461-019-02510-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Several studies evidenced that a sedentary lifestyle is related with higher levels of systemic inflammation and highlighted that physical activity can trigger anti-inflammatory effects. To evaluate the impact of self-prescribed physical activity on fitness status, metabolism, inflammation and immune-activation in people living with HIV, an interim analysis of the results of the clinical trial PRIMO (NCT03392805) was performed. Patients enrolled were divided in 2 groups on the basis of self-prescribed physical activity: a physically active group (self-prescribed physical activity) and a sedentary group. Physical fitness was evaluated by sport medicine specialists and related to nutritional status, anthropometric variables, adipokines levels (adiponectin, leptin, resistin), peripheral immune-activation (CD38, HLA-DR on CD4 and CD8), and plasma inflammatory markers (IL-6 and TNF-α). The physically active group had a better profile in anthropometric measures and aerobic fitness but did not show lower levels of immune-activation compared to sedentary group. Also serum IL-6, TNF-α, and adipokines levels showed no statistical differences. On the basis of these data, a regular self-organized physical activity seems useful to improve cardio-respiratory fitness, but unable to control HIV-related immune-activation.
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19
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Santinelli L, Ceccarelli G, Borrazzo C, Celani L, Pavone P, Innocenti GP, Spagnolello O, Fimiani C, Ceci F, Di Sora F, Mezzaroma I, Mastroianni CM, d'Ettorre G. Real word outcomes associated with use of raltegravir in older people living with HIV: results from the 60 months follow-up of the RAL-age cohort. Expert Rev Anti Infect Ther 2020; 18:485-492. [PMID: 32096433 DOI: 10.1080/14787210.2020.1733415] [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: 01/01/2023]
Abstract
Objective: In people living with HIV (PLWH), antiretroviral treatments have increased the median life expectancy. Raltegravir (RAL) represents a long-term safe regimen used both in the first-line antiretroviral treatments and in the optimization strategies. Aim of the study was to evaluate the real-life efficacy, tolerability, and safety of the long-term RAL use in a multicenter cohort of elderly PLWH.Methods: A 60-month follow-up observational study was carried out in the RAL-AGE Cohort including aged PLWH (≥60 years old) treated with RAL-based regimens (n = 96). The control group was a cohort of PLWH aged less than 60 years (n = 50).Results: RAL treated aged HIV population experiences an increase of CD4+ cells and a stable control of viral load at 60 months of follow-up. A significant improvement in lipid metabolism profile, a decrease of platelet count and a reduction in cardiovascular risk levels were observed in the older population. Immune activation markers expressed on CD4+ T cells decreased compared to baseline, but this difference was greater in the control group.Conclusion: A 60-month treatment with RAL-containing regimens is safe and highly effective in the older PLWH and these data give new insights on the elderly population.Clinical trial registration: NCT02765776 and NCT03579485.
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Affiliation(s)
- Letizia Santinelli
- Department of Public Health and Infectious Diseases, University of Rome "Sapienza", Rome, Italy
| | - Giancarlo Ceccarelli
- Department of Public Health and Infectious Diseases, University of Rome "Sapienza", Rome, Italy.,Infectious Diseases Clinic, Azienda Policlinico Umberto I, Rome, Italy
| | - Cristian Borrazzo
- Department of Public Health and Infectious Diseases, University of Rome "Sapienza", Rome, Italy
| | - Luigi Celani
- Department of Public Health and Infectious Diseases, University of Rome "Sapienza", Rome, Italy
| | - Paolo Pavone
- Department of Public Health and Infectious Diseases, University of Rome "Sapienza", Rome, Italy
| | | | - Ornella Spagnolello
- Department of Public Health and Infectious Diseases, University of Rome "Sapienza", Rome, Italy.,Infectious Diseases Clinic, Azienda Policlinico Umberto I, Rome, Italy.,Emergency Department, Royal Infirmary of Edinburgh, EMERGE - Emergency Medicine Research Group Edinburgh, Edinburgh, UK
| | - Caterina Fimiani
- Department of Public Health and Infectious Diseases, University of Rome "Sapienza", Rome, Italy
| | - Fabrizio Ceci
- Department of Experimental Medicine, University of Rome "Sapienza", Rome, Italy
| | - Fiorella Di Sora
- Emergency Department, Royal Infirmary of Edinburgh, EMERGE - Emergency Medicine Research Group Edinburgh, Edinburgh, UK.,Unit of Clinical Immunology, Azienda Ospedaliera San Giovanni-Addolorata, Rome, Italy
| | - Ivano Mezzaroma
- Department of Translational and Precision Medicine, University of Rome "Sapienza", Rome, Italy
| | | | - Gabriella d'Ettorre
- Department of Public Health and Infectious Diseases, University of Rome "Sapienza", Rome, Italy
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20
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Nguyen I, Kim AS, Chow FC. Prevention of stroke in people living with HIV. Prog Cardiovasc Dis 2020; 63:160-169. [PMID: 32014514 DOI: 10.1016/j.pcad.2020.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 01/29/2020] [Indexed: 12/13/2022]
Abstract
In the era of effective antiretroviral therapy (ART), HIV has become a manageable disease marked by an elevated risk of non-AIDS-related comorbidities, including stroke. Rates of stroke are higher in people living with HIV (PLWH) compared with the general population. Elevated stroke risk may be attributable to traditional risk factors, HIV-associated chronic inflammation and immune dysregulation, and possible adverse effects of long-standing ART use. Tailoring stroke prevention strategies for PLWH requires knowledge of how stroke pathogenesis may differ from non-HIV-associated stroke, knowledge of long-term stroke outcomes in HIV, and accurate stroke risk assessment tools. As a result, the approach to primary and secondary stroke prevention in PLWH relies heavily on guidelines developed for the general population, with an emphasis on optimization of traditional vascular risk factors and early initiation of ART. This review summarizes existing evidence on HIV-associated stroke mechanisms and considerations for stroke prevention for PLWH.
