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Abrantes AM, Ferguson E, Stein MD, Magane KM, Fielman S, Karzhevsky S, Flanagan A, Siebers R, Quintiliani LM. Design and rationale for a randomized clinical trial testing the efficacy of a lifestyle physical activity intervention for people with HIV and engaged in unhealthy drinking. Contemp Clin Trials 2024; 144:107632. [PMID: 39019155 DOI: 10.1016/j.cct.2024.107632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 06/17/2024] [Accepted: 07/13/2024] [Indexed: 07/19/2024]
Abstract
BACKGROUND Among people living with HIV (PLWH), unhealthy drinking presents an increased risk for negative outcomes. Physical inactivity and sedentariness raise additional health risks. Despite evidence that physical activity (PA) is associated with improved physical and mental functioning and reduced alcohol cravings, there have been no PA studies conducted with PLWH engaged in unhealthy drinking. We describe a study protocol of a remote lifestyle physical activity (LPA) intervention to increase PA and reduce alcohol consumption among PLWH. METHODS Using online advertisements, 220 low-active PLWH engaged in unhealthy drinking will be recruited and randomized nationwide. After providing informed consent and completing a baseline interview, participants will receive a Fitbit. Participants will complete 15 days of ecologic momentary assessment through a phone application and up to 15 days of Fitbit wear time. Following this period, participants will be randomly assigned to a Fitbit-only control condition or a LPA and Fitbit intervention condition. Health counselors meet with control participants once (and have 6 subsequent brief check ins on Fibit use) and with intervention participants 7 times for PA counseling over a 12-week period. Follow-up assessments will be conducted at 3- and 6-months post-randomization. We hypothesize that individuals in the LPA and Fitbit condition will have lower rates of alcohol consumption and higher rates of PA at 6-month follow-up. CONCLUSION The randomized controlled trial described in this paper investigates remote methods to influence multimorbidity among PLWH using a LPA approach for increasing PA and reducing alcohol consumption.
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Affiliation(s)
- Ana M Abrantes
- Behavioral Medicine and Addictions Research, Butler Hospital, Providence, RI, United States of America; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States of America.
| | - Erin Ferguson
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, United States of America
| | - Michael D Stein
- Boston University School of Public Health, Boston University, Boston, MA, United States of America
| | - Kara M Magane
- Boston University School of Public Health, Boston University, Boston, MA, United States of America
| | - Sarah Fielman
- Boston University School of Public Health, Boston University, Boston, MA, United States of America
| | - Skylar Karzhevsky
- Boston University School of Public Health, Boston University, Boston, MA, United States of America
| | - Amanda Flanagan
- Boston University School of Public Health, Boston University, Boston, MA, United States of America
| | - Robert Siebers
- Boston University School of Public Health, Boston University, Boston, MA, United States of America
| | - Lisa M Quintiliani
- Department of Medicine, Tufts University, Tufts Medical Center, Boston, MA, United States of America
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2
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Iriarte E, Cooley S, Wisch J, Erlandson KM, Ances BM, Jankowski C. Area Deprivation Index and Frailty Among Older People With HIV. J Appl Gerontol 2024:7334648241262658. [PMID: 39025783 DOI: 10.1177/07334648241262658] [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] [Indexed: 07/20/2024] Open
Abstract
We evaluated the relationship between neighborhood disadvantage (measured by the Area Deprivation Index [ADI]) and frailty. We performed a secondary analysis, pooling cross-sectional data collected from 209 people with HIV (PWH) aged ≥50 years enrolled in studies in Colorado (CO) and Missouri (MO). MO participants (N = 137) had a higher ADI (µ= 70, ơ2 = 25) compared to CO (µ= 32, ơ2 = 15; p < .001). No significant differences in ADI were observed between frailty categories when cohorts were examined either separately or combined; however, when comparing individual frailty criteria, the most apparent differences by neighborhood disadvantage were seen among those with limited physical activity (μ = 67, ơ2 = 28) compared to those without (μ = 55, ơ2 = 29, p = .03). Neighborhood disadvantage was associated with low physical activity but not with overall frailty status. Future research should examine how access to physical activity spaces varies based on ADI, as this could be crucial in preventing frailty.
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Affiliation(s)
- Evelyn Iriarte
- University of Colorado College of Nursing, Anschutz Medical Campus, Aurora, CO, USA
- Pontificia Universidad Católica de Chile School of Nursing, Santiago, Chile
| | - Sarah Cooley
- Washington University in St. Louis, St Louis, MO, USA
| | - Julie Wisch
- Washington University in St. Louis, St Louis, MO, USA
| | - Kristine M Erlandson
- University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Beau M Ances
- Washington University in St. Louis, St Louis, MO, USA
| | - Catherine Jankowski
- University of Colorado College of Nursing, Anschutz Medical Campus, Aurora, CO, USA
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3
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Feeney ER, Boix V, Hsue PY. Chronotropic incompetence in HIV infection. AIDS 2024; 38:921-923. [PMID: 38578962 DOI: 10.1097/qad.0000000000003868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Affiliation(s)
- Eoin R Feeney
- UCD Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, Ireland
| | - Vicente Boix
- Hospital General Universitario Dr Balmis
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Priscilla Y Hsue
- Division of Cardiology, University of California, San Francisco, CA, USA
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4
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Brañas F, Díaz-Álvarez J, Fernández-Luna J, Vásquez-Brolen BD, García-Molina R, Moreno E, Ryan P, Martínez-Sanz J, Luna L, Martínez M, Dronda F, Sánchez-Conde M. A 12-week multicomponent exercise program enhances frailty by increasing robustness, improves physical performance, and preserves muscle mass in older adults with HIV: MOVIhNG study. Front Public Health 2024; 12:1373910. [PMID: 38694984 PMCID: PMC11062244 DOI: 10.3389/fpubh.2024.1373910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 03/06/2024] [Indexed: 05/04/2024] Open
Abstract
Background Our aim was to analyze the effects of a multicomponent exercise program (MEP) on frailty and physical performance in older adults with HIV (OAWH) since exercise can reverse frailty in the older population overall, but there is no data for OAWH. Methods A prospective longitudinal study with intervention and control group was designed. Sedentary adults 50 or over with and without HIV were included. The intervention was a 12-week home-based MEP. Dependent variables were frailty (frailty phenotype), physical performance (Senior Fitness Test), muscle mass (ASMI) by bioimpedance. Pre- and postintervention measurements were analyzed using McNemar's test for categorical variables and the Wilcoxon signed-rank test for quantitative variables. Results 40 OAWH and 20 OA without HIV. The median age was 56.5 years. 23.3% were women. The prevalence of frailty was 6.6% with no frail HIV-negative participants. Three of the four frail HIV-participants transitioned two (50%) from frail to prefrail and one (25%) to robust after the MEP. In participants with an adherence ≥50%, physical performance was significantly improved [basal vs. 12 week]: upper extremity strength [13 (13-15) vs. 16 (15-19), p = 0.0001], lower extremity strength [13 (11-16) vs. 15 (13-16), p = 0.004], aerobic endurance [62 (55-71) vs. 66 (58-80), p = 0.005]. Participants with low adherence experienced a significant worsening in ASMI [8.35 (7.44-9.26) vs. 7.09 (6.08-8.62), p = 0.03]. Conclusion A 12-week MEP enhances frailty by increasing robustness in OAWH, and improves physical performance, and preserves muscle mass in older adults with good adherence to the MEP independently of HIV status. Clinical trial number NCT 05435521
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Affiliation(s)
- Fátima Brañas
- Geriatrics Department, Hospital Universitario Infanta Leonor, Madrid, Spain
- FIIB H.U Infanta Leonor y H.U. Sureste, Madrid, Spain
- Medicine Department, Universidad Complutense, Madrid, Spain
| | - Jorge Díaz-Álvarez
- Infectious Diseases Department, Hospital Universitario Ramón y Cajal. IRYCIS, Madrid, Spain
| | | | | | - Rafael García-Molina
- Geriatrics Department, Hospital Nuestra Señora del Perpetuo Socorro, Albacete, Spain
- CIBER de Envejecimiento y Fragilidad (CIBERFES), ISCIII, Madrid, Spain
| | - Elena Moreno
- Infectious Diseases Department, Hospital Universitario Ramón y Cajal. IRYCIS, Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC). ISCIIII, Madrid, Spain
| | - Pablo Ryan
- FIIB H.U Infanta Leonor y H.U. Sureste, Madrid, Spain
- Medicine Department, Universidad Complutense, Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC). ISCIIII, Madrid, Spain
- HIV Clinic, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Javier Martínez-Sanz
- Infectious Diseases Department, Hospital Universitario Ramón y Cajal. IRYCIS, Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC). ISCIIII, Madrid, Spain
| | - Laura Luna
- Infectious Diseases Department, Hospital Universitario Ramón y Cajal. IRYCIS, Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC). ISCIIII, Madrid, Spain
| | - Marta Martínez
- Geriatrics Department, Hospital Universitario Infanta Leonor, Madrid, Spain
- Medicine Department, Universidad Complutense, Madrid, Spain
| | - Fernando Dronda
- Infectious Diseases Department, Hospital Universitario Ramón y Cajal. IRYCIS, Madrid, Spain
| | - Matilde Sánchez-Conde
- Infectious Diseases Department, Hospital Universitario Ramón y Cajal. IRYCIS, Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC). ISCIIII, Madrid, Spain
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5
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Jankowski CM, Konigsberg IR, Wilson MP, Sun J, Brown TT, Julian CG, Erlandson KM. Skeletal muscle DNA methylation: Effects of exercise and HIV. Aging Cell 2024; 23:e14025. [PMID: 37920126 PMCID: PMC10776118 DOI: 10.1111/acel.14025] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 10/13/2023] [Accepted: 10/15/2023] [Indexed: 11/04/2023] Open
Abstract
Aging, human immunodeficiency virus (HIV) infection, and antiretroviral therapy modify the epigenetic profile and function of cells and tissues, including skeletal muscle (SkM). In some cells, accelerated epigenetic aging begins very soon after the initial HIV infection, potentially setting the stage for the early onset of frailty. Exercise imparts epigenetic modifications in SkM that may underpin some health benefits, including delayed frailty, in people living with HIV (PWH). In this first report of exercise-related changes in SkM DNA methylation among PWH, we investigated the impact of 24 weeks of aerobic and resistance exercise training on SkM (vastus lateralis) DNA methylation profiles and epigenetic age acceleration (EAA) in older, virally suppressed PWH (n = 12) and uninfected controls (n = 18), and associations of EAA with physical function at baseline. We identified 983 differentially methylated positions (DMPs) in PWH and controls at baseline and 237 DMPs after training. The influence of HIV serostatus on SkM methylation was more pronounced than that of exercise training. There was little overlap in the genes associated with the probes most significantly differentiated by exercise training within each group. Baseline EAA (mean ± SD) was similar between PWH (-0.4 ± 2.5 years) and controls (0.2 ± 2.6 years), and the exercise effect was not significant (p = 0.79). EAA and physical function at baseline were not significantly correlated (all p ≥ 0.10). This preliminary investigation suggests HIV-specific epigenetic adaptations in SkM with exercise training but confirmation in a larger study that includes transcriptomic analysis is warranted.
