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Okusanya TR, Okoka EM, Kuyebi MA, Oyadiran OT, Kowe T, Noor RA, Omotayo MO, Abioye AI. Nutrition counselling and clinical outcomes in HIV: A systematic review and meta-analysis. HIV Med 2024; 25:462-478. [PMID: 38158600 DOI: 10.1111/hiv.13603] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 12/05/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND People living with the HIV (PLHIV) are at an increased risk of various diseases due to a weakened immune system, particularly if they are naïve or poorly adherent to antiretroviral therapy (ART). Nutrients play a critical role in improving immune health, especially among this population. We systematically reviewed the evidence concerning the impact of nutritional counselling on the occurrence of important clinical outcomes among PLHIV. METHODS Medical literature databases (PubMed, EMBASE and Web of Science) were searched from inception to October 2022 for relevant published studies (n = 12) of nutritional counselling and HIV-related outcomes in adults on ART. Random-effects meta-analyses were conducted when the exposure-outcome relationships were similar in three or more studies. RESULTS Although the methodologies of nutritional intervention varied across all studies, overall, the evidence from the meta-analysis indicates a nsignificant positive association between nutrition counselling and improvements in CD4 cell count, body mass index and low-density lipoprotein concentration. However, the existing literature does not provide enough evidence to establish a significant impact of nutrition counselling on other immune, anthropometric, and metabolic outcomes including viral load, weight, and lean mass due to the differences in the study designs. CONCLUSION Well-powered randomized controlled trials are needed that explore the effect of evidence-based, individualized nutrition counselling on HIV-related clinical outcomes.
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2
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Tsuro U, Oladimeji KE, Pulido-Estrada GA, Apalata TR. The Effect of Cardiorespiratory Exercise in the Prevention and Treatment of Hypertension among HIV-Infected Individuals on Antiretroviral Therapy in Mthatha, South Africa. Healthcare (Basel) 2023; 11:1836. [PMID: 37444670 DOI: 10.3390/healthcare11131836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 06/18/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
The prevalence of hypertension among people living with HIV (PLHIV) on antiretroviral therapy (ART) is concerning. Physical activity is a proposed approach for managing and avoiding hypertension in this population. While cardiorespiratory exercises (CET) have been efficacious in the general population, its effectiveness in PLHIV on ART, especially in the study setting, in Mthatha is unknown. Consequently, the purpose of this study was to see if CET improves cardiorespiratory fitness in HAART-treated PLHIV with blood flow restriction (BFR) in Mthatha, South Africa. A quasi-experimental study with 98 participants (49 of whom were cases) was carried out. Cases were participants assigned to the CET intervention group that comprised of concurrent training as it included both aerobic and resistance exercise, matched on age and gender. The relationship between CET and hypertension was assessed using logistic regression after adjusting for possible confounding variables. At baseline, there was no significant difference between the physical characteristics of the two groups, and after the intervention, there was a significant difference. Obesity and central adiposity were identified as strong risk factors for hypertension. The findings also indicated that a reduction in waist circumference and body mass index had a significant positive association with hypertension treatment amongst the intervention group (p < 0.05). According to the results of the study, CET has the potential to be an efficient and economical non-pharmacological intervention for the management and control of hypertension in PLHIV. However, further study is required to establish how long, how intense, and what kind of exercise is best for this population.
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Affiliation(s)
- Urgent Tsuro
- Department of Public Health, Faculty of Health Sciences, Walter Sisulu University, Mthatha 5100, Eastern Cape, South Africa
| | - Kelechi Elizabeth Oladimeji
- Department of Public Health, Faculty of Health Sciences, Walter Sisulu University, Mthatha 5100, Eastern Cape, South Africa
- College of Graduate Studies, University of South Africa, Johannesburg 0001, Gauteng, South Africa
| | | | - Teke Ruffin Apalata
- Department of Laboratory Medicine and Pathology, Faculty of Health Sciences, Walter Sisulu University, Mthatha 5100, Eastern Cape, South Africa
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3
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Masters MC, Yang J, Lake JE, Abraham AG, Kingsley L, Brown TT, Palella FJ, Erlandson KM. Diabetes mellitus is associated with declines in physical function among men with and without HIV. AIDS 2022; 36:637-646. [PMID: 34999609 PMCID: PMC8957604 DOI: 10.1097/qad.0000000000003160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the longitudinal relationships between abnormal glucose metabolism and physical function in persons with HIV (PWH) and without HIV. DESIGN Prospective cohort study of men with or at risk for HIV in four United States cities between 2006 and 2018. METHODS Men with or at risk for HIV from the Multicenter AIDS Cohort Study (MACS) had semi-annual assessments of glycemic status, grip strength, and gait speed. We used linear mixed models with random intercept to assess associations between glycemic status and physical function. Glycemic status was categorized as normal, impaired fasting glucose (IFG), controlled diabetes mellitus [hemoglobin A1C (HbA1C) <7.5%], or uncontrolled diabetes mellitus (HbA1C ≥ 7.5%). RESULTS Of 2240 men, 52% were PWH. Diabetes mellitus was similar among PWH (7.7%) vs. persons without HIV (6.7%, P = 0.36) at baseline. PWH had slower gait speed (1.17 vs. 1.20 m/s, P < 0.01) but similar grip strength (40.1 vs. 39.8 kg, P = 0.76) compared with persons without HIV at baseline. In multivariate models, gait speed decline was greater with controlled diabetes mellitus [-0.018 m/s (-0.032 to -0.005), P = 0.01] and grip strength decline was greater with controlled [-0.560 kg (-1.096 to -0.024), P = 0.04] and uncontrolled diabetes mellitus [-0.937 kg (-1.684 to -0.190), P = 0.01), regardless of HIV serostatus compared with normoglycemic individuals. DISCUSSION Abnormal glucose metabolism was associated with declines in gait speed and grip strength regardless of HIV serostatus. These data suggest that improvement in glucose control should be investigated as an intervenable target to prevent progression of physical function limitations among PWH.
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Affiliation(s)
- Mary C Masters
- Department of Medicine, Northwestern University, Chicago, Illinois
| | - Jingyan Yang
- Department of Epidemiology, Mailman School of Public Heath, Columbia University, New York, New York
| | - Jordan E Lake
- Department of Internal Medicine, McGovern Medical School, University of Texas, Houston, Texas
| | - Alison G Abraham
- Department of Ophthalmology, Johns Hopkins University School of Medicine
- Department of Epidemiology, The Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Lawrence Kingsley
- Department of Infectious Diseases and Microbiology
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Todd T Brown
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University, Baltimore, Maryland
| | - Frank J Palella
- Department of Medicine, Northwestern University, Chicago, Illinois
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4
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Diggins CE, Russo SC, Lo J. Metabolic Consequences of Antiretroviral Therapy. Curr HIV/AIDS Rep 2022; 19:141-153. [PMID: 35299263 DOI: 10.1007/s11904-022-00600-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2022] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW This review reports on published studies describing metabolic changes associated with antiretroviral therapy (ART) to treat HIV disease including a historical perspective of earlier ART agents, but with the main focus on newer ART agents currently in use. RECENT FINDINGS Studies from different countries around the world have shown that integrase inhibitor (INSTI)-based regimens as well as tenofovir alafenamide (TAF) are associated with weight gain, with women and people of black race at especially high risk. Some studies preliminarily suggest worsened metabolic outcomes associated with this weight gain including adverse effects on glucose homeostasis. Antiretroviral therapy can affect weight, adipose tissue, glucose, and lipids. As obesity is prevalent and increasing among people with HIV, awareness of risk factors for weight gain, including the ART medications associated with greater weight gain, are needed in order to inform prevention efforts. Further research is needed to better understand the long-term health consequences of INSTI- and TAF-associated weight increases.
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Affiliation(s)
- Caroline E Diggins
- Metabolism Unit, Division of Endocrinology, Massachusetts General Hospital, LON-207, 55 Fruit Street, Boston, MA, 02114, USA
| | - Samuel C Russo
- Metabolism Unit, Division of Endocrinology, Massachusetts General Hospital, LON-207, 55 Fruit Street, Boston, MA, 02114, USA
| | - Janet Lo
- Metabolism Unit, Division of Endocrinology, Massachusetts General Hospital, LON-207, 55 Fruit Street, Boston, MA, 02114, USA.
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5
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Chang HH. Weight Gain and Metabolic Syndrome in Human Immunodeficiency Virus Patients. Infect Chemother 2022; 54:220-235. [PMID: 35706080 PMCID: PMC9259920 DOI: 10.3947/ic.2022.0061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 05/16/2022] [Indexed: 12/31/2022] Open
Abstract
While human immunodeficiency virus (HIV)-associated wasting has declined with significant advances in antiretroviral therapy (ART), weight gain and metabolic syndrome (MetS) are now becoming a problem for people living with HIV (PLWH) worldwide. The development of a new and more effective ART regimen has increased viral suppression and improved immunologic function recovery, leading to the extension of the lifespan of PLWH. It has recently been reported as one of the significant factors associated with weight gain, obesity, and long-term metabolic consequences in PLWH. This article reviewed the epidemiology of overweight and MetS among PLWH and the known risk factors for weight gain and its major comorbidities, such as dyslipidemia, diabetes mellitus, cardiovascular diseases, neurocognitive disorders, and liver diseases, in PLWH. In addition, reports on the pharmacological and surgical management of overweight and obesity in PLWH has been briefly summarized.
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Affiliation(s)
- Hyun-Ha Chang
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
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6
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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: 4] [Impact Index Per Article: 1.3] [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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7
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Kim JI, Kim SA, Park K, Kim J, Lee L, Choi SW, Ku BJ. [Effects of BeHaS Program on Health Behavior, Physiologic Index and Self-Esteem of the Elderly Living Alone with Metabolic Syndrome Based on Community Based Participatory Research]. J Korean Acad Nurs 2021; 50:571-582. [PMID: 32895343 DOI: 10.4040/jkan.19261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 06/17/2020] [Accepted: 06/18/2020] [Indexed: 11/09/2022]
Abstract
PURPOSE This study aimed to determine the effects of a 12-week metabolic syndrome BeHaS (Be Happy and Strong) program in elderly people with metabolic syndrome living alone, based on a community-based participatory research (CBPR). METHODS A nonequivalent control group pre-posttest design was used, and the participants were 43 elderly people living alone (experimental group 24, control group 19). The experimental group received a one-hour program per week and two individual health consultations during 12 weeks. The control group received two sessions about the metabolic syndrome and two individual health consultations. The effects of health behavior, blood pressure, blood sugar levels, abdominal circumference, triglycerides, and self-esteem were evaluated. The data were analyzed using the independent t-test and Mann-Whitney U test. RESULTS The health behavior with respect to the metabolic syndrome in the experimental group increased significantly (t = - 3.19, p = .002). Both diastolic blood pressure and abdominal circumference decreased in the experimental group (t = 2.00, p = .028 and t = 3.91, p < .001). No significant differences were observed between the groups in systolic blood pressure, fasting blood sugar levels, triglycerides, and self-esteem. CONCLUSION The 12-week metabolic syndrome BeHaS program using community resources improves the health of elderly people with metabolic syndrome living alone. Based on these findings, further studies on the effectiveness of the metabolic syndrome BeHaS program and the experiences of those who participated in the CBPR are warranted.