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Affiliation(s)
- Ivy Nguyen
- Department of Neurology, University of California, San Francisco, CA, United States of America
| | - Anthony S Kim
- Department of Neurology, University of California, San Francisco, CA, United States of America
| | - Felicia C Chow
- Department of Neurology, University of California, San Francisco, CA, United States of America; Department of Medicine, Division of Infectious Diseases, University of California San Francisco, CA, United States of America.
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21
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Feinstein MJ, Hsue PY, Benjamin LA, Bloomfield GS, Currier JS, Freiberg MS, Grinspoon SK, Levin J, Longenecker CT, Post WS. Characteristics, Prevention, and Management of Cardiovascular Disease in People Living With HIV: A Scientific Statement From the American Heart Association. Circulation 2019; 140:e98-e124. [PMID: 31154814 DOI: 10.1161/cir.0000000000000695] [Citation(s) in RCA: 373] [Impact Index Per Article: 74.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
As early and effective antiretroviral therapy has become more widespread, HIV has transitioned from a progressive, fatal disease to a chronic, manageable disease marked by elevated risk of chronic comorbid diseases, including cardiovascular diseases (CVDs). Rates of myocardial infarction, heart failure, stroke, and other CVD manifestations, including pulmonary hypertension and sudden cardiac death, are significantly higher for people living with HIV than for uninfected control subjects, even in the setting of HIV viral suppression with effective antiretroviral therapy. These elevated risks generally persist after demographic and clinical risk factors are accounted for and may be partly attributed to chronic inflammation and immune dysregulation. Data on long-term CVD outcomes in HIV are limited by the relatively recent epidemiological transition of HIV to a chronic disease. Therefore, our understanding of CVD pathogenesis, prevention, and treatment in HIV relies on large observational studies, randomized controlled trials of HIV therapies that are underpowered to detect CVD end points, and small interventional studies examining surrogate CVD end points. The purpose of this document is to provide a thorough review of the existing evidence on HIV-associated CVD, in particular atherosclerotic CVD (including myocardial infarction and stroke) and heart failure, as well as pragmatic recommendations on how to approach CVD prevention and treatment in HIV in the absence of large-scale randomized controlled trial data. This statement is intended for clinicians caring for people with HIV, individuals living with HIV, and clinical and translational researchers interested in HIV-associated CVD.
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Mabweazara SZ, Ley C, Leach LL. Physical activity, social support and socio-economic status amongst persons living with HIV and AIDS: a review. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2019; 17:203-212. [PMID: 30003848 DOI: 10.2989/16085906.2018.1475400] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Physical activity can be used for the effective and comprehensive management of HIV and AIDS. Social support and socio-economic status (SES) are two factors that shape physical activity behaviours. Individuals of low SES carry a disproportionate burden of the HIV and AIDS epidemic. In addition, limited resources constitute socio-ecological barriers predisposing such individuals to physical inactivity. The purpose of this narrative review is to examine the available literature on physical activity, social support and SES and to generate recommendations for designing and implementing physical activity interventions targeting people living with HIV and AIDS (PLWHA) of low SES. The review used literature from Google, Google Scholar and PubMed on physical activity of PLWHA, social support for physical activity, and SES and physical activity. Qualitative and quantitative studies in English were included from 1970 to 2016. The results show that social support plays a major role in promoting physical activity and counteracting the barriers to PA in PLWHA of low SES. The results on the role of social support and the influence of SES are integrated to help design appropriate physical activity interventions for PLWHA of low SES. Well-designed interventions should utilise social support and be contextualised for PLWHA of low SES, whose living conditions present multiple barriers to physical activity.
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Affiliation(s)
- Smart Z Mabweazara
- a Department of Sport Recreation and Exercise Science , University of the Western Cape , Bellville , South Africa
| | - Clemens Ley
- b Institute of Sport Science , University of Vienna , Vienna , Austria
| | - Lloyd L Leach
- a Department of Sport Recreation and Exercise Science , University of the Western Cape , Bellville , South Africa
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23
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Montoya JL, Jankowski CM, O’Brien KK, Webel AR, Oursler KK, Henry BL, Moore DJ, Erlandson KM. Evidence-informed practical recommendations for increasing physical activity among persons living with HIV. AIDS 2019; 33:931-939. [PMID: 30946147 PMCID: PMC6457127 DOI: 10.1097/qad.0000000000002137] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Jessica L. Montoya
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Catherine M. Jankowski
- University of Colorado Anschutz Medical Campus, College of Nursing, Aurora, Colorado, USA
| | - Kelly K. O’Brien
- Department of Physical Therapy; Rehabilitation Sciences Institute; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Allison R. Webel
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | - Krisann K. Oursler
- Geriatric Research and Education, Salem Veterans Medical Center, Salem, Virginia, USA; Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Brook L. Henry
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - David J. Moore
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Kristine M. Erlandson
- Division of Infectious Diseases; Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, College of Nursing, Aurora, Colorado, USA
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24
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Martin K, Naclerio F, Karsten B, Vera JH. Physical activity and quality of life in people living with HIV. AIDS Care 2019; 31:589-598. [PMID: 30712360 DOI: 10.1080/09540121.2019.1576848] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
As life expectancy in people living with HIV (PWH) has increased, the focus of management has shifted to preventing and treating chronic illnesses. Regular physical activity (PA) has been shown to reduce the impact of HIV on both physical and mental health. Our objectives were to assess the PA levels of PWH compared to HIV negative controls; investigate factors associated with PA; and determine the effect of PA levels on quality of life and mental well-being. We recruited 110 PWH and 110 HIV negative controls in this cross-sectional, single-centre study. Physical activity, quality of life and mental well-being were assessed using the rapid assessment of physical activity tool, EQ-5D-5L Questionnaire, and the Warwick-Edinburgh Mental Well-being Score. Binary logistic regression and multiple linear regression were used to identify factors associated with PA levels and mental well-being scores respectively. PWH were less likely to meet the WHO-recommended PA requirements compared to controls (50.0% vs. 64.5%; p = 0.041) and had significantly lower mental wellbeing and quality of life scores. Additionally, in PWH higher PA levels were associated with improved self-rated quality of life scores (p = 0.027). Our results suggest that targeted exercise programmes could have a beneficial effect on health status in PWH.