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Affiliation(s)
| | - Iain R. Konigsberg
- Department of Biomedical InformaticsUniversity of Colorado Anschutz Medical CampusColoradoAuroraUSA
| | - Melissa P. Wilson
- Division of Infectious Diseases, Department of MedicineUniversity of Colorado Anschutz Medical CampusColoradoAuroraUSA
| | - Jing Sun
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthMarylandBaltimoreUSA
| | - Todd T. Brown
- Division of Endocrinology, Diabetes, & Metabolism, Department of MedicineJohns Hopkins UniversityMarylandBaltimoreUSA
| | - Colleen G. Julian
- Department of Biomedical InformaticsUniversity of Colorado Anschutz Medical CampusColoradoAuroraUSA
| | - Kristine M. Erlandson
- Division of Infectious Diseases, Department of MedicineUniversity of Colorado Anschutz Medical CampusColoradoAuroraUSA
- Division of Geriatric Medicine, Department of MedicineUniversity of Colorado Anschutz Medical CampusColoradoAuroraUSA
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6
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Durstenfeld MS, Wilson MP, Jankowski CM, Ditzenberger GL, Longenecker CT, Erlandson KM. Chronotropic Incompetence among People with HIV Improves with Exercise Training in the Exercise for Healthy Aging Study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.11.10.23298367. [PMID: 37986954 PMCID: PMC10659453 DOI: 10.1101/2023.11.10.23298367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
Background People with HIV (PWH) have lower exercise capacity compared to HIV-uninfected peers, which may be explained by chronotropic incompetence (CI), the inability to increase heart rate during exercise. Methods The Exercise for Healthy Aging Study included adults ages 50-75 with and without HIV. Participants completed 12 weeks of moderate intensity exercise, before randomization to moderate or high intensity for 12 additional weeks. We compared adjusted heart rate reserve (AHRR; CI <80%) on cardiopulmonary exercise testing by HIV serostatus, and change from baseline to 12 and 24 weeks using mixed effects models. Results Among 32 PWH and 37 controls (median age 56, 7% female, mean BMI 28 kg/m2), 28% of PWH compared to 11% of controls had CI at baseline (p=0.067). AHRR was lower among PWH (91 vs 102%; difference 11%, 95% CI 2.5-19.7; p=0.01). At week 12, AHRR normalized among PWH (+8%, 95% CI 4-11; p<0.001) and was sustained at week 24 (+5, 95%CI 1-9; p=0.008) compared to no change among controls (95%CI -4 to 4; p=0.95; pinteraction=0.004). After 24 weeks of exercise, only 15% PWH and 10% of controls had CI (p=0.70). Conclusions Chronotropic incompetence contributes to reduced exercise capacity among PWH and improves with exercise training.
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Affiliation(s)
- Matthew S. Durstenfeld
- Division of Cardiology at ZSFG and Department of Medicine, University of California, San Francisco (UCSF), USA
| | - Melissa P. Wilson
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Catherine M. Jankowski
- College of Nursing, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Grace L. Ditzenberger
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Chris T. Longenecker
- Division of Cardiology and Department of Global Health, University of Washington Medical Center, Seattle, WA, USA
| | - Kristine M. Erlandson
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
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7
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Durstenfeld MS, Peluso MJ, Spinelli MA, Li D, Hoh R, Chenna A, Yee B, Winslow J, Petropoulos C, Gandhi M, Henrich TJ, Aras MA, Long CS, Deeks SG, Hsue PY. Association of SARS-CoV-2 Infection and Cardiopulmonary Long COVID With Exercise Capacity and Chronotropic Incompetence Among People With HIV. J Am Heart Assoc 2023; 12:e030896. [PMID: 37830367 PMCID: PMC10757521 DOI: 10.1161/jaha.123.030896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/23/2023] [Indexed: 10/14/2023]
Abstract
Background Postacute sequelae of COVID-19 (PASC) and HIV are both associated with reduced exercise capacity, but whether SARS-CoV-2 or PASC are associated with exercise capacity among people with HIV (PWH) is unknown. We hypothesized that PWH with PASC would have reduced exercise capacity from chronotropic incompetence. Methods and Results We conducted cross-sectional cardiopulmonary exercise testing within a COVID recovery cohort that included PWH with and without prior SARS-CoV-2 infection and people without HIV with prior SARS-CoV-2 infection (controls). We evaluated associations of HIV, SARS-CoV-2, and PASC with exercise capacity (peak oxygen consumption) and chronotropy (adjusted heart rate reserve). We included 83 participants (median age, 54 years; 35% women; 37 PWH): 23 out of 37 (62%) PWH and all 46 controls had prior SARS-CoV-2 infection, and 11 out of 23 (48%) PWH and 28 out of 46 (61%) without HIV had PASC. Peak oxygen consumption was reduced among PWH versus controls (80% predicted versus 99%, P=0.005), a difference of 5.5 mL/kg per minute (95% CI, 2.7-8.2; P<0.001). Chronotropic incompetence was more prevalent among PWH (38% versus 11%, P=0.002), with lower adjusted heart rate reserve (60% versus 83%, P<0.0001) versus controls. Among PWH, SARS-CoV-2 coinfection and PASC were not associated with exercise capacity. Chronotropic incompetence was more common among PWH with PASC: 7 out of 11 (64%) with PASC versus 7 out of 26 (27%) without PASC (P=0.04). Conclusions Exercise capacity and chronotropy are lower among PWH compared with individuals with SARS-CoV-2 infection without HIV. Among PWH, SARS-CoV-2 infection and PASC were not strongly associated with reduced exercise capacity. Chronotropic incompetence may be a common underrecognized mechanism of exercise intolerance among PWH, especially those with cardiopulmonary PASC.
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Affiliation(s)
- Matthew S. Durstenfeld
- Department of MedicineUniversity of CaliforniaSan FranciscoCA
- Division of CardiologyZuckerberg San Francisco GeneralSan FranciscoCA
| | - Michael J. Peluso
- Department of MedicineUniversity of CaliforniaSan FranciscoCA
- Division of HIV, Infectious Diseases, and Global Medicine, Zuckerberg San Francisco General HospitalUniversity of CaliforniaSan FranciscoCA
| | - Matthew A. Spinelli
- Department of MedicineUniversity of CaliforniaSan FranciscoCA
- Division of HIV, Infectious Diseases, and Global Medicine, Zuckerberg San Francisco General HospitalUniversity of CaliforniaSan FranciscoCA
| | - Danny Li
- Division of CardiologyZuckerberg San Francisco GeneralSan FranciscoCA
| | - Rebecca Hoh
- Division of HIV, Infectious Diseases, and Global Medicine, Zuckerberg San Francisco General HospitalUniversity of CaliforniaSan FranciscoCA
| | - Ahmed Chenna
- Monogram Biosciences, LabCorpSouth San FranciscoCA
| | - Brandon Yee
- Monogram Biosciences, LabCorpSouth San FranciscoCA
| | - John Winslow
- Monogram Biosciences, LabCorpSouth San FranciscoCA
| | | | - Monica Gandhi
- Department of MedicineUniversity of CaliforniaSan FranciscoCA
- Division of HIV, Infectious Diseases, and Global Medicine, Zuckerberg San Francisco General HospitalUniversity of CaliforniaSan FranciscoCA
| | - Timothy J. Henrich
- Department of Experimental MedicineUniversity of CaliforniaSan FranciscoCA
| | - Mandar A. Aras
- Department of MedicineUniversity of CaliforniaSan FranciscoCA
- Division of CardiologyUCSF HealthSan FranciscoCA
| | - Carlin S. Long
- Department of MedicineUniversity of CaliforniaSan FranciscoCA
- Division of CardiologyUCSF HealthSan FranciscoCA
| | - Steven G. Deeks
- Department of MedicineUniversity of CaliforniaSan FranciscoCA
- Division of HIV, Infectious Diseases, and Global Medicine, Zuckerberg San Francisco General HospitalUniversity of CaliforniaSan FranciscoCA
| | - Priscilla Y. Hsue
- Department of MedicineUniversity of CaliforniaSan FranciscoCA
- Division of CardiologyZuckerberg San Francisco GeneralSan FranciscoCA
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8
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Sánchez-Conde M, Alba C, Castro I, Dronda F, Ramírez M, Arroyo R, Moreno S, Rodríguez JM, Brañas F. Comparison of the Fecal Bacteriome of HIV-Positive and HIV-Negative Older Adults. Biomedicines 2023; 11:2305. [PMID: 37626801 PMCID: PMC10452058 DOI: 10.3390/biomedicines11082305] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 08/12/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
HIV infection is considered a scenario of accelerated aging. Previous studies have suggested a link between aging, frailty, and gut dysbiosis, but there is a knowledge gap regarding the HIV population. Our objective was to compare the fecal bacteriome of older people with HIV (PWH) and non-HIV controls, and to assess potential links between gut dysbiosis and frailty. A total of 36 fecal samples (24 from PWH and 12 from non-HIV controls) were submitted to a metataxonomic analysis targeting the V3-V4 hypervariable region of the 16S rRNA gene. High-quality reads were assembled and classified into operational taxonomic units. Alpha diversity, assessed using the Shannon index, was higher in the control group than in the HIV group (p < 0.05). The relative abundance of the genus Blautia was higher in the HIV group (p < 0.001). The presence of Blautia was also higher in PWH with depression (p = 0.004), whereas the opposite was observed for the genus Bifidobacterium (p = 0.004). Our study shows shifts in the composition of the PWH bacteriome when compared to that of healthy controls. To our knowledge, this is the first study suggesting a potential link between depression and gut dysbiosis in the HIV population.
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Affiliation(s)
- Matilde Sánchez-Conde
- Infectious Diseases Department, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), 28034 Madrid, Spain; (F.D.); (S.M.)