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Affiliation(s)
- Jong Im Kim
- College of Nursing, Chungnam National University, Daejeon, Korea
| | - Sun Ae Kim
- Department of Nursing, Korea National University of Transportation, Jeungpyeong, Korea.
| | - Keumok Park
- Department of Nursing, The College of Health and Welfare Woosong University, Daejeon, Korea
| | - Jiyoung Kim
- College of Nursing, Chungnam National University, Daejeon, Korea
| | - Lina Lee
- College of Nursing, Chungnam National University, Daejeon, Korea
| | - Si Wan Choi
- Department of Internal Medicine, College of Medicine, Chungnam, Korea.National University, Daejeon, Korea
| | - Bon Jeong Ku
- Department of Internal Medicine, College of Medicine, Chungnam, Korea.National University, Daejeon, Korea
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8
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Raggio G, Goodman G, Robbins GK, Looby SE, Labbe A, Psaros C. Developing a pilot lifestyle intervention to prevent cardiovascular disease in midlife women with HIV. HIV Res Clin Pract 2021; 22:1-13. [PMID: 33616022 DOI: 10.1080/25787489.2021.1883957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Background: Women with HIV (WWH) are at elevated risk for cardiovascular disease (CVD) compared to men with HIV. Lifestyle interventions, like the Diabetes Prevention Program (DPP), may reduce CVD risk, but most fail to address barriers to healthy behaviors facing WWH. OBJECTIVE Objective: To inform the adaptation of the DPP for midlife WWH, pilot the modified intervention, and assess feasibility, acceptability, and implementation barriers. METHODS Methods: Interviews were conducted with cisgender, English-speaking WWH ages 40-59 to assess intervention preferences. The adapted DPP was piloted and evaluated. CVD knowledge, CVD risk perception, quality of life, and physical activity were assessed pre- and post-intervention. RESULTS Results: Eighteen WWH completed interviews. Adaptations included reducing the number of sessions and adding HIV, CVD, stress, aging, menopause, and smoking content. Of 14 women contacted for the pilot, seven completed a baseline, five attended group sessions, and five completed a post-treatment assessment. Attendance barriers included transportation access and costs. Satisfaction was moderate; informal exit interviews indicated that women would recommend the program. CVD knowledge, perceived risk, and physical activity increased, and fatigue and mental health improved. Content on nutrition, aging, HIV, and stress was seen as most useful; suggested changes included group exercises and additional content on recipes, HIV management, and aging. CONCLUSIONS Conclusions: Midlife WWH reported benefits from our adapted intervention. Increases in CVD knowledge and perceived CVD risk suggest improved awareness of the impact of lifestyle behaviors. Retention was adequate; socioeconomic barriers were common. Intervention feasibility and acceptability may be improved via remote access and further content customization.
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Affiliation(s)
- Greer Raggio
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA.,National Center for Weight and Wellness, Washington, DC, USA
| | - Georgia Goodman
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA.,The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Gregory K Robbins
- Division of Infectious Diseases, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Sara E Looby
- Metabolism Unit, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA.,Yvonne L. Munn Center for Nursing Research, Massachusetts General Hospital, Boston, MA, USA
| | - Allison Labbe
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Christina Psaros
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
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9
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Poles J, Tiozzo E, Konefal J, Rodriguez A, Woolger JM, Lewis JE. The Effects of a Nutrition Education Program on Dietary Intake and Biomarkers in HIV+ Adults. Am J Lifestyle Med 2021; 16:511-520. [DOI: 10.1177/1559827620986790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 12/18/2020] [Accepted: 12/18/2020] [Indexed: 11/17/2022] Open
Abstract
Background. People living with HIV (PLWH) have increased risk of cardiovascular disease (CVD). Dietary behavior modification may assist in the treatment of CVD, but the optimal dose of nutrition education is unknown. The current aim was to determine if a weekly 1-hour nutrition education program would improve multiple outcomes among PLWH. Methods. Participants (n = 62) were assessed on dietary intake, serum biomarkers, and physical characteristics at baseline and 3 months, and percent change was calculated. Participants were grouped into 3 attendance categories of the classes: none, fair, or good. Analyses of covariance were performed on the outcomes. Results. Calories, protein, fat, saturated fat, carbohydrate, sugar, added sugar, and glycemic load were significantly different (all P values <.05). Those who attended no class typically had increases in these variables versus those with fair or good attendance. High-density lipoprotein cholesterol (HDL-C; P = .006) and total cholesterol/HDL-C ratio ( P = .083) were different, as those who attended no class or had fair attendance worsened, but those with good attendance improved. Conclusions. Several outcomes improved more so among those with good class attendance versus those with either fair or no attendance. Thus, an interactive nutrition education program may be an effective tool to help improve the health of PLWH.
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Affiliation(s)
- Jillian Poles
- Department of Kinesiology and Sport Sciences, University of Miami School of Education and Human Development, Miami, Florida
| | - Eduard Tiozzo
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida
| | - Janet Konefal
- Department of Family Medicine and Community Health, University of Miami Miller School of Medicine, Miami, Florida
| | - Allan Rodriguez
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Judi M. Woolger
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - John E. Lewis
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida
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10
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Aging with HIV in Latin America and the Caribbean: a Systematic Review. Curr HIV/AIDS Rep 2021; 18:1-47. [PMID: 33400168 DOI: 10.1007/s11904-020-00538-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE OF REVIEW With the establishment of antiretroviral treatment (ART) programs in low- and middle-income countries, people with HIV (PWH) in Latin America and the Caribbean (LAC) are living longer, subsequently developing chronic non-communicable diseases (NCDs). Few studies focus on the impact of aging among older LAC PWH. This systematic review aims to fill this information gap and understand the burden of aging with HIV in LAC. We identified peer-reviewed literature published in English, Spanish, or Portuguese from several databases to assess currently available evidence on the burden of aging with HIV in LAC and selected six common NCDs found in older PWH (cardiovascular disease [CVD], bone and musculoskeletal [MSK] disorders, cancer, renal disease, neurocognitive impairment [NCI], and depression). RECENT FINDINGS Of the 5942 publications reviewed, only 53 articles were found with populations 40 years and older or age-related findings (27 CVD, 13 NCI or depression, 6 MSK disorders, 4 renal disease, 3 cancer). Most (79%) publications were from Brazil with few longitudinal studies on aging with HIV. Prevalence of illnesses such as CVD, NCI, depression, or osteoporosis varied widely depending on the screening instrument utilized and geographic population surveyed. Age was a significant predictor of comorbidity in nearly all studies. Our results demonstrate the need for longitudinal studies and validated screening instruments appropriate for use among PWH in LAC. Understanding the mechanisms behind aging in HIV and the roles of sociocultural factors and genetic diversity specific to LAC is needed to appropriately manage chronic comorbidities as PWH age.
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11
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Ashwitha SK, Jacob PA, Ajaj A, Shirke MM, Harky A. Management of cardiovascular diseases in HIV/AIDS patients. J Card Surg 2020; 36:236-243. [PMID: 33225472 DOI: 10.1111/jocs.15213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 11/09/2020] [Indexed: 11/30/2022]
Abstract
Human immunodeficiency virus (HIV) infection/acquired immunodeficiency syndrome, a pandemic in the current population causes severe weakness of the body's immune system making the infected patient more vulnerable to life-threatening conditions. The disease predisposes the infected patient to several cardiovascular diseases and cerebrovascular diseases such as heart failure and stroke. The decline in CD4 cells following HIV infection, vulnerability to opportunistic infections and underlying HIV pathology plays a major role in the development of cardiovascular manifestations, and treatment targeting cardiomyopathy in this specific patient subset is not well recognized. Patients living with HIV (PLWH) also experience discrimination in receiving cardiovascular disease care and this needs to be addressed by strengthening frameworks for monitoring and providing nonjudgmental healthcare. This review aims to study the profile of the cardiovascular disease in HIV patients, treatment, and provide evidence of the disparity in the provision of healthcare with regard to PLWH.
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Affiliation(s)
- Santoshi K Ashwitha
- Department of Medicine, School of Medicine, Queen's University Belfast, Belfast, UK
| | - Preethi A Jacob
- Department of Medicine, School of Medicine, Queen's University Belfast, Belfast, UK
| | - Abdullah Ajaj
- Department of Medicine, School of Medicine, Queen's University Belfast, Belfast, UK
| | - Manasi M Shirke
- Department of Medicine, School of Medicine, Queen's University Belfast, Belfast, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.,Liverpool Heart and Chest Hospital, Department of Cardiovascular Science, University of Liverpool, Liverpool, UK.,Department of Cardiac Surgery, Alder Hey Children Hospital, Liverpool, UK
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12
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Aparecida Silveira E, Falco MO, Santos ASEADC, Noll M, de Oliveira C. Nutritional Intervention Reduces Dyslipidemia, Fasting Glucose and Blood Pressure in People Living with HIV/AIDS in Antiretroviral Therapy: A Randomized Clinical Trial Comparing Two Nutritional Interventions. Nutrients 2020; 12:E2970. [PMID: 32998416 PMCID: PMC7601880 DOI: 10.3390/nu12102970] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/25/2020] [Accepted: 09/23/2020] [Indexed: 11/16/2022] Open
Abstract
Antiretroviral therapy (ART) increases the risk of cardiometabolic diseases in people living with HIV/AIDS (PLWHA). However, there is a lack of evidence regarding the effectiveness of a nutritional intervention on several cardiometabolic parameters in this population. Therefore, this study aimed to evaluate the effectiveness of two nutritional interventions on several cardiometabolic parameters in PLWHA treated with ART. A parallel randomized clinical trial was performed with PLWHA treated with ART. The participants (n = 88) were divided into two intervention groups: (1) nutritional counseling (n = 44) and (2) individualized dietary prescription (n = 44). The follow-up period was 30 weeks. A reduction in low-density lipoprotein (LDL) was the primary outcome. Secondary outcome variables were reductions in total cholesterol (TC), triglycerides (TG), fasting plasma glucose (FPG), systolic and diastolic blood pressures (SBP and DBP, respectively), waist circumference (WC), body mass index (BMI), and increases in high-density lipoproteins (HDL). A multiple linear regression was used to analyze the effectiveness of the interventions, adjusted for sociodemographic, lifestyle, and clinical characteristics. Sixty-two PLWHA completed the trial (nutritional counseling, n = 32; individualized dietary prescription, n = 30). At follow-up, we observed in the nutritional counseling group significant reductions in SBP (p = 0.036) and DBP (p = 0.001). Significant reductions in FPG (p = 0.008) and DBP (p = 0.023) were found in the individualized dietary prescription group. In the fully adjusted models, significant reductions in LDL, SBP, DBP, and BMI were found in the individualized dietary prescription group. In conclusion, the two investigated nutritional interventions were effective in reducing some cardiometabolic risk factors in PLWHA. However, after adjustments for covariates, the individualized dietary prescription showed significant reductions in the primary outcome and, also, in more cardiometabolic risk factors than the nutritional counseling.
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Affiliation(s)
- Erika Aparecida Silveira
- Department of Epidemiology & Public Health, Institute of Epidemiology & Health Care, University College London, London WC1E 6BT, UK
- Postgraduate Program in Health Sciences, Faculty of Medicine, Federal University of Goiás, Goiânia 74605-050, Brazil; (M.O.F.); (A.S.e.A.d.C.S.)
| | - Marianne Oliveira Falco
- Postgraduate Program in Health Sciences, Faculty of Medicine, Federal University of Goiás, Goiânia 74605-050, Brazil; (M.O.F.); (A.S.e.A.d.C.S.)
| | | | - Matias Noll
- Department of Public Health, Instituto Federal Goiano, Ceres 76300-000, Brazil;
| | - Cesar de Oliveira
- Department of Epidemiology & Public Health, Institute of Epidemiology & Health Care, University College London, London WC1E 6BT, UK
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13
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Wing RR, Becofsky K, Wing EJ, McCaffery J, Boudreau M, Evans EW, Unick J. Behavioral and Cardiovascular Effects of a Behavioral Weight Loss Program for People Living with HIV. AIDS Behav 2020; 24:1032-1041. [PMID: 31004243 DOI: 10.1007/s10461-019-02503-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
We recently reported that a 12-week internet weight loss program produced greater weight losses than education control in overweight/obese people living with HIV (PLWH) (4.4 kg vs 1.0 kg; p < 0.05). This manuscript presents the changes in diet, physical activity, behavioral strategies, and cardio-metabolic parameters. Participants (N = 40; 21 males, 19 females) were randomly assigned to an internet behavioral weight loss (WT LOSS) program or internet education control (CONTROL) and assessed before and after the 12-week program. Compared to CONTROL, the WT LOSS arm reported greater use of behavioral strategies, decreases in intake (- 681 kcal/day; p = 0.002), modest, non-significant, increases in daily steps (+ 1079 steps/day) and improvements on the Healthy Eating Index. There were no significant effects on cardio-metabolic parameters. The study suggests that a behavioral weight loss program increases the use of behavioral strategies and modestly improves dietary intake and physical activity in PLWH. Further studies with larger sample sizes and longer follow-up are needed.Clinical Trials Registration: NCT02421406.