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Affiliation(s)
- Kevin Martin
- a Brighton and Sussex University Hospitals NHS Trust , Brighton , UK
| | - Fernando Naclerio
- b Department of Life and Sports Sciences , University of Greenwich , London , UK
| | - Bettina Karsten
- d Department of Exercise and Sport Science , LUNEX International University of Health, Exercise and Sports , Differdingen , Luxembourg
| | - Jaime H Vera
- a Brighton and Sussex University Hospitals NHS Trust , Brighton , UK.,c Department of Global Health and Infection , Brighton and Sussex Medical School , Brighton , UK
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25
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Safeek RH, Hall KS, Lobelo F, del Rio C, Khoury AL, Wong T, Morey MC, McKellar MS. Low Levels of Physical Activity Among Older Persons Living with HIV/AIDS Are Associated with Poor Physical Function. AIDS Res Hum Retroviruses 2018; 34:929-935. [PMID: 29984584 PMCID: PMC6909688 DOI: 10.1089/aid.2017.0309] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Antiretroviral therapy (ART) has prolonged lives of persons living with HIV/AIDS (PLWHA), resulting in greater incidence of aging-related diseases and disability. Physical activity (PA) is recommended for healthy aging, but little is known about PA in older PLWHA. The purpose of this study was to objectively assess PA levels in older PLWHA and the associations with physical function. Twenty-one PLWHA, ≥50 years old, on ART with undetectable HIV-1 viral loads, wore an accelerometer to assess PA, including number of steps, activity intensity, and energy expenditure over 7 days. A physical function performance battery assessing aerobic capacity, strength, and gait speed was also completed. Average age was 66, and 67% were male. An average of 3,442 (interquartile range: 4,613) steps were walked daily, with 254.9 kcals expended. Participants spent most waking hours (75%) sedentary, with minimal hours (24%) in light-intensity activity. Only 5 min per day (35 min per week), on average, were spent in moderate-to-vigorous physical activity (MVPA). Maximal gait speed and 6-min walk test significantly correlated (p < .05) with all PA outcomes. Usual gait speed significantly correlated with all PA outcomes, except for daily kcals and light-intensity activity. Greater PA was associated with better physical performance, while high sedentary time was associated with poorer performance. To our knowledge, this is the first study to objectively measure PA in older PLWHA. Our findings indicate that older PLWHA accumulate substantial sedentary time. Most (86%) do not achieve recommended MVPA levels. This activity profile was associated with poor physical function. Providers should promote PA among PLWHA.
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Affiliation(s)
- Rachel H. Safeek
- Center for AIDS Research at Emory University, Emory University School of Medicine, Atlanta, Georgia
| | - Katherine S. Hall
- Division of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, North Carolina
- Claude D. Pepper Older Americans Independence Center, Duke University Medical Center, Durham, North Carolina
- Geriatric Research, Education and Clinical Center, Durham Veterans Affairs Healthcare System, Durham, North Carolina
| | - Felipe Lobelo
- Exercise is Medicine Global Research and Collaboration Center, Emory Rollins School of Public Health, Emory University, Atlanta, Georgia
- Hubert Department of Global Health, Emory Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Carlos del Rio
- Center for AIDS Research at Emory University, Emory University School of Medicine, Atlanta, Georgia
- Hubert Department of Global Health, Emory Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Audrey L. Khoury
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Tammy Wong
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Miriam C. Morey
- Division of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, North Carolina
- Claude D. Pepper Older Americans Independence Center, Duke University Medical Center, Durham, North Carolina
- Geriatric Research, Education and Clinical Center, Durham Veterans Affairs Healthcare System, Durham, North Carolina
| | - Mehri S. McKellar
- Claude D. Pepper Older Americans Independence Center, Duke University Medical Center, Durham, North Carolina
- Geriatric Research, Education and Clinical Center, Durham Veterans Affairs Healthcare System, Durham, North Carolina
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
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Mkhize BT, Mabaso MHL, Madurai S, Mkhize-Kwitshana ZL. The Investigation of the Use of Prealbumin as a Tool for Nutritional Assessment in Adults Coinfected with HIV and Intestinal Helminth Parasites in KwaZulu-Natal, South Africa. BIOMED RESEARCH INTERNATIONAL 2018; 2018:7805857. [PMID: 30065944 PMCID: PMC6051331 DOI: 10.1155/2018/7805857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 05/14/2018] [Indexed: 12/17/2022]
Abstract
Serum prealbumin is considered to be as important as albumin in the nutritional status assessment. However, there is relatively little evidence of its advantage over the commonly used albumin. This study investigated the use of prealbumin compared to albumin as a marker of nutritional status in adults singly and dually infected with human immunodeficiency virus (HIV) and intestinal helminths, with or without inflammatory conditions, in different body mass index (BMI) categories. This cross-sectional study was conducted in a periurban setting in KwaZulu-Natal, South Africa. Multivariate multinomial logistic regression models were fitted to investigate the effect of prealbumin and albumin in nutritional assessment among HIV and helminth individuals with or without inflammation, indicated by elevated and normal C-reactive protein (CRP) levels. In normal CRP, albumin was significantly lower in unadjusted BMI [RRR = 0.8, p = 0.001] and in normal weight [RRR = 0.7, p = 0.003] and overweight [RRR = 0.5, p = 0.001] participants. In elevated CRP, albumin was significantly lower [RRR = 0.8, p = 0.050] and prealbumin was significantly higher in unadjusted BMI [RRR = 1.2, p = 0.034] and overweight [RRR = 1.4, p = 0.052] individuals. The current study found that prealbumin can differentiate between inflammation-induced reduction of albumin and true malnutrition in adults singly or coinfected with HIV and intestinal helminths in the presence or absence of inflammation in various BMI categories.