- CIBER de Enfermedades Infecciosas (CIBERINFECT), Instituto de Salud Carlos III, 28220 Madrid, Spain
| | - Claudio Alba
- Department of Nutrition and Food Science, Complutense University of Madrid, 28040 Madrid, Spain; (C.A.); (I.C.); (J.M.R.)
| | - Irma Castro
- Department of Nutrition and Food Science, Complutense University of Madrid, 28040 Madrid, Spain; (C.A.); (I.C.); (J.M.R.)
| | - Fernando Dronda
- Infectious Diseases Department, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), 28034 Madrid, Spain; (F.D.); (S.M.)
| | - Margarita Ramírez
- Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain;
| | - Rebeca Arroyo
- Department of Nutrition and Food Science, Complutense University of Madrid, 28040 Madrid, Spain; (C.A.); (I.C.); (J.M.R.)
| | - Santiago Moreno
- Infectious Diseases Department, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), 28034 Madrid, Spain; (F.D.); (S.M.)
| | - Juan Miguel Rodríguez
- Department of Nutrition and Food Science, Complutense University of Madrid, 28040 Madrid, Spain; (C.A.); (I.C.); (J.M.R.)
| | - Fátima Brañas
- Geriatric Department, Hospital Universitario Infanta Leonor, 28031 Madrid, Spain
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9
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Simon L, Primeaux SD, Levitt DE, Bourgeois B, Johannsen NM, Peters A, Ahmed J, Marshall RH, Fairchild AH, Ferguson TF, Molina PE. An aerobic exercise intervention to improve metabolic health among people living with HIV with at-risk alcohol use: the ALIVE-Ex research study protocol. AIDS Res Ther 2023; 20:35. [PMID: 37296413 PMCID: PMC10251573 DOI: 10.1186/s12981-023-00530-2] [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] [Received: 02/25/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Effective antiretroviral therapy (ART) in people living with HIV (PLWH) has improved life expectancy and increased risk of age-associated cardiometabolic comorbidities. At-risk alcohol use is more frequent among PLWH and increases the risk of health challenges. PLWH with at-risk alcohol use are more likely to meet criteria for prediabetes/diabetes and this is associated with impaired whole-body glucose-insulin dynamics. METHODS The Alcohol & Metabolic Comorbidities in PLWH: Evidence Driven Interventions Study (ALIVE-Ex Study, NCT03299205) is a longitudinal, prospective, interventional study to determine the effects of an aerobic exercise protocol on improving dysglycemia among PLWH with at-risk alcohol use. The intervention is a moderate intensity aerobic exercise protocol implemented 3 days per week for 10 weeks at the Louisiana State University Health Sciences Center-New Orleans. Participants who have a fasting blood glucose level between 94 and 125 mg/dl will be enrolled in the study. Oral glucose tolerance tests, fitness assessments, and skeletal muscle biopsies will be performed pre- and post-exercise intervention. The primary outcome is to determine whether the exercise protocol improves measures of whole-body glucose-insulin dynamics, cardiorespiratory fitness, and skeletal muscle metabolic and bioenergetic function. Secondary outcomes are to determine whether the exercise intervention improves cognitive function and overall quality of life. Results generated will demonstrate the effect of exercise on glycemic measures in PLWH with subclinical dysglycemia and at-risk alcohol use. CONCLUSIONS The proposed intervention will also have the potential to be scalable to promote lifestyle changes among PLWH, particularly in underserved communities.
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Affiliation(s)
- Liz Simon
- Department of Physiology, LSU Health Sciences Center, 1901 Perdido Street, MEB/7205, New Orleans, LA, 70112, USA
- Comprehensive Alcohol HIV/AIDS Research Center, LSU Health Sciences Center, New Orleans, LA, 70112, USA
| | - Stefany D Primeaux
- Department of Physiology, LSU Health Sciences Center, 1901 Perdido Street, MEB/7205, New Orleans, LA, 70112, USA
- Joint Diabetes, Endocrinology & Metabolism Program, Pennington Biomedical Research Center, Baton Rouge, LA, 70808, USA
| | - Danielle E Levitt
- Department of Physiology, LSU Health Sciences Center, 1901 Perdido Street, MEB/7205, New Orleans, LA, 70112, USA
- Comprehensive Alcohol HIV/AIDS Research Center, LSU Health Sciences Center, New Orleans, LA, 70112, USA
- Department of Kinesiology & Sport Management, Texas Tech University, Lubbock, TX, 79409, USA
| | - Brianna Bourgeois
- Department of Physiology, LSU Health Sciences Center, 1901 Perdido Street, MEB/7205, New Orleans, LA, 70112, USA
- Comprehensive Alcohol HIV/AIDS Research Center, LSU Health Sciences Center, New Orleans, LA, 70112, USA
| | - Neil M Johannsen
- School of Kinesiology, Louisiana State University, Baton Rouge, LA, 70803, USA
| | - Adrianna Peters
- Department of Physiology, LSU Health Sciences Center, 1901 Perdido Street, MEB/7205, New Orleans, LA, 70112, USA
- Comprehensive Alcohol HIV/AIDS Research Center, LSU Health Sciences Center, New Orleans, LA, 70112, USA
| | - Jameel Ahmed
- Department of Medicine, LSU Health Sciences Center, New Orleans, LA, 70112, USA
| | - Richard H Marshall
- Department of Radiology, Tulane University School of Medicine, New Orleans, LA, 70112, USA
| | | | - Tekeda F Ferguson
- Joint Diabetes, Endocrinology & Metabolism Program, Pennington Biomedical Research Center, Baton Rouge, LA, 70808, USA
- Department of Epidemiology, LSU Health Sciences Center, New Orleans, LA, 70112, USA
| | - Patricia E Molina
- Department of Physiology, LSU Health Sciences Center, 1901 Perdido Street, MEB/7205, New Orleans, LA, 70112, USA.
- Comprehensive Alcohol HIV/AIDS Research Center, LSU Health Sciences Center, New Orleans, LA, 70112, USA.
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10
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Cinque F, Cespiati A, Lombardi R, Guaraldi G, Sebastiani G. Nutritional and Lifestyle Therapy for NAFLD in People with HIV. Nutrients 2023; 15:nu15081990. [PMID: 37111209 PMCID: PMC10140991 DOI: 10.3390/nu15081990] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/17/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023] Open
Abstract
HIV infection and nonalcoholic fatty liver disease (NAFLD) are two major epidemics affecting millions of people worldwide. As people with HIV (PWH) age, there is an increased prevalence of metabolic comorbidities, along with unique HIV factors, such as HIV chronic inflammation and life-long exposure to antiretroviral therapy, which leads to a high prevalence of NAFLD. An unhealthy lifestyle, with a high dietary intake of refined carbohydrates, saturated fatty acids, fructose added beverages, and processed red meat, as well as physical inactivity, are known to trigger and promote the progression of NAFLD to nonalcoholic steatohepatitis, liver fibrosis, and hepatocellular carcinoma. Furthermore, with no currently approved pharmacotherapy and a lack of clinical trials that are inclusive of HIV, nutritional and lifestyle approaches still represent the most recommended treatments for PWH with NAFLD. While sharing common features with the general population, NAFLD in PWH displays its own peculiarities that may also reflect different impacts of nutrition and exercise on its onset and treatment. Therefore, in this narrative review, we aimed to explore the role of nutrients in the development of NAFLD in PWH. In addition, we discussed the nutritional and lifestyle approaches to managing NAFLD in the setting of HIV, with insights into the role of gut microbiota and lean NAFLD.
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Affiliation(s)
- Felice Cinque
- Division of Gastroenterology and Hepatology, and Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
- Medicine and Metabolic Disease Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy
| | - Annalisa Cespiati
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
- Medicine and Metabolic Disease Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy
| | - Rosa Lombardi
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
- Medicine and Metabolic Disease Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy
| | - Giovanni Guaraldi
- Modena HIV Metabolic Clinic, Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria di Modena, 41124 Modena, Italy
| | - Giada Sebastiani
- Division of Gastroenterology and Hepatology, and Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
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11
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Aomori M, Matsumoto C, Takebayashi S, Matsuyama N, Uto Y, Tanaka M, Samukawa S, Kato H, Nakajima H, Maeda H. Effects of a smartphone app-based diet and physical activity program for men living with HIV who have dyslipidemia: A pilot randomized controlled trial. Jpn J Nurs Sci 2023:e12535. [PMID: 37060244 DOI: 10.1111/jjns.12535] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/24/2023] [Accepted: 03/06/2023] [Indexed: 04/16/2023]
Abstract
AIMS People living with HIV are at a high risk for cardiovascular disease owing to antiretroviral therapy use and chronic inflammation. There is limited evidence on the evaluation of serum lipid levels through lifestyle modification. This study aims to evaluate the effect of a smartphone application-based diet and exercise improvement program on men living with HIV and dyslipidemia. METHODS This was a randomized controlled trial recruiting Japanese men living with HIV who have dyslipidemia: intervention group (n = 19) and control group (n = 19). The intervention group received a third individual guidance session during the 6-month intervention and was encouraged to record their diet on a smartphone application. An intention-to-treat analysis of the results was conducted. RESULTS The intervention group showed significantly reduced change in low-density lipoprotein levels compared to the control group (-4.00 ± 20.2 mg/dL vs. 10.11 ± 21.1 mg/dL) (p = .042) from baseline to 6 months post-intervention. No significant differences were found in other serum lipid levels. Abdominal circumference decreased significantly in the intervention group (p = .048) from baseline to 6 months post-intervention. Total energy, protein, carbohydrate, fat, and salt intake, dietary and physical activity behavior change stages and social support, dietary self-efficacy, and loneliness significantly improved in the intervention group (p < .05) from baseline to 6 months post-intervention. CONCLUSIONS A diet and physical activity improvement program using a smartphone application based on Japanese-specific health guidance may reduce low-density lipoprotein cholesterol levels in this population. Further sample expansion and examination of long-term effects are needed.
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Affiliation(s)
- Maki Aomori
- Doctoral Program of Nursing, Graduate School of Health Sciences, Kumamoto University, Kumamoto, Japan
- Department of Nursing, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Chiharu Matsumoto
- Department of Nursing, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Sanae Takebayashi
- Nursing Department, Yokohama City University Hospital, Yokohama, Japan
| | - Nao Matsuyama
- Nursing Department, Yokohama City University Hospital, Yokohama, Japan
| | - Yukiko Uto
- Nursing Department, Yokohama City University Hospital, Yokohama, Japan
| | - Miho Tanaka
- Nursing Department, Yokohama City University Hospital, Yokohama, Japan
| | - Sei Samukawa
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hideaki Kato
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
- Infection Prevention and Control Department, Yokohama City University Hospital, Yokohama, Japan
| | - Hideaki Nakajima
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hitomi Maeda
- Department of Nursing, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
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12
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Cooley S, Nelson BM, Rosenow A, Westerhaus E, Cade WT, Reeds DN, Vaida F, Yarasheski KE, Paul RH, Ances BM. Exercise Training to Improve Brain Health in Older People Living With HIV: Study Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e41421. [PMID: 36943345 PMCID: PMC10131751 DOI: 10.2196/41421] [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: 08/02/2022] [Revised: 02/02/2023] [Accepted: 02/05/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND With the advent of antiretrovirals, people living with HIV are living near-normal lifespans. However, people living with HIV are at greater risk of experiencing cognitive impairment and reduced brain integrity despite well-controlled viremia. A robust literature supports exercise interventions as a method of improving cognition and structural brain integrity in older individuals without HIV. The effects of exercise on cardiometabolic, neurocognitive, and neural structures in middle-aged to older people living with HIV are less well known, with few prospective studies examining these measures. OBJECTIVE This prospective randomized clinical trial will examine the effects of a 6-month exercise training intervention compared to a 6-month stretching intervention (control) on cardiorespiratory fitness, physical function and strength, cognition, and neuroimaging measures of brain volumes and cerebral blood flow in people living with HIV. METHODS Sedentary middle-aged to older people living with HIV (ages≥40; n=150) with undetectable HIV viral load (<20 copies/mL) will be enrolled in the study. At the baseline and final visit, fasting plasma lipid, insulin, glucose, and brain neurotrophic factor concentrations; cardiorespiratory fitness; cognitive performance; brain volumes; and cerebral blood flow via a magnetic resonance imaging scan will be measured. Participants will be randomized in a 2:1 ratio to either the exercise or control stretching intervention. All participants will complete their assigned programs at a community fitness center 3 times a week for 6 months. A professional fitness trainer will provide personal training guidance at all sessions for individuals enrolled in both arms. Individuals randomized to the exercise intervention will perform endurance and strength training exercises, while those randomized to the control intervention will perform stretches to increase flexibility. A midpoint visit (at 3 months) will assess cognitive performance, and at the end point visit, subjects will undergo cardiorespiratory fitness and cognition testing, and a magnetic resonance imaging scan. Physical activity throughout the duration of the trial will be recorded using an actigraph. RESULTS Recruitment and data collection are complete as of December 2020. Data processing, cleaning, and organization are complete as of December 2021. Data analysis began in January 2022, with the publication of study results for primary aims 1 and 2 expected by early 2023. CONCLUSIONS This study will investigate the effects of a 6-month aerobic and resistance exercise training intervention to improve cardiometabolic risk factors, cognitive performance, cerebral structure, and blood flow in sedentary people living with HIV. Results will inform clinicians and patients of the potential benefits of a structured aerobic exercise training program on the cognitive, functional, and cardiometabolic health status of older people living with HIV. Assessment of compliance will inform the development and implementation of future exercise programs for people living with HIV. TRIAL REGISTRATION ClinicalTrials.gov NCT02663934; https://clinicaltrials.gov/ct2/show/NCT02663934. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/41421.