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Affiliation(s)
- Rena R Wing
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University and The Miriam Hospital, Providence, RI, USA.
- Weight Control and Diabetes Research Center, 196 Richmond Street, Providence, RI, 02903, USA.
| | - Katie Becofsky
- Department of Kinesiology, University of Massachuetts Amherst, Amherst, MA, USA
| | - Edward J Wing
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Jeanne McCaffery
- Allied Health Science, University of Connecticut, Storrs, CT, USA
| | | | - E Whitney Evans
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University and The Miriam Hospital, Providence, RI, USA
- Weight Control and Diabetes Research Center, 196 Richmond Street, Providence, RI, 02903, USA
| | - Jessica Unick
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University and The Miriam Hospital, Providence, RI, USA
- Weight Control and Diabetes Research Center, 196 Richmond Street, Providence, RI, 02903, USA
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14
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Abstract
Obesity and chronic disease are growing problems among people living with HIV (PLWH) across the globe. While a variety of treatments have been developed to address cardiovascular and metabolic disease among PLWH, few treatments have focused on helping PLWH and obesity lose weight. In the general population, behavioral weight loss interventions (i.e., diet, physical activity, and behavior therapy) are the first-line treatment for adults for whom weight loss is recommended. However, little research has tested whether the benefits of these programs translate to PLWH. This paper highlights the key components of behavioral weight loss programs, their outcomes in the general population and in the few studies of PLWH, and suggestions for tailoring these programs for PLWH. Behavioral weight loss programs are a strong potential treatment for reducing the burden of obesity among PLWH and merit future research attention.
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15
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Abstract
PURPOSE OF REVIEW The proportion of overweight and obese persons with HIV (PWH) has increased since the introduction of antiretroviral therapy (ART). We aim to summarize recent literature on risks of weight gain, discuss adipose tissue changes in HIV and obesity, and synthesize current understanding of how excess adiposity and HIV contribute to metabolic complications. RECENT FINDINGS Recent studies have implicated contemporary ART regimens, including use of integrase strand transfer inhibitors and tenofovir alafenamide, as a contributor to weight gain, though the mechanisms are unclear. Metabolic dysregulation is linked to ectopic fat and alterations in adipose immune cell populations that accompany HIV and obesity. These factors contribute to an increasing burden of metabolic diseases in the aging HIV population. Obesity compounds an increasing burden of metabolic disease among PWH, and understanding the role of fat partitioning and HIV- and ART-related adipose tissue dysfunction may guide prevention and treatment strategies.
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Affiliation(s)
- Samuel S Bailin
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, 1161 21st Avenue South, Nashville, TN, 37232-2582, USA
| | - Curtis L Gabriel
- Division of Gastroenterology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Celestine N Wanjalla
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, 1161 21st Avenue South, Nashville, TN, 37232-2582, USA
| | - John R Koethe
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, 1161 21st Avenue South, Nashville, TN, 37232-2582, USA.
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16
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Masters MC, Perez J, Tassiopoulos K, Andrade A, Ellis R, Yang J, Brown TT, Palella FJ, Erlandson KM. Gait Speed Decline Is Associated with Hemoglobin A1C, Neurocognitive Impairment, and Black Race in Persons with HIV. AIDS Res Hum Retroviruses 2019; 35:1065-1073. [PMID: 31468979 DOI: 10.1089/aid.2019.0101] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Gait speed declines at a faster rate in persons with HIV (PWH) than in the general population but the risk factors associated with this decline are not well understood. In the AIDS Clinical Trials Group (ACTG) A5322 (HAILO, HIV Infection, Aging, and Immune Function Long-term Observational Study), an observational cohort study of PWH ≥40 years of age, those who developed slow gait during the first 3 years of follow-up were compared with persons who maintained normal speed. Associations with demographic and clinical covariates were assessed using multivariable logistic regression. Of 929 participants, 81% were men, 31% Black, and 20% Hispanic. Median age was 51 years [interquartile range (IQR) = 46-56]. At study entry, 92% had plasma HIV RNA <50 copies/mL with median CD4 count 631 cells/mm3 (IQR = 458-840). At study entry, 7% of participants had slow gait, 16% had neurocognitive impairment (NCI), and 12% had diabetes. Over 3 years, 87% maintained normal gait speed, 3% maintained a slow gait, 6% developed a slow gait, and 4% improved from slow to normal gait speed. In multivariable models, hemoglobin A1C (HbA1C) percentage, per one unit increase [odds ratio (OR) = 1.36; 95% confidence interval (CI) = 1.03-1.81; p = .033], NCI (OR = 3.47; 95% CI = 1.57-7.69 p = .002), and black versus white race (OR = 2.45; 95% CI = 1.08-5.59; p = .032) at entry were significantly associated with development of slow gait compared with those maintaining normal gait speed. The association between baseline HbA1C and development of slow gait speed highlights an intervenable target to prevent progression of physical function limitations.
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Affiliation(s)
- Mary Clare Masters
- Division of Infectious Diseases, Northwestern University, Chicago, Illinois
| | - Jeremiah Perez
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Katherine Tassiopoulos
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | | | - Ronald Ellis
- Department of Neurosciences, University of California, San Diego, California
| | - Jingyan Yang
- Mailman School of Public Health, Columbia University, New York, New York
| | - Todd T. Brown
- Division of Endocrinology, Diabetes, & Metabolism, Johns Hopkins University, Baltimore, Maryland
| | - Frank J. Palella
- Division of Infectious Diseases, Northwestern University, Chicago, Illinois
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17
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Ghayomzadeh M, Etesami MS, Earnest CP, Rezaei S, Navalta JW, Taj L, SeyedAlinaghi S, Mohraz M, Gharakhanlou R, Voltarelli FA. Effect of a Short-term Lifestyle Modification Program on Quality of Life, Anthropometric Characteristics and CD4+T Cell Count of HIV Infected Patients in Tehran/Iran: A Randomized Controlled Trial. Explore (NY) 2019; 15:308-315. [PMID: 30833130 DOI: 10.1016/j.explore.2019.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 01/18/2019] [Accepted: 01/31/2019] [Indexed: 02/08/2023]
Abstract
CONTEXT Increasing physical activity and promoting healthy behaviors may play a key role in reducing the adverse effects of antiretroviral therapy and HIV. OBJECTIVE This study investigated the effects of an 8-week lifestyle modification program (LMP) on quality of life, anthropometric characteristics and CD4+T cell count of people living with HIV (PLWH). METHODS Thirty PLWH taking ART were randomly assigned to a lifestyle modification program (LMP) (n = 15) or standard care control (CON) group (n = 15). All volunteers underwent body composition, CD4+T cell count measurement and quality of life assessments at the beginning and end of a two-month experimental period. RESULTS At follow-up, we observed a significant increase in CD4+T cell count (117.52 cells/mm3; 95% CI, 36.59-198.45) and all subscales and total quality of life score (Short-Form 36 (SF-36) in the LMP group. While we did not observe a significant change in body composition for the LMP group, we did observe a significant increase in body fat (1.75%; 95% CI, 0.15, 2.33) and a reduction in lean body mass (-1.26; 95% CI, -1.26, -2.39) for the CON group. CONCLUSION A LMP can be safely used as an effective intervention for improving quality of life and immune competence of PLWH who lack time to participate in a structured exercise regimen. TRIAL REGISTRATION IRCT 201604034076N18. Registered: 2016-05-05 .web address of TRIAL: en.search.irct.ir/trial/4262.
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Affiliation(s)
- Morteza Ghayomzadeh
- Department of Sport Sciences, Faculty of Humanities, Tarbiat Modares University, Tehran, Iran
| | | | - Conrad P Earnest
- Exercise and Sport Nutrition Laboratory, Texas A&M University, College Station, TX, USA
| | - Sajjad Rezaei
- Department of Sport Sciences, Faculty of Humanities, Tarbiat Modares University, Tehran, Iran
| | - James Wilfred Navalta
- Department of Kinesiology and Nutrition Sciences, University of Nevada, Las Vegas, NV, USA
| | - Leila Taj
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - SeyedAhmad SeyedAlinaghi
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran.
| | - Minoo Mohraz
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Gharakhanlou
- Department of Sport Sciences, Faculty of Humanities, Tarbiat Modares University, Tehran, Iran
| | - Fabrício Azevedo Voltarelli
- Graduation Program of Health Sciences, Faculty of Medicine, Federal University of Mato Grosso, Cuiabá, Brazil
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18
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Weiss JJ, Sanchez L, Hubbard J, Lo J, Grinspoon SK, Fitch KV. Diet Quality Is Low and Differs by Sex in People with HIV. J Nutr 2019; 149:78-87. [PMID: 30624677 PMCID: PMC6351143 DOI: 10.1093/jn/nxy241] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 08/31/2018] [Indexed: 01/04/2023] Open
Abstract
Background People with HIV (PWH) are at risk for developing metabolic comorbidities driven, in part, by immune activation/inflammation. Little is known about diet quality, a potential modifiable factor in PWH. Objectives This study aimed to explore diet quality in terms of conformance with US dietary guidelines by calculating Healthy Eating Index-2010 (HEI) scores among adults with and without HIV in Boston, MA, and determine associations with HEI and markers of immune activation/inflammation. Methods One-hundred and three HIV-infected [50 women, 53 men; mean ± SD age: 47 ± 7 y; body mass index (BMI, in kg/m2): 26 ± 5] and 38 uninfected adults (17 women, 21 men; age: 46 ± 7 y; BMI: 28 ± 4) were included in this cross-sectional analysis. Participants who completed a 4-d food record from which HEI could be calculated were included. HEI was compared between participants with and without HIV, within HIV-infected participants stratified by sex, and by HIV serostatus and sex. In the HIV group, predictors of HEI were determined in multivariable modeling. Univariate associations with diet quality and inflammation/immune markers were assessed. Results The HEI score was 51.3 in the HIV-infected participants and 57.3 in the HIV-uninfected participants (P = 0.052). In the comparison by HIV serostatus and sex, HIV-infected women had significantly lower HEI (49.2) compared with HIV-infected men (55.7) (P = 0.005) and HIV-uninfected men (61.8) (P = 0.002). Adjusting for potential confounding factors, sex remained an independent predictor of HEI in HIV (P = 0.02). In the HIV group, higher log HEI was associated with lower concentration of the immune activation marker sCD14 (P = 0.009). Conclusions Diet quality tended to be lower in HIV-infected individuals compared with HIV-uninfected individuals and was lower among HIV-infected women compared with HIV-infected men, and HIV-uninfected men. There may also be an association with diet quality and sCD14 in PWH. Future prospective studies are needed to confirm these findings and determine whether improving diet quality is a useful strategy to reduce metabolic abnormalities in this population. This study was registered at clinicaltrials.gov as NCT00455793.