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Affiliation(s)
- B. T. Mkhize
- Department of Biomedical and Clinical Technology, Faculty of Health Sciences, Durban University of Technology, Durban, South Africa
- Department of Medical Microbiology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - M. H. L. Mabaso
- Epidemiology and Strategic Information Unit, HIV/AIDS, STI and TB (HAST), Human Sciences Research Council, Durban, South Africa
| | - S. Madurai
- Global Clinical and Viral Laboratory, Durban, South Africa
| | - Z. L. Mkhize-Kwitshana
- Department of Medical Microbiology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- Department of Biomedical Sciences, Faculty of Natural Sciences, Mangosuthu University of Technology, Durban, South Africa
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Perazzo J, Webel AR, Alam SK, Sattar A, McComsey G. Relationships Between Physical Activity and Bone Density in People Living with HIV: Results from the SATURN-HIV Study. J Assoc Nurses AIDS Care 2018; 29:528-537. [PMID: 29735237 PMCID: PMC5999576 DOI: 10.1016/j.jana.2018.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 03/22/2018] [Indexed: 12/31/2022]
Abstract
We conducted a cross-sectional secondary analysis of baseline data from the SATURN-HIV study (N = 147; 78% male, 68% Black, median body mass index [BMI] 26.72 kg/m2, 13% with osteopenia, HIV-1 RNA < 1,000 copies/mL, stable antiretroviral therapy [ART]) to explore the relationship between physical activity (PA) and bone mineral density (BMD). We measured self-reported minutes of PA and BMD in the overall sample and subgroups based on national recommendations (≥150 minutes/week). Forty-one (28%) participants met recommended PA levels. Higher intensity PA was associated with higher BMD at the total hip (r = 0.27, p = .09; n = 41; 28%) and lumbar spine (r = 0.32, p < .05), and predicted higher BMD at the hip (p < .01; controlling for age, BMI, ART). Lumbar spine BMD did not retain significance in the regression model. Moderate-to-high intensity PA could prevent or mitigate excessive bone loss in people living with HIV.
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Affiliation(s)
- Joseph Perazzo
- University of Cincinnati, Cincinnati, Ohio, USA and former postdoctoral fellow at Case Western Reserve University, Cleveland Ohio, USA
| | - Allison R. Webel
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Case Western Reserve University, Cleveland, Ohio, USA
| | - S.M. Khurshid Alam
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Abdus Sattar
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Grace McComsey
- Case Rainbow Babies & Children's Hospital, Case Western Reserve University/Case Medical Center, Cleveland, Ohio, USA
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Oursler KK, Sorkin JD, Ryan AS, Katzel LI. A pilot randomized aerobic exercise trial in older HIV-infected men: Insights into strategies for successful aging with HIV. PLoS One 2018; 13:e0198855. [PMID: 29894513 PMCID: PMC5997336 DOI: 10.1371/journal.pone.0198855] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 05/19/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND HIV-infected adults have increased risk for age-related diseases and low cardiorespiratory fitness that can be prevented and improved with exercise. Yet, exercise strategies have not been well studied in older adults with HIV and may require substantial adaptation to this special population. OBJECTIVE To determine the safety and efficacy of aerobic exercise in older HIV-infected men in a randomized trial comparing different levels of exercise intensity. METHODS We conducted a pilot exercise trial in 22 HIV-infected men ≥50 years of age receiving antiretroviral therapy who were randomized 1:1 to moderate-intensity aerobic exercise (Mod-AEX) or high-intensity aerobic exercise (High-AEX) that was performed three times weekly for 16 weeks in a supervised setting. Primary outcome was cardiorespiratory fitness (VO2peak) measured by treadmill testing. Secondary outcomes were exercise endurance, six-minute walk distance (6-MWD), body composition measured by Dual-energy X-ray absorptiometry (DXA), and fasting plasma levels of lipids and glucose. RESULTS VO2peak increased in the High-AEX group (3.6 ±1.2 mL/kg/min, p = 0.02) but not in the Mod-AEX group (0.4 ±1.4 mL/kg/min, p = 0.7) with a significant between group difference (p<0.01). Exercise endurance increased in both the High-AEX group (27 ±11%, p = 0.02) and the Mod-AEX group (11 ±4%, p = 0.04). The 6-MWD increased in both the High-AEX (62 ±18m, p = 0.01) and the Mod-AEX group (54 ±14m, p = 0.01). Changes in VO2peak and 6-MWD were clinically relevant. There were no serious exercise-related adverse events. Dropouts were similar between group (27% overall) and were related to joint pain. CONCLUSIONS This pilot exercise trial demonstrates that moderate to high-intensity aerobic exercise in older HIV-infected men increases endurance and ambulatory function. However, increased cardiorespiratory fitness was observed only with high-intensity aerobic exercise despite substantial baseline impairment. Future research is needed to determine exercise strategies in older HIV-infected adults that address advanced aging and comorbidity yet are durable and feasible.