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Affiliation(s)
- Sarah Cooley
- Department of Neurology, School of Medicine, Washington University in St. Louis, Saint Louis, MO, United States
| | - Brittany M Nelson
- Department of Neurology, School of Medicine, Washington University in St. Louis, Saint Louis, MO, United States
| | - Alexander Rosenow
- Department of Neurology, School of Medicine, Washington University in St. Louis, Saint Louis, MO, United States
| | - Elizabeth Westerhaus
- Department of Neurology, School of Medicine, Washington University in St. Louis, Saint Louis, MO, United States
| | - W Todd Cade
- Doctor of Physical Therapy Division, Duke University School of Medicine, Durham, NC, United States
| | - Dominic N Reeds
- Department of Medicine and the Center for Human Nutrition, Washington University in St. Louis, Saint Louis, MO, United States
| | - Florin Vaida
- Division of Biostatistics and Bioinformatics, School of Public Health, University of California San Diego, San Diego, CA, United States
| | - Kevin E Yarasheski
- Division of Endocrinology, School of Medicine, Washington University in Saint Louis, Saint Louis, MO, United States
| | - Robert H Paul
- Department of Psychology, University of Missouri St. Louis, Saint Louis, MO, United States
| | - Beau M Ances
- Department of Neurology, School of Medicine, Washington University in St. Louis, Saint Louis, MO, United States
- Department of Radiology, School of Medicine, Washington University in St. Louis, Saint Louis, MO, United States
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13
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Kehler DS, Milic J, Guaraldi G, Fulop T, Falutz J. Frailty in older people living with HIV: current status and clinical management. BMC Geriatr 2022; 22:919. [PMID: 36447144 PMCID: PMC9708514 DOI: 10.1186/s12877-022-03477-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 09/23/2022] [Indexed: 12/05/2022] Open
Abstract
This paper will update care providers on the clinical and scientific aspects of frailty which affects an increasing proportion of older people living with HIV (PLWH). The successful use of combination antiretroviral therapy has improved long-term survival in PLWH. This has increased the proportion of PLWH older than 50 to more than 50% of the HIV population. Concurrently, there has been an increase in the premature development of age-related comorbidities as well as geriatric syndromes, especially frailty, which affects an important minority of older PLWH. As the number of frail older PLWH increases, this will have an important impact on their health care delivery. Frailty negatively affects a PLWH's clinical status, and increases their risk of adverse outcomes, impacting quality of life and health-span. The biologic constructs underlying the development of frailty integrate interrelated pathways which are affected by the process of aging and those factors which accelerate aging. The negative impact of sarcopenia in maintaining musculoskeletal integrity and thereby functional status may represent a bidirectional interaction with frailty in PLWH. Furthermore, there is a growing body of literature that frailty states may be transitional. The recognition and management of related risk factors will help to mitigate the development of frailty. The application of interdisciplinary geriatric management principles to the care of older PLWH allows reliable screening and care practices for frailty. Insight into frailty, increasingly recognized as an important marker of biologic age, will help to understand the diversity of clinical status occurring in PLWH, which therefore represents a fundamentally new and important aspect to be evaluated in their health care.
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Affiliation(s)
- D. Scott Kehler
- grid.55602.340000 0004 1936 8200Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, NS Canada ,grid.55602.340000 0004 1936 8200School of Physiotherapy, Faculty of Health, Dalhousie University, Room 402 Forrest Building 5869 University Ave, B3H 4R2, PO Box 15000 Halifax, NS Canada
| | - Jovana Milic
- grid.7548.e0000000121697570Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanni Guaraldi
- grid.7548.e0000000121697570Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Tamas Fulop
- grid.86715.3d0000 0000 9064 6198Department of Medicine, Geriatric Division, Research Center On Aging, Université de Sherbrooke, Sherbrooke, QC Canada
| | - Julian Falutz
- grid.63984.300000 0000 9064 4811Division of Geriatric Medicine, Division of Infectious Diseases, Comprehensive HIV Aging Initiative, McGill University Health Center, Montreal, QC Canada
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14
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Levitt DE, Simon L, Lin HY, Siggins RW, Ferguson TF, Molina PE, Welsh DA. Alcohol use, physical activity, and muscle strength moderate the relationship between body composition and frailty risk among people living with HIV. Alcohol Clin Exp Res 2022; 46:2041-2053. [PMID: 36124866 PMCID: PMC10801810 DOI: 10.1111/acer.14941] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/19/2022] [Accepted: 09/14/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Antiretroviral therapy has improved life expectancy among people living with HIV (PLWH). Despite increased longevity, PLWH are at increased risk of age-related comorbidities, including frailty. We examined the relationship between body composition and frailty among PLWH, and moderation of this relationship by substance use, physical activity (PA), and physical function. METHODS Participants (n = 341; 71% male, 48 ± 10 years, body mass index (BMI) = 27.3 ± 7.0 kg/m2 ) enrolled in the New Orleans Alcohol Use in HIV (NOAH) study underwent measures of body composition, muscle strength, and gait speed. Whole blood phosphatidylethanol (PEth) was measured, and substance use and PA were self-reported. Frailty risk measures included the 58-Item Deficit Index (DI58) and the Veterans Aging Cohort Study (VACS) Index 1.0, where higher scores indicate greater frailty risk. RESULTS Multivariable linear regression adjusted for age, sex, and race showed that higher fat-free mass index (FFMI), body fat (%), waist-to-hip ratio, and body mass index (BMI) ≥ 25.0 kg/m2 vs. < 25.0 kg/m2 were significantly (p < 0.05) associated with decreased frailty risk measured by the VACS Index, whereas adjusted analyses showed no association between body composition variables and the DI58 score. Recent alcohol use, muscle strength, and PA, but not lifetime alcohol use or gait speed, significantly moderated associations between body composition variables and frailty risk with medium-to-large effect sizes. Subgroup analyses revealed a negative relationship between DI58 and FFMI among people with PEth > 8 ng/ml and negative relationships of VACS Index with FFMI and WHR in people with lower muscle strength. Overweight or obese BMI categories were positively associated with DI58 in people with lower muscle strength or higher PA level but negatively associated in those with higher muscle strength. CONCLUSIONS Our findings indicate that body composition has significant modulatory effects on frailty risk in PLWH, where obesity increases the risk of frailty and greater muscle mass may be protective, even in individuals who use alcohol. These results highlight the importance of considering body composition, physical activity, and physical function in assessing frailty risk in PLWH, particularly among individuals who use alcohol. Moreover, they support the implementation of physical activity interventions to ameliorate the risk of frailty in aging PLWH.
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Affiliation(s)
- Danielle E. Levitt
- Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, LA, USA
- Department of Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
- Department of Kinesiology & Sport Management, Texas Tech University, Lubbock, TX, USA
| | - Liz Simon
- Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, LA, USA
- Department of Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Hui-Yi Lin
- Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, LA, USA
- Biostatistics Program, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Robert W. Siggins
- Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, LA, USA
- Department of Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Tekeda F. Ferguson
- Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, LA, USA
- Department of Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
- Department of Epidemiology, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Patricia E. Molina
- Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, LA, USA
- Department of Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - David A. Welsh
- Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, LA, USA
- Department of Internal Medicine, Section of Pulmonary/Critical Care, Louisiana State University Health Sciences Center, New Orleans, LA, USA
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15
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Qin XM, Park JY, Kim BR, Joo CH. The Effects of Exercise on Acute Immune Responses in Relative Leisure-Deprived People Living with HIV/AIDS: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:8155. [PMID: 35805814 PMCID: PMC9266274 DOI: 10.3390/ijerph19138155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/08/2022] [Accepted: 06/08/2022] [Indexed: 12/04/2022]
Abstract
Exercise training involving exercises of optimal intensity and duration improves psychological and medical variables in relative leisure-deprived people living with HIV/AIDS. This study aimed to analyze associated psychological variables and the effect of exercise intensity and duration on immune responses in relative leisure-deprived people infected with HIV. The participants completed different moderate-intensity exercises (30 min (60−80% HRmax) and 45 min (60−80% HRmax)) and high-intensity exercise for 10 min (>80% HRmax). Levels higher than “normal” were rated for relative leisure deprivation, indicating relative deprivation of leisure among participants. The overall level of quality of life was “normal”, indicating that quality of life was not considered high. The stress level was psychologically considered low. Time had a significant effect on cortisol levels (p < 0.05). Compared to pre-exercise, cortisol level was significantly decreased immediately after moderate exercise for 45 min and 3 h post-exercise after high-intensity exercise for 10 min (p < 0.05). However, time and the interaction of condition and time had no significant effect on IL-6 and sIgA levels (p > 0.05). Despite the small sample size of this pilot study, the results demonstrate that moderate-intensity exercise can be recommended to improve the health and quality of life of people infected with HIV.
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Affiliation(s)
- Xin-Min Qin
- Department of Sport Science, Kangwon National University, Chuncheon 24341, Korea; (X.-M.Q.); (J.-Y.P.)
| | - Ji-Young Park
- Department of Sport Science, Kangwon National University, Chuncheon 24341, Korea; (X.-M.Q.); (J.-Y.P.)
| | - Bo-Ram Kim
- Department of Physical Education, Korea University, Seoul 02841, Korea
| | - Chang-Hwa Joo
- Department of Sport Science, Kangwon National University, Chuncheon 24341, Korea; (X.-M.Q.); (J.-Y.P.)