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Affiliation(s)
- Julian J Weiss
- Program in Nutritional Metabolism, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Laura Sanchez
- Program in Nutritional Metabolism, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Jane Hubbard
- Translational and Clinical Research Center, Massachusetts General Hospital, Boston, MA
| | - Janet Lo
- Program in Nutritional Metabolism, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Steven K Grinspoon
- Program in Nutritional Metabolism, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Kathleen V Fitch
- Program in Nutritional Metabolism, Massachusetts General Hospital and Harvard Medical School, Boston, MA,Address correspondence to KVF (e-mail: )
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19
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Stroke in HIV. Can J Cardiol 2018; 35:280-287. [PMID: 30825950 DOI: 10.1016/j.cjca.2018.11.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 11/21/2018] [Accepted: 11/30/2018] [Indexed: 12/26/2022] Open
Abstract
Stroke is a heterogeneous disease in persons living with human immunodeficiency virus (HIV). HIV is thought to increase the risk of stroke through both HIV-related and traditional stroke risk factors, which vary with respect to the patient's age and clinical characteristics. Numerous studies show that detectable viremia and immunosuppression increase the risk of stroke across all ages, whereas traditional risk factors are more common in the aging population with HIV. As persons living with HIV age and acquire traditional stroke risk factors, the prevalence of stroke will likely continue to increase. Large- and small-vessel disease are the most common causes of stroke, although it is important to evaluate for infectious etiology as well. Research regarding the management of stroke in patients with HIV is scant, and recommendations often parallel those for the general population. Treatment of HIV and effective reduction of traditional stroke risk factors is important to reduce the risk of stroke in persons living with HIV. Future research will help elucidate the pathophysiology of HIV and stroke risk, investigate sex differences in stroke risk, and evaluate the safety and benefits of standard stroke preventative measures and HIV-specific interventions in this population.
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20
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Pérez Chaparro CGA, Zech P, Schuch F, Wolfarth B, Rapp M, Heiβel A. Effects of aerobic and resistance exercise alone or combined on strength and hormone outcomes for people living with HIV. A meta-analysis. PLoS One 2018; 13:e0203384. [PMID: 30180202 PMCID: PMC6122835 DOI: 10.1371/journal.pone.0203384] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 08/20/2018] [Indexed: 01/20/2023] Open
Abstract
Background Infection with human immunodeficiency virus (HIV) affects muscle mass, altering independent activities of people living with HIV (PLWH). Resistance training alone (RT) or combined with aerobic exercise (AE) is linked to improved muscle mass and strength maintenance in PLWH. These exercise benefits have been the focus of different meta-analyses, although only a limited number of studies have been identified up to the year 2013/4. An up-to-date systematic review and meta-analysis concerning the effect of RT alone or combined with AE on strength parameters and hormones is of high value, since more and recent studies dealing with these types of exercise in PLWH have been published. Methods Randomized controlled trials evaluating the effects of RT alone, AE alone or the combination of both (AERT) on PLWH was performed through five web-databases up to December 2017. Risk of bias and study quality was attained using the PEDro scale. Weighted mean difference (WMD) from baseline to post-intervention changes was calculated. The I2 statistics for heterogeneity was calculated. Results Thirteen studies reported strength outcomes. Eight studies presented a low risk of bias. The overall change in upper body strength was 19.3 Kg (95% CI: 9.8–28.8, p< 0.001) after AERT and 17.5 Kg (95% CI: 16–19.1, p< 0.001) for RT. Lower body change was 29.4 Kg (95% CI: 18.1–40.8, p< 0.001) after RT and 10.2 Kg (95% CI: 6.7–13.8, p< 0.001) for AERT. Changes were higher after controlling for the risk of bias in upper and lower body strength and for supervised exercise in lower body strength. A significant change towards lower levels of IL-6 was found (-2.4 ng/dl (95% CI: -2.6, -2.1, p< 0.001). Conclusion Both resistance training alone and combined with aerobic exercise showed a positive change when studies with low risk of bias and professional supervision were analyzed, improving upper and, more critically, lower body muscle strength. Also, this study found that exercise had a lowering effect on IL-6 levels in PLWH.
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Affiliation(s)
- Camilo Germán Alberto Pérez Chaparro
- University Outpatient Clinic–Center for Sports Medicine, Department Sports & Health Sciences, University of Potsdam, Potsdam, Brandenburg, Germany
- * E-mail:
| | - Philipp Zech
- Social and Preventive Medicine, Department Exercise and Health Sciences, University of Potsdam, Potsdam, Brandenburg, Germany
| | - Felipe Schuch
- Post-graduate Program in Health and Human Development, La Salle University, Canoas, RS, Brazil
| | - Bernd Wolfarth
- Department of Sports Sciences, Division of Sports Medicine, Humboldt Universität zu Berlin, Berlin, Germany
| | - Michael Rapp
- Social and Preventive Medicine, Department Exercise and Health Sciences, University of Potsdam, Potsdam, Brandenburg, Germany
| | - Andreas Heiβel
- Social and Preventive Medicine, Department Exercise and Health Sciences, University of Potsdam, Potsdam, Brandenburg, Germany
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21
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Noncommunicable diseases among HIV-infected persons in low-income and middle-income countries: a systematic review and meta-analysis. AIDS 2018; 32 Suppl 1:S5-S20. [PMID: 29952786 DOI: 10.1097/qad.0000000000001888] [Citation(s) in RCA: 151] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To appropriately identify and treat noncommunicable diseases (NCDs) among persons living with HIV (PLHIV) in low-and-middle-income countries (LMICs), it is imperative to understand the burden of NCDs among PLHIV in LMICs and the current management of the diseases. DESIGN Systematic review and meta-analysis. METHODS We examined peer-reviewed literature published between 1 January 2010 and 31 December 2016 to assess currently available evidence regarding HIV and four selected NCDs (cardiovascular disease, cervical cancer, depression, and diabetes) in LMICs with a focus on sub-Saharan Africa. The databases, PubMed/MEDLINE, Cochrane Review, and Scopus, were searched to identify relevant literature. For conditions with adequate data available, pooled estimates for prevalence were generated using random fixed effects models. RESULTS Six thousand one hundred and forty-three abstracts were reviewed, 377 had potentially relevant prevalence data and 141 were included in the summary; 57 were selected for quantitative analysis. Pooled estimates for NCD prevalence were hypertension 21.2% (95% CI 16.3-27.1), hypercholesterolemia 22.2% (95% CI 14.7-32.1), elevated low-density lipoprotein 23.2% (95% CI 15.2-33.6), hypertriglyceridemia 27.2% (95% CI 20.7-34.8), low high-density lipoprotein 52.3% (95% CI 35.6-62.8), obesity 7.8% (95% CI 4.3-13.9), and depression 24.4% (95% CI 12.5-42.1). Invasive cervical cancer and diabetes prevalence were 1.3-1.7 and 1.3-18%, respectively. Few NCD-HIV integrated programs with screening and management approaches that are contextually appropriate for resource-limited settings exist. CONCLUSION Improved data collection and surveillance of NCDs among PLHIV in LMICs are necessary to inform integrated HIV/NCD care models. Although efforts to integrate care exist, further research is needed to optimize the efficacy of these programs.
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22
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Levy ME, Greenberg AE, Hart R, Powers Happ L, Hadigan C, Castel A. High burden of metabolic comorbidities in a citywide cohort of HIV outpatients: evolving health care needs of people aging with HIV in Washington, DC. HIV Med 2017; 18:724-735. [PMID: 28503912 DOI: 10.1111/hiv.12516] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2017] [Indexed: 12/23/2022]
Abstract
OBJECTIVES With the increasing impact of cardiovascular disease among populations aging with HIV, contemporary prevalence estimates for predisposing metabolic comorbidities will be important for guiding the provision of relevant lifestyle and pharmacological interventions. We estimated the citywide prevalence of hypertension, type 2 diabetes, dyslipidaemia, and obesity; examined differences by demographic subgroups; and assessed clinical correlates. METHODS Utilizing an electronic medical record (EMR) database from the DC Cohort study - a multicentre prospective cohort study of HIV-infected outpatients - we assessed the period prevalence of metabolic comorbidities between 2011 and 2015 using composite definitions that incorporated diagnoses, pharmacy records, and clinical/laboratory results. RESULTS Of 7018 adult patients (median age 50 years; 77% black), 50% [95% confidence interval (CI) 49-51] had hypertension, 13% (95% CI: 12-14) had diabetes, 48% (95% CI: 47-49) had dyslipidaemia, and 35% (95% CI: 34-36) had obesity. Hypertension was more prevalent among black patients, diabetes and obesity were more prevalent among female and black patients, dyslipidaemia was more prevalent among male and white patients, and comorbidities were more prevalent among older patients (all P < 0.001). For many patients, evidence of treatment for these comorbidities was not available in the EMR. Longer time since HIV diagnosis, greater duration of antiretroviral treatment, and having controlled immunovirological parameters were associated with metabolic comorbidities. CONCLUSIONS These findings underscore the pervasive burden of metabolic comorbidities among HIV-infected persons, serve as the basis for future analyses characterizing their impact on subsequent adverse cardiovascular outcomes, and highlight the need for an increased focus on the prevention and control of comorbid complications in this population.
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Affiliation(s)
- M E Levy
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health at the George Washington University, Washington, DC, USA
| | - A E Greenberg
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health at the George Washington University, Washington, DC, USA
| | - R Hart
- Research Department, Cerner Corporation, Kansas City, MO, USA
| | - L Powers Happ
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health at the George Washington University, Washington, DC, USA
| | - C Hadigan
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - A Castel
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health at the George Washington University, Washington, DC, USA
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23
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Reeds DN, Pietka TA, Yarasheski KE, Cade WT, Patterson BW, Okunade A, Abumrad NA, Klein S. HIV infection does not prevent the metabolic benefits of diet-induced weight loss in women with obesity. Obesity (Silver Spring) 2017; 25:682-688. [PMID: 28245099 PMCID: PMC5373981 DOI: 10.1002/oby.21793] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 12/07/2016] [Accepted: 01/04/2017] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To test the hypothesis that HIV infection impairs the beneficial effects of weight loss on insulin sensitivity, adipose tissue inflammation, and endoplasmic reticulum (ER) stress. METHODS A prospective clinical trial evaluated the effects of moderate diet-induced weight loss on body composition, metabolic function, and adipose tissue biology in women with obesity who were HIV-seronegative (HIV-) or HIV-positive (HIV+). Body composition, multiorgan insulin sensitivity (assessed by using a two-stage hyperinsulinemic-euglycemic clamp procedure with stable isotopically labeled tracer infusions), and adipose tissue expression of markers of inflammation, autophagy, and ER stress were evaluated in 8 HIV- and 20 HIV+ women with obesity before and after diet-induced weight loss of 6% to 8%. RESULTS Although weight loss was not different between groups (∼7.5%), the decrease in fat-free mass was greater in HIV+ than HIV- subjects (-4.4 ± 0.7% vs. -1.7 ± 1.0%, P < 0.05). Weight loss improved insulin sensitivity in adipose tissue (suppression of palmitate rate of appearance [Ra]), liver (suppression of glucose Ra), and muscle (glucose disposal) similarly in both groups. Weight loss did not affect adipose tissue expression of markers of inflammation or ER stress in either group. CONCLUSIONS Moderate diet-induced weight loss improves multiorgan insulin sensitivity in HIV+ women to the same extent as women who are HIV-. However, weight loss causes a greater decline in fat-free mass in HIV+ than HIV- women.
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Affiliation(s)
- Dominic N Reeds
- Center for Human Nutrition, Washington University School of Medicine, St Louis, Missouri, USA
| | - Terri A Pietka
- Center for Human Nutrition, Washington University School of Medicine, St Louis, Missouri, USA
| | - Kevin E Yarasheski
- Center for Human Nutrition, Washington University School of Medicine, St Louis, Missouri, USA
| | - W Todd Cade
- Center for Human Nutrition, Washington University School of Medicine, St Louis, Missouri, USA
| | - Bruce W Patterson
- Center for Human Nutrition, Washington University School of Medicine, St Louis, Missouri, USA
| | - Adewole Okunade
- Center for Human Nutrition, Washington University School of Medicine, St Louis, Missouri, USA
| | - Nada A Abumrad
- Center for Human Nutrition, Washington University School of Medicine, St Louis, Missouri, USA
| | - Samuel Klein
- Center for Human Nutrition, Washington University School of Medicine, St Louis, Missouri, USA
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24
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Benedini S, Luzi L. Lipodystrophy HIV-related and FGF21: A new marker to follow the progression of lipodystrophy? J Transl Int Med 2016; 4:150-154. [PMID: 28191538 DOI: 10.1515/jtim-2016-0026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Recently new evidence about fibroblast growth factor 21 (FGF21) highlights the opportunities to use this molecule in new pharmaceutical formulations to combat type 2 diabetes and metabolic syndrome. It is well known that HIV is per se a condition of insulin resistance and in particular the patient with HIV-related lipodystrophy has a condition strictly related to metabolic syndrome. Lipodystrophy is associated with severe metabolic side effects, including dyslipidemia, hepatic insulin resistance, and lipid oxidation impairment. Research carried out showed that FGF21 levels were significantly increased in untreated HIV-1-infected patients and the increase was much marked in HIV-1-infected antiretroviral-treated patients that have developed lipodystrophy and in the patients with greatest metabolic alterations. FGF21 is expressed mainly by the liver, but also by other tissues such as the thymus, adipose tissue, and skeletal muscle. Therefore, many researchers have considered the investigation of possible variations of FGF21 in patients with significant alterations in body composition both in regard to fat mass and lean mass. In the light of the possible interactions between FGF21 and metabolic syndrome, it seems interesting to evaluate the implication of this hormone in patients with HIV-related lipodystrophy who have a severe metabolic picture of insulin resistance with important alterations in body composition.