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Affiliation(s)
- Krisann K. Oursler
- Geriatric Research, Education, and Clinical Center, Baltimore Veterans Affairs Medical Center, Veterans Affairs Maryland Health Care System, Baltimore, MD, United States of America
- Department of Medicine, Division Gerontology and Geriatric Medicine, The University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - John D. Sorkin
- Geriatric Research, Education, and Clinical Center, Baltimore Veterans Affairs Medical Center, Veterans Affairs Maryland Health Care System, Baltimore, MD, United States of America
- Department of Medicine, Division Gerontology and Geriatric Medicine, The University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Alice S. Ryan
- Geriatric Research, Education, and Clinical Center, Baltimore Veterans Affairs Medical Center, Veterans Affairs Maryland Health Care System, Baltimore, MD, United States of America
- Department of Medicine, Division Gerontology and Geriatric Medicine, The University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Leslie I. Katzel
- Geriatric Research, Education, and Clinical Center, Baltimore Veterans Affairs Medical Center, Veterans Affairs Maryland Health Care System, Baltimore, MD, United States of America
- Department of Medicine, Division Gerontology and Geriatric Medicine, The University of Maryland School of Medicine, Baltimore, MD, United States of America
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de Lima LRA, Back IDC, Nunes EA, Silva DAS, Petroski EL. Aerobic fitness and physical activity are inversely associated with body fat, dyslipidemia and inflammatory mediators in children and adolescents living with HIV. J Sports Sci 2018; 37:50-58. [PMID: 29882716 DOI: 10.1080/02640414.2018.1481724] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
This study aimed to investigate if moderate to vigorous physical activity (MVPA) and aerobic fitness are associated with cardiovascular risk factors in HIV+ children and adolescents. Sixty-five children and adolescents (8 to 15 years) provided minutes of MVPA measured by accelerometers and peak oxygen uptake (peak VO2) by breath-by-breath respiratory exchange. Cardiovascular risk factors were characterized by body fat, blood pressure, total cholesterol, HDL-c, LDL-c, triglycerides, glucose, insulin, C-reactive protein (CRP), interleukin (IL)-6, tumor necrosis factor-alpha (TNF-α) and carotid intima-media thickness. Results indicated that higher MVPA was associated with lower values of total (β = -3.566) and trunk body fat (β = -3.495), total cholesterol (β = -0.112) and LDL-c (β = -0.830). Likewise, higher peak VO2 was associated with lower total (β = -0.629) and trunk body fat values (β = -0.592) and levels of CRP (β = -0.059). The physically active participants had lower total cholesterol (-24.4 mg.dL-1) and LDL-c (-20.1 mg.dL-1) compared to participants judged to be insufficiently active. Moreover, participants with satisfactory peak VO₂ showed lower total (-4.1%) and trunk (-4.3%) body fat, CRP (-2.3 mg.L-1), IL-6 (-2.4 pg.mL-1) and TNF-α (-1.0 pg.mL-1) compared to low peak VO2 peers. High levels of MVPA and aerobic fitness may prevent developing of cardiovascular risk factors in children and adolescents HIV+.
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Affiliation(s)
- Luiz Rodrigo Augustemak de Lima
- a Department of Physical Education , Research Centre for Kinanthropometry and Human Performance, Federal University of Santa Catarina , Florianópolis , Brazil
| | - Isabela de Carlos Back
- b Department of Pediatrics , Medical School, Federal University of Santa Catarina , Florianópolis , Brazil
| | - Everson Araújo Nunes
- c Physiological Sciences Department , Centre of Biological Sciences, Federal University of Santa Catarina , Florianópolis , Brazil
| | - Diego Augusto Santos Silva
- a Department of Physical Education , Research Centre for Kinanthropometry and Human Performance, Federal University of Santa Catarina , Florianópolis , Brazil
| | - Edio Luiz Petroski
- a Department of Physical Education , Research Centre for Kinanthropometry and Human Performance, Federal University of Santa Catarina , Florianópolis , Brazil
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Vancampfort D, Stubbs B, Mugisha J. Physical activity and HIV in sub-Saharan Africa: a systematic review of correlates and levels. Afr Health Sci 2018; 18:394-406. [PMID: 30602967 PMCID: PMC6306981 DOI: 10.4314/ahs.v18i2.25] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Self-management strategies such as physical activity (PA) can address disability and optimize mental, physical, social and economic outcomes for persons living with HIV (PLWH). Understanding factors that influence PA behavior in PLWH is a first step in order to devise effective interventions. Objective The present review provides a systematic review of the correlates of PA in PLWH in sub-Saharan Africa. Methods Electronic databases were searched till April 2016. Keywords included ‘physical activity’ or ‘exercise’ or ‘sports’ and ‘AIDS’ or ‘HIV’. Results Ten correlates were identified in 6 studies including 1,015 (329♂) PLWH (mean age range=30.5–40.8years). Lower levels of PA were associated with older age (2/2 studies), a lower number of CD4 cells/µl (1/1), a more severe HIV-stage (1/1), a higher HIV load (1/1), the presence of opportunistic infections (1/1) and a higher BMI (1/1). Fisher's exact tests showed there were more significant correlates in objective tools versus subjective self-report (P=0.03). Conclusion The current review shows that participation in PA by PLWH in sub-Saharan Africa is associated with a range of complex factors which should be considered in the daily care of PLWH. This however might require repackaging of the current interventions for PLWH to allow a focus on PA.