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16
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Bowman ER, Wilson M, Riedl KM, MaWhinney S, Jankowski CM, Funderburg NT, Erlandson KM. Lipidome Alterations with Exercise Among People With and Without HIV: An Exploratory Study. AIDS Res Hum Retroviruses 2022; 38:544-551. [PMID: 35302400 PMCID: PMC9297322 DOI: 10.1089/aid.2021.0154] [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: 11/13/2022] Open
Abstract
Age-related comorbidities and physical function impairments in aging people with HIV (PWH) can be improved through exercise interventions. The mechanisms underlying these improvements, including lipidomic changes, are unknown. Sedentary adults (50-75 years old) with or without HIV participated in supervised endurance/resistance exercise for 24 weeks. Plasma lipid concentrations (∼1,200 lipid species from 13 lipid classes) at baseline and week 24 were measured by mass spectrometry. Given multiple comparisons, unadjusted and Benjamini-Hochberg corrected p values are reported. Analyses are considered exploratory. Twenty-five PWH and 24 controls had paired samples at baseline and week 24. The change in total triacylglycerol (TAG) concentrations after exercise intervention differed between groups (unadj-p = 0.006, adj-p = 0.078) with concentrations increasing among controls, but not among PWH. Changes in concentrations of TAG species composed of long-chain fatty acids differed between groups (unadj-p < 0.04) with increases among controls, but not among PWH. Changes in total diacylglycerol (DAG) concentration from baseline to week 24 differed between groups (unadj-p = 0.03, adj-p = 0.2) with an increase in PWH and a nonsignificant decrease in controls. Baseline to week 24 changes in DAGs composed of palmitic acid (16:0), palmitoleic acid (16:1), and stearic acid (18:0) differed by serostatus (unadj-p = 0.009-0.03; adj-p 0.10-0.12), with nonsignificant increases and decreases in concentrations in PWH and controls, respectively. Concentrations of individual lysophosphatidylcholine (LPC) and ceramide (CER) species also differed by HIV serostatus (unadj-p < = 0.05). Although exploratory, the effects of exercise on the lipidome may differ among people with and without HIV, potentially due to underlying alterations in lipid processing and fatty acid oxidation in PWH. Clinical Trials NCT02404792.
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Affiliation(s)
- Emily R. Bowman
- College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Melissa Wilson
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kenneth M. Riedl
- College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Samantha MaWhinney
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Catherine M. Jankowski
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | | | - Kristine M. Erlandson
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
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17
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Bristow C, Barber T. Managing frailty in people with human immunodeficiency virus. Br J Hosp Med (Lond) 2022; 83:1-7. [DOI: 10.12968/hmed.2021.0474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The population of people living with human immunodeficiency virus (HIV) is ageing and has an increasing burden of non-acquired immune deficiency syndrome (AIDS)-related morbidity and mortality, including frailty. Frailty is prevalent at a younger age in this population and is associated with multimorbidity, disability and death. This article examines the key interventions to ameliorate the advancement of frailty in people living with HIV. It explores methods of successfully delivering a multidisciplinary holistic approach to this complex patient group, using three case studies. The most effective frailty intervention is exercise. Group-based physiotherapy classes protect against functional decline and frailty symptomatology. Optimisation of medical and psychiatric comorbidities, including deprescribing when appropriate, is also essential. Addressing the social determinants of frailty, such as social isolation and loneliness, are beneficial, but are dependent on local charities and resources. More research is required to assess pharmacological and nutritional interventions in frailty. This requires a greater understanding of the exact pathophysiology of frailty, which remains poorly understood.
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Affiliation(s)
- Clare Bristow
- Department of HIV Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - Tristan Barber
- Institute for Global Health, University College London, London, UK
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Soares VL, Soares WF, Zanetti HR, Neves FF, Silva-Vergara ML, Mendes EL. Daily Undulating Periodization Is More Effective Than Nonperiodized Training on Maximal Strength, Aerobic Capacity, and TCD4+ Cell Count in People Living With HIV. J Strength Cond Res 2022; 36:1738-1748. [PMID: 32604148 DOI: 10.1519/jsc.0000000000003675] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
ABSTRACT Soares, VL, Soares, WF, Zanetti, HR, Neves, FF, Silva-Vergara, ML, and Mendes, EL. Daily undulating periodization is more effective than nonperiodized training on maximal strength, aerobic capacity, and TCD4+ cell count in people living with HIV. J Strength Cond Res 36(6): 1738-1748, 2022-The aim of this study was to evaluate the effects of daily undulating periodization (DUP) and nonperiodized training (NPT) programs on maximal muscle strength, body composition, aerobic capacity, muscle power, and immune markers in people living with HIV (PLWHIV). A total of 41 PLWHIV were randomly assigned to control (CON [n = 15]), DUP (n = 13), and NPT (n = 13) groups. The DUP and NPT groups performed combined training 3 times a week on nonconsecutive days during 12 weeks, whereas the CON group was asked to maintain their current level of activity. After the 12-week training program, DUP produced greater gains in muscle strength (except for bench press), V̇o2peak, and muscle power than NPT (p < 0.05). Compared to CON, the training groups showed significantly (p < 0.05) increased muscle strength (DUP = 31.0 ± 13.9 kg; NPT = 17.7 ± 9.2 kg; CON = -0.3 ± 1.5 kg), fat-free mass (DUP = 1.9 ± 1.5 kg; NPT = 1.4 ± 1.9 kg; CON = -0.1 ± 1.2 kg), and metabolic equivalent (DUP = 2.3 ± 1.3; NPT = 1.8 ± 1.9), and decreased body fat mass (DUP = -2.1 ± 1.6 kg; NPT = -1.4 ± 1.5 kg; CON = 0.1 ± 0.2) and functional aerobic impairment (DUP = -35.9 ± 17.0%; NPT = -25.8 ± 22.0%; CON = 0.8 ± 3.0%). There was an increase in TCD4+ cells only in the DUP group (p < 0.05). The training effect generally provided a positive correlation between change in leg press strength (r = 0.393, p < 0.05), triceps pulley strength (r = 0.417, p < 0.05), lat pull-down strength (r = 0.459, p < 0.05), and muscle power (r = 0.324, p < 0.05) with changing CD4 + lymphocyte count. Daily undulating periodization protocol showed to be safe, applicable, and more efficient for increasing strength, aerobic capacity, and TCD4+ cells compared to NPT in PLWHIV.
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Affiliation(s)
- Vitor Lopes Soares
- Exercise Science, Health and Human Performance Research Group, Department of Sport Sciences, Postgraduate Program in Physical Education, Federal University of Triângulo Mineiro, Uberaba, MG, Brazil
| | - Weverton Fonseca Soares
- Exercise Science, Health and Human Performance Research Group, Department of Sport Sciences, Postgraduate Program in Physical Education, Federal University of Triângulo Mineiro, Uberaba, MG, Brazil
| | - Hugo Ribeiro Zanetti
- Department of Physical Education, Master Institute of Education President Antônio Carlos, Araguari, MG, Brazil
| | - Fernando Freitas Neves
- Department of Medical Clinics, Institute of Health Sciences, Clinics Hospital, Federal University of Triângulo Mineiro, Uberaba, MG, Brazil ; and
| | - Mário Leon Silva-Vergara
- Department of Medical Clinics, Institute of Health Sciences, Clinics Hospital, Federal University of Triângulo Mineiro, Uberaba, MG, Brazil ; and
| | - Edmar Lacerda Mendes
- Exercise Science, Health and Human Performance Research Group, Department of Sport Sciences, Postgraduate Program in Physical Education, Federal University of Triângulo Mineiro, Uberaba, MG, Brazil
- Department of Sport Sciences, Institute of Health Sciences, Federal University of Triângulo Mineiro, Uberaba, MG, Brazil
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Cook P, Jankowski C, Erlandson KM, Reeder B, Starr W, Flynn Makic MB. Low- and High-Intensity Physical Activity Among People with HIV: Multilevel Modeling Analysis Using Sensor- and Survey-Based Predictors. JMIR Mhealth Uhealth 2022; 10:e33938. [PMID: 35436236 PMCID: PMC9135322 DOI: 10.2196/33938] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/13/2022] [Accepted: 02/17/2022] [Indexed: 01/02/2023] Open
Abstract
Background
High-intensity physical activity improves the health of people with HIV. Even when people have good intentions to engage in physical activity, they often find it difficult to maintain physical activity behavior in the long term. Two Minds Theory is a neurocognitive model that explains gaps between people’s intentions and behaviors based on the operations of 2 independent mental systems. This model predicts that everyday experiences will affect physical activity and that factors outside people’s awareness, such as sleep and stress, can have particularly strong effects on physical activity behaviors.
Objective
We designed this study to test the effects of daily experiences on physical activity among people with HIV, including measures of people’s conscious experiences using daily electronic surveys and measures of nonconscious influences using sensor devices.
Methods
In this study, 55 people with HIV wore a Fitbit Alta for 30 days to monitor their physical activity, sleep, and heart rate variability (HRV) as a physiological indicator of stress. Participants also used their smartphones to complete daily electronic surveys for the same 30 days about fatigue, self-efficacy, mood, stress, coping, motivation, and barriers to self-care. Time-lagged, within-person, multilevel models were used to identify the best prospective predictors of physical activity, considering the daily survey responses of people with HIV and sensor data as predictors of their physical activity the following day. We also tested baseline surveys as predictors of physical activity for comparison with daily variables.
Results
Different people had different average levels of physical activity; however, physical activity also varied substantially from day to day, and daily measures were more predictive than baseline surveys. This suggests a chance to intervene based on day-to-day variations in physical activity. High-intensity physical activity was more likely when people with HIV reported less subjective fatigue on the prior day (r=−0.48) but was unrelated to actual sleep based on objective sensor data. High-intensity physical activity was also predicted by higher HRV (r=0.56), indicating less stress, lower HIV-related stigma (r=−0.21), fewer barriers to self-care (r=−0.34), and less approach coping (r=−0.34). Similar variables predicted lower-level physical activity measured based on the number of steps per day of people with HIV.
Conclusions
Some predictors of physical activity, such as HRV, were only apparent based on sensor data, whereas others, such as fatigue, could be measured via self-report. Findings about coping were unexpected; however, other findings were in line with the literature. This study extends our prior knowledge on physical activity by demonstrating a prospective effect of everyday experiences on physical activity behavior, which is in line with the predictions of Two Minds Theory. Clinicians can support the physical activity of people with HIV by helping their patients reduce their daily stress, fatigue, and barriers to self-care.
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Affiliation(s)
- Paul Cook
- College of Nursing, University of Colorado, Aurora, CO, United States
| | | | | | - Blaine Reeder
- Sinclair School of Nursing, University of Missouri, Columbia, MO, United States
| | - Whitney Starr
- School of Medicine, University of Colorado, Aurora, CO, United States
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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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21
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Deminice R, Oliveira VHF, Webel AR, Erlandson KM. Sarcopenia Related to Human Immunodeficiency Virus: Protective Effects of Exercise. Exerc Sport Sci Rev 2022; 50:73-80. [PMID: 35029356 PMCID: PMC8917999 DOI: 10.1249/jes.0000000000000282] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
We discuss recent evidence supporting the hypothesis that sarcopenia is an emerging health concern among people with human immunodeficiency virus (HIV) because of increasing life expectancy and HIV- and treatment-related comorbidities. We also hypothesize that combined exercise at higher intensity has a key role in managing sarcopenia in this population because it directly (increases muscle strength and stimulates hypertrophy) and indirectly (prevents mitochondrial dysfunction, oxidative stress, and persistent inflammation) counteracts sarcopenia hallmarks.