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Affiliation(s)
- Stefano Benedini
- Department of Biomedical Sciences and Health, Università degli Studi di Milano, Milan, Italy; Endocrinology Unit, IRCCS Policlinico San Donato, San Donato M.se (MI), Italy
| | - Livio Luzi
- Department of Biomedical Sciences and Health, Università degli Studi di Milano, Milan, Italy; Endocrinology Unit, IRCCS Policlinico San Donato, San Donato M.se (MI), Italy; Metabolism Research Center, IRCCS Policlinico San Donato, Milan, Italy
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25
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Willig AL, Overton ET. Metabolic Complications and Glucose Metabolism in HIV Infection: A Review of the Evidence. Curr HIV/AIDS Rep 2016; 13:289-96. [PMID: 27541600 PMCID: PMC5425100 DOI: 10.1007/s11904-016-0330-z] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
HIV infection and antiretroviral therapy (ART) use are associated with perturbations in glucose and lipid metabolism. Increasing incidence of diabetes, cardiovascular disease, and obesity highlights the need for early identification and treatment of metabolic dysfunction. Newer ART regimens are less toxic for cellular function and metabolism but have failed to completely eliminate metabolic dysfunction with HIV infection. Additional factors, including viral-host interactions, diet, physical activity, non-ART medications, and aging may further contribute to metabolic disease risk in the HIV setting. We summarize the recent literature regarding the impact on metabolic function of HIV infection, ART, and pharmaceutical or lifestyle prescriptions.
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Affiliation(s)
- Amanda L Willig
- Division of Infectious Diseases. UAB Center for AIDS Research, University of Alabama School of Medicine, 845 19th Street South, BBRB 207, Birmingham, AL, 35294, USA
| | - Edgar Turner Overton
- Division of Infectious Diseases, University of Alabama School of Medicine, 908 20th St, South, CCB Rm 330A, Birmingham, AL, 35294, USA.
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26
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Papagianni M, Tziomalos K. Obesity in patients with HIV infection: epidemiology, consequences and treatment options. Expert Rev Endocrinol Metab 2016; 11:395-402. [PMID: 30058909 DOI: 10.1080/17446651.2016.1220297] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Even though wasting used to characterize patients with HIV infection prior to the antiretroviral therapy (ART) era, obesity is becoming increasingly prevalent in this population. Areas covered: In the present review, we discuss the epidemiology, consequences and treatment options for obesity in patients with HIV infection. Expert commentary: Obesity exerts a multitude of detrimental cardiometabolic effects and appears to contribute to the increasing cardiovascular mortality of this population. However, there are very limited data on the optimal management of obesity in patients with HIV infection. Given the potential for interactions between antiobesity agents and ART that might compromise viral control, lifestyle changes should represent the cornerstone for the prevention and management of obesity in HIV infection.
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Affiliation(s)
- Marianthi Papagianni
- a First Propedeutic Department of Internal Medicine, Medical School , Aristotle University of Thessaloniki, AHEPA Hospital , Thessaloniki , Greece
| | - Konstantinos Tziomalos
- a First Propedeutic Department of Internal Medicine, Medical School , Aristotle University of Thessaloniki, AHEPA Hospital , Thessaloniki , Greece
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Lamarca K, García Sarasola A, Vidal F, Domingo P. Drug therapies for HIV-related metabolic disorders. Expert Opin Pharmacother 2016; 17:1327-38. [PMID: 27192322 DOI: 10.1080/14656566.2016.1187133] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Human immunodeficiency virus (HIV) has become a chronic disease often associated with dyslipidaemia and insulin resistance. Combination antiretroviral therapy (cART) may contribute to metabolic disturbances, eventually leading to increased cardiovascular disease (CVR) in this population. Escalating interventions to decrease CVR include promoting a healthy lifestyle, such as quitting smoking, diet and regular exercise. If they do not achieve the goals, a change of cART should be considered, followed by or used concomitantly with the use of chemical therapies. AREAS COVERED The aim of this article is to review the available drug therapies for the treatment of metabolic disorders in HIV-infected patients and to examine their safety and effectiveness in this population. A review of the literature was conducted, highlighting the most relevant articles. EXPERT OPINION Switching strategies can be useful but its expected benefit is not high. Therefore, chemical intervention is often needed. Statins have been proven to reduce CVR in the general population and in HIV-infected patients. Simvastatin is contraindicated in patients treated with boosted PI due to interactions; atorvastatin is safe at submaximal dose and needs close monitoring, while pravastatin lacks lipid-lowering potency, and rosuvastatin and pitavastatin are safe. Ezetimibe and fibrates are also safe and effective in HIV-infected patients and can be used in combination with statins. The management of glucose homeostatic disorders in HIV-infected patients follows the same guidelines as in the general population. However, there are specific considerations with respect to the interactions of particular medications with cART. When drug therapy is needed, metformin is the first-line drug. Decisions regarding second- and third-line drugs should be carefully individualized.
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Affiliation(s)
- Karuna Lamarca
- a Infectious Diseases Unit , Hospital de la Santa Creu I Sant Pau, Universitat Autònoma de Barcelona , Barcelona , Spain
| | - Ana García Sarasola
- a Infectious Diseases Unit , Hospital de la Santa Creu I Sant Pau, Universitat Autònoma de Barcelona , Barcelona , Spain
| | - Francesc Vidal
- b Infectious Diseases Unit , Hospital Universitari Joan XXIII , Tarragona , Spain
| | - Pere Domingo
- c Infectious Diseases Department, Institut de Recerca Biomèdica (IRB) de Lleida , Hospitals Universitaris Arnau de Vilanova & Santa María, Universitat de Lleida , Lleida , Spain
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Lee G, Choi HY, Yang SJ. [Effects of Dietary and Physical Activity Interventions on Metabolic Syndrome: A Meta-analysis]. J Korean Acad Nurs 2016; 45:483-94. [PMID: 26364523 DOI: 10.4040/jkan.2015.45.4.483] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 01/31/2015] [Accepted: 05/26/2015] [Indexed: 11/09/2022]
Abstract
PURPOSE This study identified effects of dietary and physical activity interventions including dietary interventions or physical activity interventions alone or combined dietary-physical activity interventions to improve symptoms in metabolic syndrome including abdominal obesity, high triglycerides, low high density lipoprotein cholesterol, elevated blood pressure, and elevated fasting glucose through meta-analysis. METHODS Articles on metabolic syndrome X published from 1988 to 2013 were searched through electronic databases, Google Scholar, and reference reviews. Methodological quality was assessed by the checklist, SIGN (Scottish Intercollegiate Guidelines Network). RESULTS In the meta-analysis, there were 9 articles reporting 13 interventions with 736 participants. Using random effect models, the dietary and/or physical activity interventions showed a lower mean difference in waist circumference (-1.30 cm, 95% CI:-2.44~-0.15, p=.027). The combined dietary-physical activity interventions showed a lower mean difference in waist circumference (-2.77 cm, 95% CI:-4.77~-0.76, p=.007) and systolic blood pressure (-5.44 mmHg, 95% CI:-10.76~-0.12, p=.044). Additionally, interventions of over 24 weeks yielded a lower mean difference in waist circumference (-2.78 cm, 95% CI:-4.69~-0.87, p=.004) and diastolic blood pressure (-1.93 mmHg, 95% CI:-3.63~-0.22, p=.026). CONCLUSION The findings indicate that dietary and/or physical activity interventions for metabolic syndrome reduce central obesity with no adverse effects. This finding provides objective evidences for dietary and physical activity management on metabolic syndrome as an efficient intervention.
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Affiliation(s)
- Guna Lee
- Division of Nursing Science, Ewha Womans University, Seoul, Korea
| | - Hye Young Choi
- Department of Nursing, Tongmyong University, Busan, Korea
| | - Sook Ja Yang
- Department of Nursing, Tongmyong University, Busan, Korea.
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Lin CH, Chiang SL, Heitkemper MM, Hung YJ, Lee MS, Tzeng WC, Chiang LC. Effects of telephone-based motivational interviewing in lifestyle modification program on reducing metabolic risks in middle-aged and older women with metabolic syndrome: A randomized controlled trial. Int J Nurs Stud 2016; 60:12-23. [PMID: 27297365 DOI: 10.1016/j.ijnurstu.2016.03.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 02/23/2016] [Accepted: 03/04/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Lifestyle modification is often difficult for middle-aged and older women living in the community who are at high risk of physical inactivity and metabolic syndrome. OBJECTIVES To examine the effects of telephone-based motivational interviewing in a 12-week lifestyle modification program on physical activity, MetS, metabolic risks (fasting plasma glucose, blood pressure, triglyceride, high-density lipoprotein, and central obesity), and the number of metabolic risks in community-living middle-aged and older women diagnosed with metabolic syndrome. RESEARCH DESIGN AND METHOD A randomized controlled trial was conducted. Recruited were 328 middle-aged and older women from a community health center in Taiwan. Eligible women medically diagnosed with metabolic syndrome (n=115) were randomly assigned to one of three groups: The experimental group received an individualized telephone delivered lifestyle modification program that included motivational interviewing delivered by an experienced nurse. The brief group received a single brief lifestyle modification counseling session with a brochure. The usual care group received standard care. Physical activity was assessed with the International Physical Activity Questionnaire and metabolic risks were determined by serum markers and anthropometric measures at pre- and post-intervention. One hundred women completed the study and an intention-to-treat analysis was performed. Generalized estimating equations were used to examine the intervention effects. RESULTS Women in the experimental group increased physical activity from 1609 to 1892 MET-min/week (β=846, p=.01), reduced the percentage of diagnosed with metabolic syndrome to 81.6% (β=-0.17, p=.003), and decreased the number of metabolic risks from 4.0 to 3.6 (β=-0.50, p<.001), compared to the usual care group (4.4-4.6). There was not a reduction in the percentage of diagnosed with metabolic syndrome in the brief group, but they had fewer metabolic risks after 12 weeks (mean=4.0 vs. 4.6, β=-0.2, p=.02) compared to the usual care group. CONCLUSIONS Motivational interviewing as a component of an individualized physical activity and lifestyle modification program has positive benefit in reducing metabolic risks in middle-aged and older women.
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Affiliation(s)
- Chia-Huei Lin
- Department of Nursing at Tri-Service General Hospital, School of Nursing, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Shang-Lin Chiang
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Margaret McLean Heitkemper
- Department of Biobehavioral Nursing and Health Systems, Division of Gastroenterology, School of Medicine, University of Washington, USA
| | - Yi-Jen Hung
- Division of Endocrinology & Metabolism, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Meei-Shyuan Lee
- School of Public Health & Graduated Institute of Medical Science, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Wen-Chii Tzeng
- School of Nursing, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Li-Chi Chiang
- School of Nursing & Graduated Institute of Medical Sciences, National Defense Medical Center & China Medical University, Taipei & Taichung, Taiwan, ROC.