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Affiliation(s)
- Davy Vancampfort
- KU Leuven — University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
- KU Leuven — University of Leuven, University Psychiatric Center KU Leuven, Leuven-Kortenberg, Belgium
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, UK
| | - James Mugisha
- Butabika National Referral and Mental Health Hospital, Kampala, Uganda
- Kyambogo University, Kampala, Uganda
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Voigt N, Cho H, Schnall R. Supervised Physical Activity and Improved Functional Capacity among Adults Living with HIV: A Systematic Review. J Assoc Nurses AIDS Care 2018; 29:667-680. [PMID: 29861318 DOI: 10.1016/j.jana.2018.05.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 05/04/2018] [Indexed: 12/18/2022]
Abstract
Physical activity (PA) combats the effects of multimorbidity and antiretroviral therapy in people living with HIV (PLWH), but PLWH often don't meet recommended PA guidelines. The purpose of our review was to investigate whether supervised PA improved functional capacity in PLWH. Preferred Reporting Items for Systematic Reviews and Meta-Analyses were followed. Five databases were searched for randomized controlled trials in English, with participants ages 18 years and older, and a supervised PA intervention. A database search yielded 8,267 articles, with 15 eligible for review inclusion. We found a low risk of bias within and across studies. Combined aerobic/progressive resistance training (PRT) improved strength, cardiovascular, and flexibility outcomes; aerobic interventions alone showed no significant improvements; PRT improved strength outcomes; yoga or yoga/meditation showed no outcome differences; and t'ai chi showed cardiovascular and flexibility improvements. We found that supervised PA increased functional capacity in PLWH and that self-report was not a reliable assessment.
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Vancampfort D, Mugisha J, Richards J, De Hert M, Probst M, Stubbs B. Physical activity correlates in people living with HIV/AIDS: a systematic review of 45 studies. Disabil Rehabil 2017; 40:1618-1629. [PMID: 28325087 DOI: 10.1080/09638288.2017.1306587] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE Understanding barriers and facilitators of physical activity participation in persons living with HIV/AIDS is an essential first step in order to devise effective interventions. The present review provides a systematic quantitative review of the physical activity correlates in people with HIV/AIDS. METHODS Major electronic databases were searched till August 2016. Keywords included "physical activity" or "exercise" or "sports" and "AIDS" or "HIV". RESULTS Out of 55 correlates from 45 studies (N = 13,167; mean age range = 30.5-58.3 years; 63.2% male) five consistent (i.e., reported in four or more studies) correlates were identified. Lower levels of physical activity were consistently associated with older age (6/10 studies), a lower educational level (6/7), a lower number of CD4 cells/μl (7/11), exposure to antiviral therapy (4/6), and the presence of lipodystrophy (4/4). Other important barriers were the presence of bodily pain (2/2), depression (3/3), and opportunistic infections (3/4). Facilitators were a higher cardiorespiratory fitness level (3/3), a higher self-efficacy (2/2), more perceived benefits (2/2), and a better health motivation (3/3). CONCLUSIONS The current review has elucidated that participation in physical activity by people with HIV/AIDS is associated with a range of complex factors which should be considered in rehabilitation programs. Implications for Rehabilitation Health care professionals should consider HIV-related bodily pain and feelings of depression when assisting people living with HIV in inititiating and maintaining an active lifestyle. Interventions to improve self-efficacy and motivation, and to help people living with HIV in understanding the benefits of exercise, may encourage greater participation.
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Affiliation(s)
- Davy Vancampfort
- a Department of Rehabilitation Sciences , KU Leuven - University of Leuven , Leuven , Belgium.,b University Psychiatric Center KU Leuven, KU Leuven - University of Leuven , Leuven-Kortenberg , Belgium
| | - James Mugisha
- c Butabika National Referral and Mental Health Hospital , Kampala , Uganda.,d Department of Sociology and Social Administration, Kyambogo University , Kampala , Uganda
| | - Justin Richards
- e School of Public Health & Charles Perkins Centre , University of Sydney , Sydney , NSW , Australia
| | - Marc De Hert
- b University Psychiatric Center KU Leuven, KU Leuven - University of Leuven , Leuven-Kortenberg , Belgium
| | - Michel Probst
- a Department of Rehabilitation Sciences , KU Leuven - University of Leuven , Leuven , Belgium
| | - Brendon Stubbs
- f Department of Physiotherapy , South London and Maudsley NHS Foundation Trust , London , UK.,g Department of Health Service and Population Research , King's College London , De Crespigny Park , London , UK
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Cardiorespiratory fitness levels and moderators in people with HIV: A systematic review and meta-analysis. Prev Med 2016; 93:106-114. [PMID: 27713101 DOI: 10.1016/j.ypmed.2016.10.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 09/16/2016] [Accepted: 10/03/2016] [Indexed: 11/21/2022]
Abstract
Cardiorespiratory fitness (CRF) is a modifiable risk factor for cardiovascular disease and premature mortality. CRF levels and moderators among people living with HIV (PLWH) are unknown. The aim of the current meta-analysis was to (1) determine mean CRF in PLWH and compare levels with age- and gender-matched healthy controls (HCs), (2) explore moderators of CRF, (3) and (4) explore moderators of CRF outcomes following physical activity (PA) interventions. Major electronic databases were searched systematically for articles reporting CRF expressed as maximum or peak oxygen uptake (ml/min/kg) in PLWH. A random effects meta-analysis calculating the pooled mean CRF including subgroup- and meta-regression analyses was undertaken. Across 21 eligible studies, the CRF level was 26.4ml/kg/min (95% CI=24.6 to 28.1) (n=1010; mean age=41years). There were insufficient data to compare CRF levels with HCs. A higher body mass index (β=-0.99, 95% CI=-1.93 to -0.06, P=0.04), older age (β=-0.31, 95% CI=-0.58 to -0.04, P=0.02) and the presence of lipodystrophy (β=-4.63, 95% CI=-7.88 to -1.39, P=0.005) were significant moderators of lower CRF levels. Higher CD4+ counts (β=0.004, 95% CI=0.0007 to 0.007, P=0.016), supervised interventions (P<0.001) and interventions with a lower frequency of weekly sessions (2 or 3 versus 4 times) (P<0.001) predicted a better CRF-outcome following PA. CRF levels of PLWH are among the lowest in comparison to other vulnerable populations. More research on the most optimal physical activity intervention characteristics is needed.