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Affiliation(s)
- Rafael Deminice
- Department of Physical Education, Londrina State University, Londrina, Paraná, Brazil
| | - Vitor H F Oliveira
- Department of Child, Family and Population Health Nursing, University of Washington, Seattle, Washington, United States
| | - Allison R Webel
- Department of Child, Family and Population Health Nursing, University of Washington, Seattle, Washington, United States
| | - Kristine M Erlandson
- University of Colorado, Anschutz Medical Campus, Aurora, Colorado, United States
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22
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Ghayomzadeh M, Hackett D, SeyedAlinaghi S, Gholami M, Hosseini Rouzbahani N, Azevedo Voltarelli F. Combined training improves the diagnostic measures of sarcopenia and decreases the inflammation in HIV-infected individuals. J Cachexia Sarcopenia Muscle 2022; 13:1024-1035. [PMID: 35142082 PMCID: PMC8977956 DOI: 10.1002/jcsm.12926] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/20/2021] [Accepted: 12/28/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND HIV-related sarcopenia is an emerging health issue that often remains undiagnosed and can lead to reduced quality of life, independence, and premature death if untreated. This study investigated the effects of a 6 month combined training (resistance plus aerobic exercise) (CT) intervention on diagnostic measures of sarcopenia, including grip strength, appendicular lean mass index (ALMI), and gait speed. METHODS Forty participants were randomized into either a CT group (n = 20; age = 38.3 ± 4.9 years) or a control group (CON; n = 20; age = 37.9 ± 5.1 years). Participants in the CT group performed three supervised sessions per week for 6 months, consisting of weekly reverse linear periodized resistance training followed by 20 min aerobic training. Participants in the CON group were instructed to continue with their current lifestyle habits. Assessments were completed at baseline and after 6 months. Statistical analyses were performed using a two-way analysis of covariance (ANCOVA) adjusted for sex and preintervention values. Primary outcomes included grip strength, ALMI, and gait speed. Secondary outcomes were changes in levels of pro-inflammatory cytokines (IL-6 and TNF-α), IGF-1, and myostatin. Associations were explored between changes in inflammatory markers (IL-6 and TNF-α), gait speed, and ALMI with grip strength. RESULTS A significant increase in ALMI was found for CT compared with CON (0.29 ± 0.13 kg/m2 vs. -0.11 ± 0.14 kg/m2 , respectively; P < 0.001). Significant improvements in grip strength (7.86 ± 8.50 kg for CT vs. -1.58 ± 2.47 kg for CON) and gait speed (0.16 ± 0.07 m/s2 for CT vs. -0.06 ± 0.52 m/s2 for CON; both P < 0.001) were also observed in CT compared with CON. Reduction in inflammatory biomarkers was found in CT compared with CON (IL-6; TNF-α, both P < 0.001). An increase in IGF-1 (74.36 ± 56.64 pg/mm3 for CT vs. 7.19 ± 99 pg/mm3 for CON; P < 0.001) and a decrease in myostatin (-158.90 ± 62.03 pg/mm3 for CT vs. -43.33 ± 146.60 pg/mm3 for CON; P < 0.001) was found following CT compared with the CON group. Change in grip strength was correlated with changes in IL-6 (r = -0.65, P < 0.001), TNF-α (r = -0.63, P < 0.001), gait speed (r = 0.63, P < 0.001), and ALMI (r = 0.54, P = 0.001), but not IGF-1 and myostatin. No adverse events were recorded, and compliance with the CT exercise sessions was high (>85%). CONCLUSIONS Combined training appears to be an effective means to counteract sarcopenia and improve various inflammatory markers and growth hormones in people living with HIV.
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Affiliation(s)
- Morteza Ghayomzadeh
- Department of Exercise Science, Murdoch University, Perth, Western Australia, Australia.,Murdoch Applied Sports Science Laboratory, Murdoch University, Perth, Western Australia, Australia
| | - Daniel Hackett
- Physical Activity, Lifestyle, Ageing and Wellbeing Faculty Research Group, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - SeyedAhmad SeyedAlinaghi
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Gholami
- Department of Medical Microbiology, Faculty of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Negin Hosseini Rouzbahani
- Department of Medical Immunology, Faculty of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Fabrício Azevedo Voltarelli
- Graduate Program in Health Sciences, Faculty of Medicine, Federal University of Mato Grosso, Cuiab'a, Brazil
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23
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Capin JJ, Wilson MP, Hare K, Vempati S, Little CE, McGregor D, Castillo-Mancilla J, Stevens-Lapsley JE, Jolley SE, Erlandson KM. Prospective telehealth analysis of functional performance, frailty, quality of life, and mental health after COVID-19 hospitalization. BMC Geriatr 2022; 22:251. [PMID: 35337276 PMCID: PMC8956362 DOI: 10.1186/s12877-022-02854-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 02/15/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND COVID-19 is a global pandemic with poorly understood long-term consequences. Determining the trajectory of recovery following COVID-19 hospitalization is critical for prioritizing care, allocating resources, facilitating prognosis, and informing rehabilitation. The purpose of this study was to prospectively evaluate recovery following COVID-19 hospitalization. METHODS Participants age 18 years or older who were hospitalized for ≥24 h due to COVID-19 completed phone/video call virtual assessments (including the 10-time chair rise test) and survey forms at three time points (2-6, 12, and 18 weeks) after hospital discharge. Univariate logistic and linear regression models assessed the associations of the outcomes with primary predictors (categorical age, sex, race/ethnicity group, and categorical pre-hospitalization frailty) at baseline; the same were used to assess differences in change from week 2-6 (continuous outcomes) or outcome persistence/worsening (categorical) at last contact. RESULTS One hundred nine adults (age 53.0 [standard deviation 13.1]; 53% female) participated including 43 (39%) age 60 or greater; 59% identified as an ethnic and/or racial minority. Over 18 weeks, the mean time to complete the 10-time chair rise test decreased (i.e., improved) by 6.0 s (95% CI: 4.1, 7.9 s; p < 0.001); this change did not differ by pre-hospital frailty, race/ethnicity group, or sex, but those age ≥ 60 had greater improvement. At weeks 2-6, 67% of participants reported a worse Clinical Frailty Scale category compared to their pre-hospitalization level, whereas 42% reported a worse frailty score at 18 weeks. Participants who did not return to pre-hospitalization levels were more likely to be female, younger, and report a pre-hospitalization category of 'very fit' or 'well'. CONCLUSIONS We found that functional performance improved from weeks 2-6 to 18 weeks of follow-up; that incident clinical frailty developed in some individuals following COVID-19; and that age, sex, race/ethnicity, and pre-hospitalization frailty status may impact recovery from COVID-19. Notably, individuals age 60 and older were more likely than those under age 45 years to return to their pre-hospitalization status and to make greater improvements in functional performance. The results of the present study provide insight into the trajectory of recovery among a representative cohort of individuals hospitalized due to COVID-19.
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Affiliation(s)
- Jacob J Capin
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Physical Therapy, Marquette University, Milwaukee, WI, USA
- Eastern Colorado Veterans Affairs Geriatric Research Education and Clinical Center (GRECC), Aurora, CO, USA
| | - Melissa P Wilson
- Department of Bioinformatics and Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kristine Hare
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Swati Vempati
- Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, 12700 E. 19th Ave, Mail Stop B168, Aurora, CO, 80045, USA
| | - Carley E Little
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Donna McGregor
- Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, 12700 E. 19th Ave, Mail Stop B168, Aurora, CO, 80045, USA
| | - Jose Castillo-Mancilla
- Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, 12700 E. 19th Ave, Mail Stop B168, Aurora, CO, 80045, USA
| | - Jennifer E Stevens-Lapsley
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Eastern Colorado Veterans Affairs Geriatric Research Education and Clinical Center (GRECC), Aurora, CO, USA
| | - Sarah E Jolley
- Division of Pulmonary and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kristine M Erlandson
- Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, 12700 E. 19th Ave, Mail Stop B168, Aurora, CO, 80045, USA.
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Oliveira VHF, Erlandson KM, Cook PF, Jankowski C, MaWhinney S, Dirajlal-Fargo S, Knaub L, Hsiao CP, Horvat Davey C, Webel AR. The High-Intensity Exercise Study to Attenuate Limitations and Train Habits in Older Adults With HIV (HEALTH): A Research Protocol. J Assoc Nurses AIDS Care 2022; 33:178-188. [PMID: 34039876 PMCID: PMC8613312 DOI: 10.1097/jnc.0000000000000276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The High-Intensity Exercise Study to Attenuate Limitations and Train Habits in Older Adults With HIV (HEALTH), which incorporates an exercise and biobehavioral coaching intervention, has the following overall goals: (a) to determine whether high-intensity interval training (HIIT) mitigates physical function impairments, fatigue, and impairments in mitochondrial bioenergetics of older people living with HIV (PLWH) to a greater extent than continuous moderate exercise (CME); and (b) to determine whether a biobehavioral coaching and mobile health text messaging intervention after HIIT or CME can promote long-term adherence to physical activity. The HEALTH study is a randomized trial of 100 older PLWH (≥50 years of age) who self-report fatigue and have a sedentary lifestyle. Enrolled participants will be randomized to 16 weeks of supervised HIIT or CME training, followed by a 12-week maintenance phase, involving a mobile health coaching intervention. Outcomes of the HEALTH study will inform the development of scalable, effective exercise recommendations tailored to the unique needs of aging PLWH.
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Affiliation(s)
- Vitor H F Oliveira
- Vitor H. F. Oliveira, PhD, is an Acting Instructor, University of Washington, School of Nursing, Seattle, Washington, USA. Kristine M. Erlandson, MD, MS, is an Associate Professor, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. Paul F. Cook, PhD, is an Associate Professor, University of Colorado College of Nursing, Anschutz Medical Campus, Aurora, Colorado, USA. Catherine Jankowski, PhD, is an Associate Professor, University of Colorado College of Nursing, Anschutz Medical Campus, Aurora, Colorado, USA. Samantha MaWhinney, ScD, is a Professor, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. Sahera Dirajlal-Fargo, DO, MS, is an Assistant Professor, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio, USA. Leslie Knaub, MS, is a Senior Professional Research Assistant, University of Colorado Anschutz Medical Campus, Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA. Chao-Pin Hsiao, RN, PhD, FAAN, is an Assistant Professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA. Christine Horvat Davey, RN, PhD, is a Research Associate and Postdoctoral Fellow, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA. Allison R. Webel, RN, PhD, FAAN, is a Professor and Associate Dean for Research, University of Washington, School of Nursing, Seattle, Washington, USA
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25
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Chetty L, Cobbing S, Chetty V. Physical Activity and Exercise for Older People Living with HIV: A Scoping Review. HIV AIDS (Auckl) 2021; 13:1079-1090. [PMID: 34984030 PMCID: PMC8702781 DOI: 10.2147/hiv.s336886] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/12/2021] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Improvements in physical, mental, and overall quality of life are well documented in younger HIV populations who exercise. Exercise guidelines exist for younger HIV populations, but none for older people living with HIV (OPLWH), especially 50 years of age and older. Our aim was to map the existing literature on the effects of exercise and physical activity prescriptions for OPLWH. METHODS We conducted a scoping review using the methodological framework proposed by the Joanna Briggs Institute. Online searches on five research databases yielded 503 published articles. Fifteen studies met the study's inclusion criteria. RESULTS The most commonly used parameters of exercise included aerobic and strength training, as well as a combination of both. The physical, psychological and Quality of Life (QoL) impact of physical activity and its effect on OPLWH is evidently beneficial. Overall, a positive correlation between exercise and physical, mental and functional status was observed. No adverse side effects, or safety and efficacy concerns, during the use of exercise were reported. CONCLUSION This review confirms the dearth of evidence on physical activity and exercise in the context of OPLWH. Of greater concern is the fact that there were no studies conducted in sub-Saharan Africa, the global region with by far the highest HIV burden.