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Saumoy M, Alonso-Villaverde C, Navarro A, Olmo M, Vila R, Ramon JM, Di Yacovo S, Ferrer E, Curto J, Vernet A, Vila A, Podzamczer D. Randomized trial of a multidisciplinary lifestyle intervention in HIV-infected patients with moderate-high cardiovascular risk. Atherosclerosis 2016; 246:301-8. [PMID: 26826629 DOI: 10.1016/j.atherosclerosis.2016.01.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 12/29/2015] [Accepted: 01/09/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the impact of a multidisciplinary lifestyle intervention on cardiovascular risk and carotid intima-media thickness (c-IMT) in HIV-infected patients with Framingham scores (FS) > 10%. DESIGN Randomized pilot study; follow-up 36 months. METHODS Virologically suppressed adult HIV-1-infected patients with FS >10% were randomized 1:1 to the intervention group (multidisciplinary lifestyle intervention) or control group (routine care). At baseline and months 12, 24 and 36, lipid parameters were analyzed and carotid ultrasound was performed to determine c-IMT and presence of plaques. Biomarkers were measured at baseline and month 36. The primary endpoints were lipid and FS changes at 36 months. RESULTS Fifty-four patients were included, 27 in each arm. Median age was 50.5 years, all patients but one were men, and FS was 16.5%. Relative to controls, total and LDL cholesterol had significantly decreased in the intervention group at 24 months (p = 0.039, p = 0.011, respectively). However, no differences between groups were found at month 36 in lipid variables, neither in FS. Tobacco use decreased in the intervention group (p = 0.031). At baseline, 74.5% of patients had subclinical atherosclerosis, and at month 36, we observed a progression in c-IMT that was greater in the intervention group (p = 0.030). D-dimer increased (p = 0.027) and soluble intercellular adhesion molecule-1 decreased (p = 0.018) at 36 months. CONCLUSIONS In this cohort of HIV-infected patients with FS>10% and a high percentage of subclinical atherosclerosis, a multidisciplinary lifestyle intervention resulted in a slight improvement in some cardiovascular risk factors and the FS during the first 2 years, but did not prevent c-IMT progression.
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Affiliation(s)
- Maria Saumoy
- HIV Unit, Infectious Disease Service, Bellvitge University Hospital, Bellvitge Biomedical Research Institute, Hospitalet de Llobregat, Spain.
| | | | - Antonio Navarro
- HIV Unit, Infectious Disease Service, Bellvitge University Hospital, Bellvitge Biomedical Research Institute, Hospitalet de Llobregat, Spain
| | - Montserrat Olmo
- HIV Unit, Infectious Disease Service, Bellvitge University Hospital, Bellvitge Biomedical Research Institute, Hospitalet de Llobregat, Spain
| | - Ramon Vila
- Vascular Surgery Service, Bellvitge University Hospital, Hospitalet de Llobregat, Spain
| | - Josep Maria Ramon
- Preventive Medicine Service, Bellvitge University Hospital, Hospitalet de Llobregat, Spain
| | - Silvana Di Yacovo
- HIV Unit, Infectious Disease Service, Bellvitge University Hospital, Bellvitge Biomedical Research Institute, Hospitalet de Llobregat, Spain
| | - Elena Ferrer
- HIV Unit, Infectious Disease Service, Bellvitge University Hospital, Bellvitge Biomedical Research Institute, Hospitalet de Llobregat, Spain
| | - Jordi Curto
- HIV Unit, Infectious Disease Service, Bellvitge University Hospital, Bellvitge Biomedical Research Institute, Hospitalet de Llobregat, Spain
| | - Antonio Vernet
- Department of Mechanical Engineering, Universitat Rovira i Virgili, Tarragona, Spain
| | - Antonia Vila
- HIV Unit, Infectious Disease Service, Bellvitge University Hospital, Bellvitge Biomedical Research Institute, Hospitalet de Llobregat, Spain
| | - Daniel Podzamczer
- HIV Unit, Infectious Disease Service, Bellvitge University Hospital, Bellvitge Biomedical Research Institute, Hospitalet de Llobregat, Spain
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Lifestyle Medicine and HIV-Infected Patients. LIFESTYLE MEDICINE 2016. [DOI: 10.1007/978-3-319-24687-1_32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Lin CH, Chiang SL, Tzeng WC, Chiang LC. Systematic review of impact of lifestyle-modification programs on metabolic risks and patient-reported outcomes in adults with metabolic syndrome. Worldviews Evid Based Nurs 2015; 11:361-8. [PMID: 25488565 DOI: 10.1111/wvn.12069] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Metabolic syndrome (MetS) is primarily attributed to an unhealthy lifestyle, which is a modifiable risk factor. Researchers have been exploring various strategies, including lifestyle-modification programs (LMPs), to prevent the progression of MetS. However, the effectiveness of LMPs on metabolic risks and patient-reported outcomes (PROs) among adults with MetS remains inconclusive. AIM To evaluate the effectiveness of LMPs on the metabolic risks and PROs among adults with MetS. METHODS A systematic review of randomized controlled trials published from January 1985 to June 2014 was conducted. The review extracted LMP interventions that included outcomes on the metabolic risks and PROs (quality of life and any other psychological health indicators). The quality of the included studies was assessed using the Cochrane Collaboration criteria. RESULTS Among the five trials included, the most commonly applied intervention components were diet plans, supervised exercise, health education, individual counseling, behavioral modification, and motivational interviewing. Three fifths of the studies were nurse-led, and only one of the selected trials was theory-guided. LMPs can effectively reduce triglyceride levels, waist circumference, and systolic blood pressure. However, few trials consistently confirmed the benefits of metabolic risks, and none revealed a significant effect on high-density lipoprotein, fasting blood glucose, or any PRO, except quality of life. The duration of LMPs in the included trials ranged from 4 to 24 weeks, and durations of at least 12 weeks significantly improved quality of life. LINKING EVIDENCE TO ACTION LMPs had positive effects on some metabolic risks and on quality of life, whereas longer-duration LMPs may have highly beneficial effects on quality of life. The essential elements of LMPs need to be evaluated more thoroughly to determine their effectiveness. Larger and more rigorous randomized controlled trials are required to assess the effectiveness of LMPs on metabolic risks and PROs among adults with MetS.
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Affiliation(s)
- Chia-Huei Lin
- Doctoral candidate, Graduate Institute of Medical Sciences, National Defense Medical Center; Lecturer of School of Nursing, National Defense Medical Center and Supervisor of Department of Nursing, Tri-Service General Hospital, Taipei, Taiwan
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Dagenais-Lussier X, Mouna A, Routy JP, Tremblay C, Sekaly RP, El-Far M, Grevenynghe JV. Current topics in HIV-1 pathogenesis: The emergence of deregulated immuno-metabolism in HIV-infected subjects. Cytokine Growth Factor Rev 2015; 26:603-13. [PMID: 26409789 DOI: 10.1016/j.cytogfr.2015.09.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 09/04/2015] [Indexed: 01/17/2023]
Abstract
HIV-1 infection results in long-lasting activation of the immune system including elevated production of pro-inflammatory cytokine/chemokines, and bacterial product release from gut into blood and tissue compartments, which are not fully restored by antiretroviral therapies. HIV-1 has also developed numerous strategies via viral regulatory proteins to hijack cell molecular mechanisms to enhance its own replication and dissemination. Here, we reviewed the relationship between viral proteins, immune activation/inflammation, and deregulated metabolism occurring in HIV-1-infected patients that ultimately dampens the protective innate and adaptive arms of immunity. Defining precisely the molecular mechanisms related to deregulated immuno-metabolism during HIV-1 infection could ultimately help in the development of novel clinical approaches to restore proper immune functions in these patients.
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Affiliation(s)
| | - Aounallah Mouna
- INRS-Institut Armand Frappier, 531 boulevard des Prairies, Laval, Quebec H7V 1B7, Canada
| | - Jean-Pierre Routy
- Division of Hematology and Chronic Viral Illness Service, McGill University Health Centre, Glen site, Montreal, Quebec H4A 3J1, Canada
| | | | | | | | - Julien van Grevenynghe
- INRS-Institut Armand Frappier, 531 boulevard des Prairies, Laval, Quebec H7V 1B7, Canada.
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Chotivichien S, Arab L, Prasithsirikul W, Manosuthi W, Sinawat S, Detels R. Effect of nutritional counseling on low-density lipoprotein cholesterol among Thai HIV-infected adults receiving antiretroviral therapy. AIDS Care 2015; 28:257-65. [PMID: 26295176 DOI: 10.1080/09540121.2015.1072127] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
HIV-infected patients receiving antiretroviral therapy have increased risk of metabolic syndrome, including dyslipidemia. In this study, we determined whether individual nutritional counseling reduced dyslipidemia, particularly low-density lipoprotein (LDL) cholesterol, among HIV-infected patients with dyslipidemia not currently taking lipid-lowering medication. We conducted a randomized 24-week trial among HIV-infected patients with dyslipidemia who were on antiretroviral therapy and were eligible to initiate therapeutic lifestyle changes according to the Thai National Cholesterol Education Program. Participants were randomly assigned to an intervention group that received individual counseling with a nutritionist for seven sessions (baseline, weeks 2, 4, 8, 12, 18, and 24) and a control group that received standard verbal diet information at baseline and nutritional counseling only at week 24. A 24-h recall technique was used to assess dietary intake for both groups at baseline and week 24. Lipid profile (total cholesterol, LDL, high-density lipoprotein (HDL), and triglyceride) was measured at baseline and after 12 and 24 weeks of therapy. An intention-to-treat and linear mixed model were used. Seventy-two patients were randomly assigned, and 62 (86%) participants completed their lipid profile test. After 12 weeks of follow-up, there were significant reductions in the intervention group for total cholesterol (-14.4 ± 4.6 mg/dL, P = .002), LDL cholesterol (-13.7 ± 4.1 mg/dL, P = .001), and triglyceride (-30.4 ± 13.8 mg/dL, P = .03). A significant reduction in LDL cholesterol was also observed in the control group (-7.7 ± 3.8 mg/dL, P = .04), but there were no significant differences in change of mean lipid levels between the groups at 12 weeks of follow-up. After 24 weeks, participants assigned to the intervention group demonstrated significantly greater decreases in serum total cholesterol (-19.0 ± 4.6 vs. 0.2 ± 4.3 mg/dL, P = .003) and LDL cholesterol (-21.5 ± 4.1 vs. -6.8 ± 3.8 mg/dL, P = .009). There were no significant changes in HDL cholesterol or triglyceride levels in either group.
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Affiliation(s)
- Saipin Chotivichien
- a Bureau of Nutrition, Department of Health , Ministry of Public Health , Nonthaburi , Thailand
| | - Lenore Arab
- b Department of Medicine , Division of General Internal Medicine and Health Services Research , 12-262 Factor, David Geffen School of Medicine at UCLA, Los Angeles , CA 90095-1736 , USA
| | - Wisit Prasithsirikul
- c Bamrasnaradura Infectious Diseases Institute, Medicine , Nonthaburi , Thailand
| | - Weerawat Manosuthi
- c Bamrasnaradura Infectious Diseases Institute, Medicine , Nonthaburi , Thailand
| | - Sangsom Sinawat
- d Department of Health , Ministry of Public Health, Bureau of Technical Advisors , Nonthaburi , Thailand
| | - Roger Detels
- e Department of Epidemiology , UCLA/Fielding School of Public Health , 71-269 CHS, Los Angeles , CA , USA
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Galescu O, Bhangoo A, Ten S. Insulin resistance, lipodystrophy and cardiometabolic syndrome in HIV/AIDS. Rev Endocr Metab Disord 2013; 14:133-40. [PMID: 23700046 DOI: 10.1007/s11154-013-9247-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
HIV associated insulin resistance, lipodistrophy and cardiometabolic syndrome have been extensively studied and continue to be the scope of much research. There is compelling evidence that both the HIV itself and the therapeutical regimes are major contributors to all of these associated comorbidities. HIV has increasingly been recognized as a disease of accelerated aging, manifested by increased progression of vascular disease and cellular markers of aging. The antiretroviral medication can increase insulin resistance and cause lipotoxocity and HIV-associated lipodystrophy leading to cardiovascular pathology. In this article we review the pathogenesis, management, and prevention of the long-term complications of HIV and its therapies, including cardiovascular disease, lipodystrophy, and insulin resistance along with the growing focus on biomarkers to predict development of end-organ disease. Through a focused literature search we review the established evidence, the developing research about the treatment strategies in treated HIV infection as well as identify potential areas for future research.