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Mashinya F, Alberts M, Colebunders R, Van Geertruyden JP. Weight status and associated factors among HIV infected people on antiretroviral therapy in rural Dikgale, Limpopo, South Africa. Afr J Prim Health Care Fam Med 2016; 8:e1-e8. [PMID: 28155318 PMCID: PMC5153409 DOI: 10.4102/phcfm.v8i1.1230] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 10/12/2016] [Accepted: 09/08/2016] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Underweight in human immunodeficiency virus (HIV)-infected people on antiretroviral therapy (ART) complicates the management of HIV infection and contributes to mortality, whereas overweight increases the risk of cardiovascular disease (CVD). AIM The study determined weight status and associated factors in people with HIV infection receiving ART. SETTING Rural primary health care clinics in Dikgale, Limpopo province, South Africa. METHODS A cross-sectional study in which data were collected using the World Health Organization (WHO) stepwise approach to surveillance (STEPS) questionnaire and calculated using WHO analysis programmes guide. Weight and height were measured using standard WHO procedures, and body mass index was calculated as weight (kg)/height (m2). Data on ART duration were extracted from patients' files. CD4 lymphocyte counts and viral load were determined using standard laboratory techniques. RESULTS Of the 214 participants, 8.9%, 54.7% and 36.4% were underweight, normal weight and overweight, respectively. Physical activity (OR: 0.99, p = 0.001) and male gender (OR: 0.29, p = 0.04) were negatively associated with overweight. Men who used tobacco were more likely to be underweight than non-tobacco users (OR: 10.87, p = 0.02). Neither ART duration nor viral load or CD4 count was independently associated with underweight or overweight in multivariate analysis. CONCLUSION A high proportion of people on ART were overweight and a smaller proportion underweight. There is a need to simultaneously address the two extreme weight problems in this vulnerable population through educating them on benefits of avoiding tobacco, engaging in physical activity and raising awareness of CVD risk.
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Affiliation(s)
- Felistas Mashinya
- Department of Pathology and Medical Science, Faculty of Health Sciences, University of Limpopo.
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[HIV and sports: good or evil?]. MMW Fortschr Med 2016; 158 Suppl 1:33-5. [PMID: 27259900 DOI: 10.1007/s15006-016-8324-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Wheeler LA, Trifonova RT, Vrbanac V, Barteneva NS, Liu X, Bollman B, Onofrey L, Mulik S, Ranjbar S, Luster AD, Tager AM, Lieberman J. TREX1 Knockdown Induces an Interferon Response to HIV that Delays Viral Infection in Humanized Mice. Cell Rep 2016; 15:1715-27. [PMID: 27184854 DOI: 10.1016/j.celrep.2016.04.048] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 03/21/2016] [Accepted: 04/09/2016] [Indexed: 10/21/2022] Open
Abstract
Despite their antiviral effect, the in vivo effect of interferons on HIV transmission is difficult to predict, because interferons also activate and recruit HIV-susceptible cells to sites of infection. HIV does not normally induce type I interferons in infected cells, but does if TREX1 is knocked down. Here, we investigated the effect of topical TREX1 knockdown and local interferon production on HIV transmission in human cervicovaginal explants and humanized mice. In explants in which TREX1 was knocked down, HIV induced interferons, which blocked infection. In humanized mice, even though TREX1 knockdown increased infiltrating immune cells, it delayed viral replication for 3-4 weeks. Similarly intravaginal application of type I interferons the day before HIV infection induced interferon responsive genes, reduced inflammation, and decreased viral replication. However, intravenous interferon enhanced inflammation and infection. Thus, in models of human sexual transmission, a localized interferon response inhibits HIV transmission but systemic interferons do not.
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Affiliation(s)
- Lee Adam Wheeler
- Program in Cellular and Molecular Medicine, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA; MD-PhD Program, Harvard Medical School, Boston, MA 02115, USA
| | - Radiana T Trifonova
- Program in Cellular and Molecular Medicine, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
| | - Vladimir Vrbanac
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02139, USA
| | - Natasha S Barteneva
- Program in Cellular and Molecular Medicine, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
| | - Xing Liu
- Program in Cellular and Molecular Medicine, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
| | - Brooke Bollman
- Program in Cellular and Molecular Medicine, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
| | - Lauren Onofrey
- Program in Cellular and Molecular Medicine, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
| | - Sachin Mulik
- Program in Cellular and Molecular Medicine, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
| | - Shahin Ranjbar
- Program in Cellular and Molecular Medicine, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
| | - Andrew D Luster
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02139, USA
| | - Andrew M Tager
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02139, USA
| | - Judy Lieberman
- Program in Cellular and Molecular Medicine, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA.