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Affiliation(s)
- Levin Chetty
- School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Saul Cobbing
- School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Verusia Chetty
- School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Abstract
OBJECTIVE People with HIV (PWH) have increased prevalence of multimorbidity and frailty at younger ages compared with the general population. This study investigated individual and combinatorial effects of neuropsychiatric and medical comorbidities as predictors of frailty in PWH. DESIGN Analysis of data from the National NeuroAIDS Tissue Consortium, a longitudinal observational cohort. METHODS Five hundred and twenty-four PWH over age 40 years were classified using Fried's Frailty criteria. Twelve comorbidities were documented from longitudinal data and associations between individual and co-occurring comorbidities with frailty were assessed using weighted network and logistic regression analyses. RESULTS At frailty assessment between 2015 and 2020, median age was 61 years, 76% were men, 94% were on antiretroviral therapy (ART), 73% had two or more comorbidities, 24% were frail, and 52% were prefrail. Among individual comorbidities, highest odds of frailty were in participants with depressive symptoms [adjusted odds ratio (aOR), 95% confidence interval (CI) 3.48 (2.22-5.46)], followed by bone disease and chronic obstructive pulmonary disease (COPD) [2.47 (1.28-4.72) and 2.13 (1.36-3.34), respectively]. Among co-occurring comorbidities, highest odds of frailty were in participants having depressive symptoms with diabetes, hypertension, or obesity [aORs (95% CIs) 5.29 (2.32-12.08), 5.21 (2.65-10.40), 4.85 (2.39-9.95), respectively], cognitive impairment with diabetes or renal disease [2.81 (1.38-5.68) and 2.53 (1.26-5.03), respectively], renal disease with cardiovascular disease [2.81 (1.32-6.01)], and diabetes with obesity [2.76 (1.39-5.45)]. CONCLUSION Co-occurrence of depressive symptoms, cognitive impairment, diabetes, or renal disease with other medical conditions substantially increases odds of frailty in older PWH. Identifying and treating these comorbidities may help to reduce functional decline with aging in PWH.
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O’Brien KK, Davis AM, Chan Carusone S, Avery L, Tang A, Solomon P, Aubry R, Zobeiry M, Ilic I, Pandovski Z, Bayoumi AM. Examining the impact of a community-based exercise intervention on cardiorespiratory fitness, cardiovascular health, strength, flexibility and physical activity among adults living with HIV: A three-phased intervention study. PLoS One 2021; 16:e0257639. [PMID: 34559851 PMCID: PMC8462727 DOI: 10.1371/journal.pone.0257639] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/02/2021] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Our aim was to examine the impact of a community-based exercise (CBE) intervention on cardiorespiratory fitness, cardiovascular health, strength, flexibility, and physical activity outcomes among adults living with HIV. METHODS We conducted a longitudinal intervention study with community-dwelling adults living with HIV in Toronto, Canada. We measured cardiopulmonary fitness (V̇O2peak (primary outcome), heart rate, blood pressure), strength (grip strength, vertical jump, back extension, push-ups, curl ups), flexibility (sit and reach test), and self-reported physical activity bimonthly across three phases. Phase 1 included baseline monitoring (8 months); Phase 2 included the CBE Intervention (6 months): participants were asked to exercise (aerobic, strength, balance and flexibility training) for 90 minutes, 3 times/week, with weekly supervised coaching at a community-based fitness centre; and Phase 3 included follow-up (8 months) where participants were expected to continue with thrice weekly exercise independently. We used segmented regression (adjusted for baseline age and sex) to assess the change in trend (slope) among phases. Our main estimates of effect were the estimated change in slope, relative to baseline values, over the 6 month CBE intervention. RESULTS Of the 108 participants who initiated Phase 1, 80 (74%) started and 67/80 (84%) completed the intervention and 52/67 (77%) completed the study. Most participants were males (87%), with median age of 51 years (interquartile range (IQR): 45, 59). Participants reported a median of 4 concurrent health conditions in addition to HIV (IQR: 2,7). Participants attended a median of 18/25 (72%) weekly supervised sessions. Change in V̇O2peak attributed to the six-month Phase 2 CBE intervention was 0.56 ml/kg/min (95% Confidence Interval (CI): -1.27, 2.39). Significant effects of the intervention were observed for systolic blood pressure (-5.18 mmHg; 95% CI: -9.66, -0.71), push-ups (2.30 additional push-ups; 95% CI: 0.69, 3.91), curl ups (2.89 additional curl ups; 95% CI: 0.61, 5.17), and sit and reach test (1.74 cm; 95% CI: 0.21, 3.28). More participants engaged in self-reported strength (p<0.001) and flexibility (p = 0.02) physical activity at the end of intervention. During Phase 3 follow-up, there was a significant reduction in trend of benefits observed during the intervention phase for systolic blood pressure (1.52 mmHg/month; 95% CI: 0.67, 2.37) and sit and reach test (-0.42 cm/month; 95% CI: -0.68, -0.16). CONCLUSION Adults living with HIV who engaged in this six-month CBE intervention demonstrated inconclusive results in relation to V̇O2peak, and potential improvements in other outcomes of cardiovascular health, strength, flexibility and self-reported physical activity. Future research should consider features tailored to promote uptake and sustained engagement in independent exercise among adults living with HIV. CLINICALTRIALS.GOV IDENTIFIER NCT02794415. https://clinicaltrials.gov/ct2/show/record/NCT02794415.
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Affiliation(s)
- Kelly K. O’Brien
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada
| | - Aileen M. Davis
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
| | | | - Lisa Avery
- University Health Network, Toronto, Ontario, Canada
- Avery Information, Oshawa, Ontario, Canada
| | - Ada Tang
- School of Rehabilitation Science, Institute of Applied Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Patricia Solomon
- School of Rehabilitation Science, Institute of Applied Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Rachel Aubry
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | | | - Ivan Ilic
- Central Toronto YMCA, Toronto, Ontario, Canada
| | | | - Ahmed M. Bayoumi
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Masa R, Baca-Atlas S, Hangoma P. Walking and perceived lack of safety: Correlates and association with health outcomes for people living with HIV in rural Zambia. JOURNAL OF TRANSPORT & HEALTH 2021; 22:101140. [PMID: 35495575 PMCID: PMC9053861 DOI: 10.1016/j.jth.2021.101140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Geographic inaccessibility disproportionately affects health outcomes of rural populations due to lack of suitable transport, prolonged travel time, and poverty. Rural patients are left with few transport options to travel to a health facility. One common option is to travel by foot, which may present additional challenges, such as perceived lack of safety while transiting. We examined the correlates of perceived lack of safety when walking to a health facility and its association with treatment and psychosocial outcomes among adults living with HIV. METHODS Data were collected from 101 adults living with HIV in Eastern Province, Zambia. All participants were receiving antiretroviral therapy at one of two health clinics. Perceived lack of safety was measured by asking respondents whether they felt unsafe traveling to and from the health facility in which they were receiving their HIV care. Outcomes included medication adherence, perceived stress, hope for the future, and barriers to pill taking. Linear and logistic regression methods were used to examine the correlates of perceived safety and its association with health outcomes. RESULTS Being older, a woman, having a primary education, living farther from a health facility, traveling longer to reach a health facility, and owing money were associated with higher likelihood of feeling unsafe when traveling by foot to health facility. Perceived lack of safety was associated with medication nonadherence, higher level of stress, lower level of agency, and more barriers to pill taking. CONCLUSIONS Perceived lack of safety when traveling by foot to a health facility may be a barrier to better treatment and psychosocial outcomes, especially among rural patients. Practitioners and policymakers should consider implementation of differentiated HIV service delivery models to reduce frequent travel to health facilities and to alleviate ART patients' worry about lack of safety when traveling by foot to a health facility.
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Affiliation(s)
- Rainier Masa
- School of Social Work, University of North Carolina at Chapel Hill, USA
- Global Social Development Innovations, University of North Carolina at Chapel Hill, USA
| | | | - Peter Hangoma
- School of Public Health, University of Zambia, Lusaka, Zambia
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Ibeneme SC, Ndukwu SC, Myezwa H, Irem FO, Ezenwankwo FE, Ajidahun AT, Ezuma AD, Nnamani A, Onodugo O, Fortwengel G, Uwakwe VC. Effectiveness of mobile text reminder in improving adherence to medication, physical exercise, and quality of life in patients living with HIV: a systematic review. BMC Infect Dis 2021; 21:859. [PMID: 34425789 PMCID: PMC8381579 DOI: 10.1186/s12879-021-06563-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 08/11/2021] [Indexed: 11/26/2022] Open
Abstract
Background Mobile text reminder (SMS) system is considered a viable strategy for targeting/facilitating healthy behavioural change including adherence to prescribed physical exercises (PE) and medication (antiretroviral therapy-ART) which should improve the quality of life (Qol) in people living with HIV/AIDS(PLWHA). Thus, the literature was appraised for evidence of SMS effectiveness in improving ART and PE adherence behaviours and QoL in PLWHA. Methods Eight databases–AMED, CINAHL, Cochrane Library, EMBASE, EMCARE, Ovid MEDLINE, PsycINFO, and PubMed-were searched up to December 2020, using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) protocol.This review included only randomised control trials (RCTs) investigating the effectiveness of SMS in improving QoL or PE or ART adherence behaviour or a combination of these variables in PLWHA >18 years. Two independent reviewers determined the eligibility of the studies. Data were extracted and the quality of the study was assessed with the Physiotherapy Evidence Database (PEDro) tool. The primary outcomes were ART and PE adherence behaviours while the secondary outcome was QoL. Result A pooled estimate of effect was not calculated due to the heterogeneity of methods and outcome measures. Therefore, a narrative synthesis of ten studies that met the inclusion criteria (n = 1621 participants at study completion) comprising males/females, aged ≥ 18 years, was done. There was a significant improvement in ART adherence behaviour except in three underpowered studies. Only the SMS interventions that were developed using the Starks 3-steps Adherence model was associated with positive outcome. The only study that evaluated QoL was underpowered and reported no significant change while there were no RCTs on PE. Conclusion Effects of SMS intervention trends towards a significant improvement in ART adherence behaviour in PLWHA. It is plausible that SMS reminders developed using the broader framework of the interpersonal health behaviour theory(ies) may have positive outcome. Nevertheless, the observed heterogeneity in the methods/outcome measures warrants a cautious interpretation of the findings. There is a lack/paucity of RCTs and therefore no evidence in support of the effectiveness of SMS intervention in improving PE adherence and QoL. Registration number NPLASY202060016. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06563-0.