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Affiliation(s)
- Ovidiu Galescu
- Department of Pediatrics, Children's Hospital at SUNY Downstate and Kings County Hospital Center, Brooklyn, NY, USA.
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Jaggers JR, Dudgeon W, Blair SN, Sui X, Burgess S, Wilcox S, Hand GA. A home-based exercise intervention to increase physical activity among people living with HIV: study design of a randomized clinical trial. BMC Public Health 2013; 13:502. [PMID: 23706094 PMCID: PMC3668143 DOI: 10.1186/1471-2458-13-502] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 05/15/2013] [Indexed: 12/21/2022] Open
Abstract
Background While combination antiretroviral therapy has extended the life expectancy of those infected with human immunodeficiency virus (HIV), there is a high prevalence of comorbidities that increase the risk of cardiovascular morbidity and mortality among people living with HIV/AIDS (PLWHA). The side effects associated with antiretroviral therapy (ART) lead to multiple metabolic disorders, making the management of these metabolic issues and risk of cardiovascular disease (CVD) in those treated with ART a critical issue. Clinical research trials, primarily clinical exercise, rarely include this population due to unique challenges in research methods with underserved minority populations living with a life threatening illness like HIV/AIDS. This paper describes the rationale and design of a randomized clinical trial evaluating the feasibility of a home-based exercise program designed to increase physical activity (PA) and reduce the risk of CVD in PLWHA. Methods/design PLWHA being treated with ART will be randomly assigned to one of two groups: a home-based PA intervention or standard care. All participants will receive an educational weight loss workbook and pedometer for self-monitoring of PA. Only those in the intervention group will receive additional elastic Thera-bands® for strength training and behavioral telephone based coaching. Discussion This study will evaluate the feasibility of a home-based program designed to increase PA among PLWHA. Further, it will evaluate the effectiveness of such a program to decrease modifiable risk factors for CVD as a secondary outcome. This study was funded by the NIH/NINR R21 Grant 1R21NRO11281. Trial registration Clinical Trial Identifier NCT01377064
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Affiliation(s)
- Jason R Jaggers
- Department of Exercise Science, University of South Carolina, Columbia, SC, USA.
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Hodges S, Holstad MM. The Impact of a Health Promotion Educational Program on Cardiovascular Risk Factors for HIV Infected Women on Antiretroviral Therapy. JOURNAL OF AIDS & CLINICAL RESEARCH 2013; 4:224. [PMID: 24432191 PMCID: PMC3889147 DOI: 10.4172/2155-6113.1000224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This study investigates the efficacy of a health promotion educational program on improving cardiovascular risk factors of weight, Body Mass Index, and waist to hip ratio in 76 predominately African American HIV-infected women. The health promotion educational program was the control group (that focused on improving self-efficacy for nutrition, exercise, stress reduction and women's health behaviors) of a NIH-funded study. The majority of participants was overweight, obese, or at high risk based on waist hip ratio at the beginning of the study. There were no statistically significant improvements in body mass index or waist hip ratio from pre intervention to up to 9 months post intervention. There were significant changes in waist hip ratio and body mass index in both directions (improvement and worsened) for a small group of participants. The health promotion program did not affect significant changes in cardiovascular risk and should be revised, lengthened, and refocused on nutrition, diet, exercise, and long term goal commitments to reduce the high risk for cardiovascular disease in this group.
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Affiliation(s)
- Samaha Hodges
- MPH, Project Manager Co-Investigator of the U.S. LATTE Arm, American Cancer Society, Atlanta, GA, USA
| | - Marcia McDonnell Holstad
- DSN, FNP-BC, FAANP, FAAN, Associate Professor, Nell Hodgson School of Nursing Emory University, Atlanta, GA, USA
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Stradling C, Chen YF, Russell T, Connock M, Thomas GN, Taheri S. The effects of dietary intervention on HIV dyslipidaemia: a systematic review and meta-analysis. PLoS One 2012; 7:e38121. [PMID: 22701607 PMCID: PMC3372478 DOI: 10.1371/journal.pone.0038121] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 05/01/2012] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Efficacy of dietary intervention for treatment and prevention of HIV-related lipid disturbances has not been well established. METHODS We conducted a systematic search of electronic databases supplemented with manual searches and conference abstracts, without language restriction. All randomised controlled trials (RCTs) with blood lipid outcomes, involving dietary intervention or supplementation for the treatment or prevention of adult HIV dyslipidaemia, versus no or other intervention were included. Two authors using predefined data fields, including study quality indicators, extracted data independently. RESULTS Eighteen studies (n = 873) met our inclusion criteria. Seven RCTs for omega-3 supplementation (n = 372), and four RCTs for dietary intervention (n = 201) were meta-analysed using random-effects models. Mild statistical heterogeneity was observed. Dietary intervention reduced triglyceride levels by -0·46 mmol/l (95%CI: -0·85 to -0·07 mmol/l) compared to control. Omega-3 supplementation reduced triglyceride levels by -1.12 mmol/l, (95%CI: -1·57 to -0·67 mmol/l) and total cholesterol, -0·36 mmol/l (95%CI: -0·67 to -0·05 mmol/l) compared to placebo/control. CONCLUSIONS Both omega-3 supplementation and dietary intervention reduced triglyceride level, with the latter possibly to a smaller extent. While dietary interventions are beneficial, more stringent dietary approaches may be necessary to fully address lipid disturbances in HIV patients. TRIAL REGISTRATION PROSPERO 2011:CRD42011001329.
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Affiliation(s)
- Clare Stradling
- HIV Metabolic Clinic, Heart of England NHS Foundation Trust, Birmingham, United Kingdom
- Birmingham and Black Country NIHR CLAHRC, University of Birmingham, Birmingham, United Kingdom
| | - Yen-Fu Chen
- Birmingham and Black Country NIHR CLAHRC, University of Birmingham, Birmingham, United Kingdom
| | - Tracy Russell
- Dietetic Department, Western General Hospital, Edinburgh, United Kingdom
| | - Martin Connock
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - G. Neil Thomas
- School of Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, United Kingdom
| | - Shahrad Taheri
- HIV Metabolic Clinic, Heart of England NHS Foundation Trust, Birmingham, United Kingdom
- Birmingham and Black Country NIHR CLAHRC, University of Birmingham, Birmingham, United Kingdom
- School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, United Kingdom
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Dietary intervention prevents dyslipidemia associated with highly active antiretroviral therapy in human immunodeficiency virus type 1-infected individuals: a randomized trial. J Am Coll Cardiol 2012; 59:979-88. [PMID: 22402068 DOI: 10.1016/j.jacc.2011.11.038] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Revised: 10/31/2011] [Accepted: 11/30/2011] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the efficacy of dietary intervention on blood lipids of human immunodeficiency virus (HIV)-1-infected patients who are started on highly active antiretroviral therapy (HAART). BACKGROUND Current guidelines recommend diet as first-step intervention for HIV-1-infected individuals with HAART-related dyslipidemia, but there is no evidence from randomized trials to support this recommendation. METHODS Eighty-three HIV-1-infected patients, naive from HAART, were randomly assigned to HAART with dietary intervention (diet group, n = 43) or HAART without dietary intervention (control group, n = 40) for 12 months. Diet, according to the National Cholesterol Education Program, was given every 3 months. Before and after intervention, 24-h food records and lipid profile were obtained. Data were analyzed by intention to treat, using mixed-effects models. RESULTS Diet resulted in reduction of percentage of fat intake (from 31 ± 7% to 21 ± 3% of calories), while controls presented no change in percentage of fat intake. Plasma cholesterol (from 151 ± 29 mg/dl to 190 ± 33 mg/dl) and low-density lipoprotein cholesterol (from 85 ± 24 mg/dl to 106 ± 31 mg/dl) increased in the control group and were unchanged in the diet group. Plasma triglycerides were reduced by diet (from 135 ± 67 mg/dl to 101 ± 42 mg/dl) and increased in the control group (from 134 ± 70 mg/dl to 160 ± 76 mg/dl). After 1-year follow-up, 21% of patients who received diet had lipid profile compatible with dyslipidemia compared with 68% (p < 0.001) of controls. CONCLUSIONS Among HIV-1-positive individuals naive of previous treatment, diet prevents dyslipidemia associated with HAART. (Effect of Nutritional Intervention on the Lipid Profile of HIV-Positive Patients Who Start HAART: a Randomized Trial; NCT00429845).
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40
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Effects of lifestyle modification and metformin on atherosclerotic indices among HIV-infected patients with the metabolic syndrome. AIDS 2012; 26:587-97. [PMID: 22112605 DOI: 10.1097/qad.0b013e32834f33cc] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Metabolic abnormalities including diabetes, dyslipidemia, hypertension, and abdominal obesity occur commonly in HIV patients, are associated with increased coronary artery calcification (CAC), and contribute to increased cardiovascular disease (CVD) in this population. We hypothesized that lifestyle modification (LSM) and metformin would improve CVD indices in HIV patients with metabolic syndrome. DESIGN A randomized, placebo-controlled trial to investigate LSM and metformin, alone and in combination, over 1 year, among 50 HIV-infected patients with metabolic syndrome. METHODS We assessed CAC, cardiovascular and metabolic indices. RESULTS Among the participants, duration of HIV-infection was 14 ± 1 year and duration of antiretroviral therapy was 6 ± 1 year. Metformin-treated patients demonstrated significantly less progression of CAC (-1 ± 2 vs. 33 ± 17, P = 0.004, metformin vs. placebo), whereas the effect of LSM on CAC progression was not significant (8 ± 6 vs. 21 ± 14, P = 0.82, LSM vs. no-LSM). Metformin had a significantly greater effect on CAC than LSM (P = 0.01). Metformin-treated patients also demonstrated less progression in calcified plaque volume (-0.4 ± 1.9 vs. 27.6 ± 13.8 μl, P = 0.008) and improved homeostatic model of assessment-insulin resistance (HOMA-IR) (P = 0.05) compared with placebo. Participants randomized to LSM vs. no-LSM showed significant improvement in HDL (P = 0.03), high-sensitivity C-reactive protein (hsCRP) (P = 0.05), and cardiorespiratory fitness. Changes in CAC among the four groups--no-LSM-placebo (43 ± 30); LSM-placebo (19 ± 7); no-LSM-metformin (1 ± 1) and LSM-metformin (-4 ± 6)--were different (P = 0.03 for ANOVA and linear trend across groups), and the majority of this effect was mediated by metformin. Results are mean ± SEM. CONCLUSION Metformin prevents plaque progression in HIV-infected patients with the metabolic syndrome.
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Petoumenos K, Worm SW. HIV infection, aging and cardiovascular disease: epidemiology and prevention. Sex Health 2012; 8:465-73. [PMID: 22127031 DOI: 10.1071/sh11020] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 05/04/2011] [Indexed: 02/02/2023]
Abstract
In the developed world, HIV infection is now well managed with very effective and less toxic antiretroviral treatment. HIV-positive patients therefore are living longer, but are now faced by challenges associated with aging. Several non-AIDS associated morbidities are increased in this population, including cardiovascular disease (CVD). It is suggested that CVD occurs earlier among HIV-positive patients compared with HIV-negative patients, and at a higher rate. Several factors have been proposed to contribute to this. First, the traditional CVD risk factors are highly prevalent in this population. High rates of smoking, dyslipidaemia and a family history of CVD have been reported. This population is also aging, with estimates of more than 25% of HIV-positive patients in the developed world being over the age of 50. Antiretroviral treatment, both through its effect on lipids and through other, sometimes less well understood, mechanisms, has been linked to increased CVD risk. HIV infection, especially untreated, is a further contributing factor to increased CVD risk in HIV-positive patients. As the HIV-positive population continues to age, the risk of CVD will continue to increase. Guidelines for the management and prevention of CVD risk have been developed, and are largely modelled on those used in the general population. However, the data currently suggest that these interventions, such as the use of lipid-lowering medications and smoking cessation programs, remain quite low. A better understanding the mechanisms of CVD risk in this aging population and further efforts in improving uptake of prevention strategies will remain an important research area.