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d’Ettorre G, Ceccarelli G, Pavone P, Vittozzi P, De Girolamo G, Schietroma I, Serafino S, Giustini N, Vullo V. What happens to cardiovascular system behind the undetectable level of HIV viremia? AIDS Res Ther 2016; 13:21. [PMID: 27127532 PMCID: PMC4848790 DOI: 10.1186/s12981-016-0105-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 04/14/2016] [Indexed: 11/08/2022] Open
Abstract
Despite the combined antiretroviral therapy has improved the length and quality of life of HIV infected patients, the survival of these patients is always decreased compared with the general population. This is the consequence of non-infectious illnesses including cardio vascular diseases. In fact large studies have indicated an increased risk of coronary atherosclerotic disease, myocardial infarction even in HIV patients on cART. In HIV infected patients several factors may contribute to the pathogenesis of cardiovascular problems: life-style, metabolic parameters, genetic predisposition, viral factors, immune activation, chronic inflammation and side effects of antiretroviral therapy. The same factors may also contribute to complicate the clinical management of these patients. Therefore, treatment of these non-infectious illnesses in HIV infected population is an emerging challenge for physicians. The purpose of this review is to focus on the new insights in non AIDS-related cardiovascular diseases in patients with suppressed HIV viremia.
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Serrano-Villar S, Gutiérrez F, Miralles C, Berenguer J, Rivero A, Martínez E, Moreno S. Human Immunodeficiency Virus as a Chronic Disease: Evaluation and Management of Nonacquired Immune Deficiency Syndrome-Defining Conditions. Open Forum Infect Dis 2016; 3:ofw097. [PMID: 27419169 PMCID: PMC4943534 DOI: 10.1093/ofid/ofw097] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 04/29/2016] [Indexed: 12/17/2022] Open
Abstract
In the modern antiretroviral therapy (ART) era, motivated people living with human immunodeficiency virus (HIV) who have access to therapy are expected to maintain viral suppression indefinitely and to receive treatment for decades. Hence, the current clinical scenario has dramatically shifted since the early 1980s, from treatment and prevention of opportunistic infections and palliative care to a new scenario in which most HIV specialists focus on HIV primary care, ie, the follow up of stable patients, surveillance of long-term toxicities, and screening and prevention of age-related conditions. The median age of HIV-infected adults on ART is progressively increasing. By 2030, 3 of every 4 patients are expected to be aged 50 years or older in many countries, more than 80% will have at least 1 age-related disease, and approximately one third will have at least 3 age-related diseases. Contemporary care of HIV-infected patients is evolving, and questions about how we might monitor and perhaps even treat HIV-infected adults have emerged. Through key published works, this review briefly describes the most prevalent comorbidities and age-associated conditions and highlights the differential features in the HIV-infected population. We also discuss the most critical aspects to be considered in the care of patients with HIV for the management and prevention of age-associated disease.
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Affiliation(s)
- Sergio Serrano-Villar
- Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria and Universidad de Alcalá , Madrid
| | - Félix Gutiérrez
- Hospital Universitario de Elche and Universidad Miguel Hernández , Alicante
| | | | - Juan Berenguer
- Juan Berenguer , Hospital Universitario Gregorio Marañón and Instituto de Investigación Sanitaria Gregorio Marañón , Madrid
| | - Antonio Rivero
- Unidad de Gestión Clínica Enfermedades Infecciosas , Hospital Universitario Reina Sofía and Instituto Maimónides de Investigación Biomédica de Córdoba
| | - Esteban Martínez
- Hospital Clínic and Instituto de Investigaciones Biomédicas August Pi i Sunyer, University of Barcelona , Spain
| | - Santiago Moreno
- Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria and Universidad de Alcalá , Madrid
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Sarmati L, D'Ettorre G, Parisi SG, Andreoni M. HIV Replication at Low Copy Number and its Correlation with the HIV Reservoir: A Clinical Perspective. Curr HIV Res 2016; 13:250-7. [PMID: 25845389 PMCID: PMC4460281 DOI: 10.2174/1570162x13666150407142539] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 01/27/2015] [Accepted: 04/02/2015] [Indexed: 01/01/2023]
Abstract
The efficacy of combination therapy (antiretroviral therapy - ARV) is demonstrated by the high rates of viral suppression achieved in most treated HIV patients. Whereas contemporary
treatments may continuously suppress HIV replication, they do not eliminate the latent reservoir, which can reactivate HIV infection if ARV is discontinued. The persistence of HIV proviral DNA and
infectious viruses in CD4+ T cells and others cells has long been considered a major obstacle in eradicating the HIV virus in treated patients. Moreover, recent studies have demonstrated the
persistence of HIV replication at low copies in most patients on suppressive ARV. The source of this ‘residual viraemia’ and whether it declines over years of therapy remain unknown. Similarly, little is known regarding the biological
relationships between the HIV reservoir and viral replication at low copies. The question of whether this ‘residual viraemia’ represents active replication or the release of non-productive virus from the reservoir has not been adequately
resolved. From a clinical perspective, both the quantification of the HIV reservoir and the detection of low levels of replication in full-responder patients on prolonged ARV may provide important information regarding the effectiveness of treatment
and the eradication of HIV. To date, the monitoring of these two parameters has been conducted only for research purposes; the routine use of standardised tests procedure is lacking.
This review aims to assess the current data regarding the correlation between HIV replication at low copies and the HIV reservoir and to provide useful information for clinicians.
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Affiliation(s)
- Loredana Sarmati
- Clinical Infectious Diseases, Tor Vergata University, V. Montpellier 1, 00133, Roma, Italy.
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