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Affiliation(s)
- Kathy Petoumenos
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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Gutierrez AD, Balasubramanyam A. Dysregulation of glucose metabolism in HIV patients: epidemiology, mechanisms, and management. Endocrine 2012; 41:1-10. [PMID: 22134974 PMCID: PMC3417129 DOI: 10.1007/s12020-011-9565-z] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Accepted: 11/07/2011] [Indexed: 02/06/2023]
Abstract
HIV-infected patients on highly active antiretroviral therapy (HAART) have increased prevalence of a number of chronic metabolic disorders of multifactorial but unclear etiology. These include disorders of lipid metabolism with or without lipodystrophy, insulin resistance, and an increased prevalence of impaired glucose tolerance, diabetes mellitus, and cardiometabolic syndrome. While much attention has been focused on the lipid and cardiovascular disorders, few investigations have attempted to characterize the prevalence, incidence, etiology, mechanisms, and management of glycemic disorders in HIV patients. In this review, we have focused specifically on a comprehensive assessment of dysglycemia in the context of HIV infection and HAART.
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Affiliation(s)
- Absalon D. Gutierrez
- Translational Metabolism Unit, Diabetes and Endocrinology Research Center, Division of Diabetes, Endocrinology and Metabolism, Baylor College of Medicine; Houston, Texas, USA
| | - Ashok Balasubramanyam
- Translational Metabolism Unit, Diabetes and Endocrinology Research Center, Division of Diabetes, Endocrinology and Metabolism, Baylor College of Medicine; Houston, Texas, USA
- Endocrine Service, Ben Taub General Hospital, Houston, Texas, USA
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43
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Gradwell E, Raman PR. The Academy of Nutrition and Dietetics National Coverage Determination Formal Request. J Acad Nutr Diet 2012; 112:149-76. [DOI: 10.1016/j.jada.2011.10.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2011] [Indexed: 01/15/2023]
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Fatkenheuer G, Duvivier C, Rieger A, Durant J, Rey D, Schmidt W, Hill A, van Delft Y, Marks S, Rieger A, Vetter N, Greil R, Pedersen C, Storgaard M, Morlat P, Katlama C, Durant J, Cotte L, Duvvier C, Rey D, Esser S, Stellbrink C, Schmidt W, Stoll M, Stephan C, Fatkenheuer G, Stoehr A, Rockstroh J, Banhegyi D, Itzchak L, Shahar E, Maayan S, Turner D, Lazzarin A, Antinori A, Carosi G, Minoli L, di Perri G, Filice G, Andreoni M, Duiculescu D, Rugina S, Erscoiu S, Streinu A, Pronin A, Pokrovsky V, Gruzdev B, Yakovlev A, Voronin E, Clotet B, Gatell J, Arribas J, Podzamczer D, Domingo P, Miralles Alvarez C, Hernandez Quero J, Furrer H, Feher J, Johnson M, Fox J, Nelson M, Fisher M, Orkin C. Lipid profiles for etravirine versus efavirenz in treatment-naive patients in the randomized, double-blind SENSE trial. J Antimicrob Chemother 2011; 67:685-90. [DOI: 10.1093/jac/dkr533] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Fitch K, Grinspoon S. Nutritional and metabolic correlates of cardiovascular and bone disease in HIV-infected patients. Am J Clin Nutr 2011; 94:1721S-1728S. [PMID: 22089442 PMCID: PMC3226025 DOI: 10.3945/ajcn.111.012120] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The treatment of HIV infection has dramatically reduced the incidence of AIDS-related illnesses. At the same time, non-AIDS-related illnesses such as cardiovascular and bone disease are becoming more prevalent in this population. The mechanisms of these illnesses are complex and are related in part to the HIV virus, antiretroviral medications prescribed for HIV infection, traditional risk factors exacerbated by HIV, and lifestyle and nutritional factors. Further prospective research is needed to clarify the mechanisms by which HIV, antiretroviral medications, and nutritional abnormalities contribute to bone and cardiovascular disease in the HIV population. Increasingly, it is being recognized that optimizing the treatment of HIV infection to improve immune function and reduce viral load may also benefit the development of non-AIDS-related illnesses such as cardiovascular and bone disease.
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Affiliation(s)
- Kathleen Fitch
- Program in Nutritional Metabolism, Massachusetts General Hospital, Boston, USA
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Kalra S, Unnikrishnan AG, Raza SA, Bantwal G, Baruah MP, Latt TS, Shrestha D, John M, Katulanda P, Somasundaram N, Sahay R, Pathan F. South Asian Consensus Guidelines for the rational management of diabetes in human immunodeficiency virus/acquired immunodeficiency syndrome. Indian J Endocrinol Metab 2011; 15:242-50. [PMID: 22028994 PMCID: PMC3193772 DOI: 10.4103/2230-8210.85573] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
As newer methods of management are made available, and accessible, survival rates with human immunodeficiency virus (HIV) are increasing. This means that chronic, metabolic complications of HIV are becoming more frequent in clinical practice, as acute morbidity is controlled. Management of HIV/acquired immunodeficiency syndrome (AIDS) is gradually expanding to include these chronic and metabolic complications of the disease, and the adverse effects associated with its treatments, including diabetes. Unfortunately, no guidelines are available to help the medical practitioners choose appropriate therapy for patients with these conditions. The aim of the South Asian Consensus Guidelines is to provide evidence-based recommendations to assist healthcare providers in the rational management of type 2 diabetes mellitus in patients with HIV. The development of these guidelines used systematic reviews of available evidence to form its key recommendations. These guidelines and associated review of literature represent a compilation of available knowledge regarding rational management of diabetes in HIV. Patients of diabetes with concomitant HIV infection are managed optimally with insulin therapy and judicious use of highly active antiretroviral therapy with suitable alternatives is also recommended. These guidelines should prove helpful to physicians, not only in South Asia, but also across the globe, while managing patients with coexistent HIV and diabetes.
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Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital and BRIDE, Karnal, India
| | | | - Syed Abbas Raza
- Department of Endocrinology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Ganpathy Bantwal
- Department of Endocrinology, St. Johns Medical College, Bangalore, India
| | | | - Tint Swe Latt
- Department of Endocrinology University of Medicine 2, Yangon, Myanmar
| | - Dina Shrestha
- Department of Endocrinology, Norvic International Hospital, Kathmandu, Nepal
| | - Mathew John
- Department of Endocrinology, Providence Endocrine and Diabetes Specialty Centre, Trivandrum, India
| | - Prasad Katulanda
- Department of Endocrinology, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | | | - Rakesh Sahay
- Department of Endocrinology, Osmania Medical College, Hyderabad, India
| | - Faruque Pathan
- Department of Endocrinology, BIRDEM Hospital, Dhaka, Bangladesh
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Sprinz E, Lazzaretti RK, Kuhmmer R, Ribeiro JP. Dyslipidemia in HIV-infected individuals. Braz J Infect Dis 2011; 14:575-88. [PMID: 21340298 DOI: 10.1016/s1413-8670(10)70115-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Accepted: 03/22/2010] [Indexed: 02/07/2023] Open
Abstract
Metabolic complications continue to play a major role in the management of HIV infection. Dyslipidemia associated with HIV infection and with the use of combined antiretroviral therapy includes elevations in triglycerides, reduced high-density cholesterol, and variable increases in low-density and total cholesterol. The association between dyslipidemia and specific antiretroviral agents has been underscored. Multiple pathogenic mechanisms by which HIV and antiretroviral agents lead to dyslipidemia have been hypothesized, but they are still controversial. The potential clinical and pathological consequences of HIV-associated hyperlipidemia are not completely known, but several studies reported an increased risk of coronary artery disease in HIV-positive individuals receiving combined antiretroviral therapy. HIV-infected persons who have hyperlipidemia should be managed similarly to those without HIV infection in accordance with the National Cholesterol Education Program. Life style changes are the primary target. Statins and fibrates and/or modification in antiretroviral therapy are possible approaches to this problem.
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Affiliation(s)
- Eduardo Sprinz
- Internal Medicine Division, Hospital de Clínicas de Porto Alegre, Brazil.
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Abstract
Morphologic and metabolic abnormalities, including subcutaneous adipose tissue wasting, central adipose tissue accumulation, dyslipidemia and disorders of glucose metabolism are common among HIV-infected patients receiving highly active antiretroviral therapy (HAART) and contribute to the risk of cardiovascular disease in this population. The pathogenesis of these disorders is due to complicated interactions between effects of chronic HIV infection, HAART medications and patient factors, including genetic susceptibility. HAART has transformed HIV into a chronic condition for many patients and as a result the majority of HIV-infected patients in many areas of the developed world will soon be aged ≥50 years. Given that metabolic and cardiovascular diseases increase with aging, knowledge of the optimal management of these conditions is essential for practitioners caring for HIV-infected patients, including endocrine subspecialists. This Review highlights the clinical management of these disorders, focusing on the latest evidence regarding the efficacy of treatment strategies, newly available medications and potential interactions between HAART medications and medications used to treat metabolic disorders.
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Affiliation(s)
- Todd T Brown
- Division of Endocrinology and Metabolism, Johns Hopkins University, 1830 East Monument Street, Baltimore, MD 21287, USA.
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Dau B, Holodniy M. The Relationship Between HIV Infection and Cardiovascular Disease. Curr Cardiol Rev 2011; 4:203-18. [PMID: 19936197 PMCID: PMC2780822 DOI: 10.2174/157340308785160589] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2008] [Revised: 05/23/2008] [Accepted: 05/23/2008] [Indexed: 12/25/2022] Open
Abstract
Over 30 million people are currently living with human immunodeficiency virus (HIV) infection, and over 2 million new infections occur per year. HIV has been found to directly affect vascular biology resulting in an increased risk of cardiovascular disease compared to uninfected persons. Although HIV infection can now be treated effectively with combination antiretroviral medications, significant toxicities such as hyperlipidemia, diabetes, and excess cardiovascular co-morbidity; as well as the potential for significant drug-drug interactions between HIV and cardiovascular medications, present new challenges for the management of persons infected with HIV. We first review basic principles of HIV pathogenesis and treatment and then discuss relevant clinical management strategies that will be useful for cardiologists who might be involved in the care of HIV infected patients.
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Affiliation(s)
- Birgitt Dau
- VA Palo Alto Health Care System and Division of Infectious Diseases and Geographic Medicine, Stanford University, Palo Alto, CA, USA
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50
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Bedimo R. Growth hormone and tesamorelin in the management of HIV-associated lipodystrophy. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2011; 3:69-79. [PMID: 22096409 PMCID: PMC3218714 DOI: 10.2147/hiv.s14561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
HIV-infected patients on highly active antiretroviral therapy (HAART) develop a complex of body composition changes known, including peripheral fat loss (lipoatrophy) and central fat accumulation (lipohypertrophy). These changes may cause significant patient distress, which could in turn interfere with adherence to antiretroviral therapy. Treatment options - including antiretroviral switch, insulin sensitizers, and surgical approaches - have been associated with limited success and potential complications. The observation that low growth hormone levels are associated with central fat accumulation among HIV patients has led to the development of tesamorelin (a growth hormone releasing hormone analog) for the management of central fat accumulation. Randomized controlled trials have shown that administration of tesamorelin is safe and effective in reducing central fat accumulation among HIV-infected patients. This effect is transient, however, and its association with improved cardiovascular risk remains unclear.
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Affiliation(s)
- Roger Bedimo
- Infectious Disease section, VA North Texas Health Care System, TX, USA
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