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Affiliation(s)
- Sam Chidi Ibeneme
- Department of Medical Rehabilitation, Faculty of Health Sciences, University of Nigeria, Enugu Campus, Enugu, Nigeria. .,Department of Physiotherapy, Faculty of Health Sciences, School of Therapeutic Studies, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa. .,University of Nigeria Centre for Clinical Trials (UNNCET), Enugu Campus, Enugu, Nigeria.
| | - Sandra C Ndukwu
- Department of Medical Rehabilitation, Faculty of Health Sciences, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Hellen Myezwa
- Department of Physiotherapy, Faculty of Health Sciences, School of Therapeutic Studies, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa
| | - Franklin Onyedinma Irem
- Department of Medical Rehabilitation, Faculty of Health Sciences, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Fortune Elochukwu Ezenwankwo
- Division of Exercise Science and Sports Medicine, University of Cape Town/Sports Science Institute of South Africa, Cape Town, South Africa
| | - Adedayo Tunde Ajidahun
- Department of Physiotherapy, Faculty of Health Sciences, School of Therapeutic Studies, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa
| | - Amarachi D Ezuma
- Department of Physiotherapy, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria
| | - Amaka Nnamani
- Department of Radiation Medicine, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Obinna Onodugo
- Department of Medicine, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Gerhard Fortwengel
- Fakultat III, Hochschule Hannover - University of Applied Sciences and Arts, Hannover, Germany
| | - Victor C Uwakwe
- Department of Medical Rehabilitation, Faculty of Health Sciences, University of Nigeria, Enugu Campus, Enugu, Nigeria
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Dillon SM, Abdo MH, Wilson MP, Liu J, Jankowski CM, Robertson CE, Tuncil Y, Hamaker B, Frank DN, MaWhinney S, Wilson CC, Erlandson KM. A Unique Gut Microbiome-Physical Function Axis Exists in Older People with HIV: An Exploratory Study. AIDS Res Hum Retroviruses 2021; 37:542-550. [PMID: 33787299 PMCID: PMC8260890 DOI: 10.1089/aid.2020.0283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Impairments in physical function and increased systemic levels of inflammation have been observed in middle-aged and older persons with HIV (PWH). We previously demonstrated that in older persons, associations between gut microbiota and inflammation differed by HIV serostatus. To determine whether relationships between the gut microbiome and physical function measurements would also be distinct between older persons with and without HIV, we reanalyzed existing gut microbiome and short chain fatty acid (SCFA) data in conjunction with previously collected measurements of physical function and body composition from the same cohorts of older (51-74 years), nonfrail PWH receiving effective antiretroviral therapy (N = 14) and age-balanced uninfected controls (N = 22). Associations between relative abundance (RA) of the most abundant bacterial taxa or stool SCFA levels with physical function and body composition were tested using HIV-adjusted linear regression models. In older PWH, but not in controls, greater RA of Alistipes, Escherichia, Prevotella, Megasphaera, and Subdoligranulum were associated with reduced lower extremity muscle function, decreased lean mass, or lower Short Physical Performance Battery (SPPB) scores. Conversely, greater RA of Dorea, Coprococcus, and Phascolarctobacterium in older PWH were associated with better muscle function, lean mass, and SPPB scores. Higher levels of the SCFA butyrate associated with increased grip strength in both PWH and controls. Our findings indicate that in older PWH, both negative and positive associations exist between stool microbiota abundance and physical function. Different relationships were observed in older uninfected persons, suggesting features of a unique gut-physical function axis in PWH.
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Affiliation(s)
- Stephanie M. Dillon
- Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Mona H. Abdo
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado, USA
| | - Melissa P. Wilson
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado, USA
| | - Jay Liu
- Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Catherine M. Jankowski
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Charles E. Robertson
- Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Yunus Tuncil
- Department of Food Science, Purdue University, West Lafayette, Indiana, USA
| | - Bruce Hamaker
- Department of Food Science, Purdue University, West Lafayette, Indiana, USA
| | - Daniel N. Frank
- Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Samantha MaWhinney
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado, USA
| | - Cara C. Wilson
- Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kristine M. Erlandson
- Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Erlandson KM, Piggott DA. Frailty and HIV: Moving from Characterization to Intervention. Curr HIV/AIDS Rep 2021; 18:157-175. [PMID: 33817767 PMCID: PMC8193917 DOI: 10.1007/s11904-021-00554-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW While the characteristics associated with frailty in people with HIV (PWH) have been well described, little is known regarding interventions to slow or reverse frailty. Here we review interventions to prevent or treat frailty in the general population and in people with HIV (PWH). RECENT FINDINGS Frailty interventions have primarily relied on nonpharmacologic interventions (e.g., exercise and nutrition). Although few have addressed frailty, many of these therapies have shown benefit on components of frailty including gait speed, strength, and low activity among PWH. When nonpharmacologic interventions are insufficient, pharmacologic interventions may be necessary. Many interventions have been tested in preclinical models, but few have been tested or shown benefit among older adults with or without HIV. Ultimately, pharmacologic and nonpharmacologic interventions have the potential to improve vulnerability that underlies frailty in PWH, though clinical data is currently sparse.
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Affiliation(s)
- Kristine M Erlandson
- Department of Medicine, Division of Infectious Diseases, University of Colorado-Anschutz Medical Campus, 12700 E. 19th Avenue, Mail Stop B168, Aurora, CO, 80045, USA.
- Department of Epidemiology, Colorado School of Public Health, Anschutz Medical Campus, Aurora, CO, USA.
| | - Damani A Piggott
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, MD, USA
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Abstract
PURPOSE OF REVIEW Older adults account for the majority of people with HIV (PWH) in high-income countries and have increasingly complex clinical profiles related to premature aging. Frailty is an important geriatric syndrome affecting a minority of PHW. Frailty negatively affects PHW's clinical status and quality of life. This review will update care providers on the current state of frailty that limits the healthspan of PWH. RECENT FINDINGS Ongoing low-level HIV replication in treated PWH leads to immune activation and chronic inflammation contributing to the destabilization of normally autoregulated physiologic systems in response to environmental and biologic challenges characteristic of frailty. Understanding these underlying mechanisms will determine potential intervention options. Potentially reversible risk factors that promote progression to and reversion from the dynamic state of frailty are being studied and will help prevent frailty. Simple assessment tools and treatment strategies for frailty are being adapted for aging PWH. SUMMARY Insight into underlying biologic mechanisms and adapting proven geriatric principles of interdisciplinary care will inform the healthy aging of PWH.
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Affiliation(s)
- Julian Falutz
- Division of Geriatric Medicine, Comprehensive HIV Aging Initiative, Combined Viral Illness Service, Division of Infectious Diseases, McGill University Health Center, Quebec, Canada
| | - Fátima Brañas
- Division of Geriatrics, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Kristine M Erlandson
- Divisions of Infectious Diseases and Geriatric Medicine, University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado, USA
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Physical Function and Frailty Tools in Mortality Prediction of Middle-Aged Adults With HIV. J Acquir Immune Defic Syndr 2021; 85:372-378. [PMID: 32732769 DOI: 10.1097/qai.0000000000002455] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Frailty and physical function impairments occur at an earlier than expected age in people with HIV (PWH). The goal of this study was to determine which tools or combination of tools assessing frailty/physical function were most predictive of mortality in a middle-aged population of PWH. METHODS Using electronic health records, we determined survival, death, or loss to follow-up for 359 PWH, aged 45-65 years originally enrolled in a 2009-2010 cross-sectional cohort study. The predictive accuracy of various physical function measures [frailty score, Veterans Aging Cohort Study (VACS) index, 400-m walk, Short Physical Performance Battery (SPPB), grip strength, and falls] were compared using integrated time-dependent receiver operating characteristic area under the curve (AUC) in single variable models. Two-variable models were compared with the best single-variable model to determine if AUC improved with additional physical function variables. RESULTS At 8-year follow-up, frailty, 400-m walk pace, SPPB, chair rise pace, VACS score, and falls were associated with increased hazard of mortality; grip strength was only predictive in sex-adjusted models. The VACS index and 400-m walk pace were the best individual predictors of mortality with time-dependent receiver operating characteristic AUC scores of 0.82, followed by SPPB (0.73), chair-rise pace (0.68), falls (0.65), frailty (0.63), and grip strength (0.55). Addition of the 400-m walk to VACS index yielded the only significant improvement in the prediction of survival compared with the VACS index alone (P = 0.04). CONCLUSION Our study highlights several clinically applicable physical function measures predictive of mortality in middle-aged PWH that can be tailored to specific patient subpopulations and clinical or research encounters.
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Masters MC, Perez J, Wu K, Ellis RJ, Goodkin K, Koletar SL, Andrade A, Yang J, Brown TT, Palella FJ, Sacktor N, Tassiopoulos K, Erlandson KM. Baseline Neurocognitive Impairment (NCI) Is Associated With Incident Frailty but Baseline Frailty Does Not Predict Incident NCI in Older Persons With Human Immunodeficiency Virus (HIV). Clin Infect Dis 2021; 73:680-688. [PMID: 34398957 DOI: 10.1093/cid/ciab122] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 02/08/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Neurocognitive impairment (NCI) and frailty are more prevalent among persons with human immunodeficiency virus (HIV, PWH) compared to those without HIV. Frailty and NCI often overlap with one another. Whether frailty precedes declines in neurocognitive function among PWH or vice versa has not been well established. METHODS AIDS Clinical Trials Group (ACTG) A5322 is an observational cohort study of older PWH. Participants undergo annual assessments for NCI and frailty. ACTG A5322 participants who developed NCI as indexed by tests of impaired executive functioning and processing speed during the first 3 years were compared to persons who maintained normal cognitive function; those who demonstrated resolution of NCI were compared to those who had persistent NCI. Participants were similarly compared by frailty trajectory. We fit multinomial logistic regression models to assess associations between baseline covariates (including NCI) and frailty, and associations between baseline covariates (including frailty) and NCI. RESULTS In total, 929 participants were included with a median age of 51 years (interquartile range [IQR] 46-56). At study entry, 16% had NCI, and 6% were frail. Over 3 years, 6% of participants developed NCI; 5% developed frailty. NCI was associated with development of frailty (odds ratio [OR] = 2.06; 95% confidence interval [CI] = .94, 4.48; P = .07). Further adjustment for confounding strengthened this association (OR = 2.79; 95% CI = 1.21, 6.43; P = .02). Baseline frailty however was not associated with NCI development. CONCLUSIONS NCI was associated with increased risk of frailty, but frailty was not associated with development of NCI. These findings suggest that the presence of NCI in PWH should prompt monitoring for the development of frailty and interventions to prevent frailty in this population.
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Affiliation(s)
- Mary Clare Masters
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jeremiah Perez
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Kunling Wu
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Ronald J Ellis
- University of California, San Diego, San Diego, California, USA
| | - Karl Goodkin
- University of Nebraska Medical Center, Omaha, Omaha, Nebraska, USA
| | | | | | | | - Todd T Brown
- Johns Hopkins University, Baltimore, Maryland, USA
| | - Frank J Palella
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ned Sacktor
- Johns Hopkins University, Baltimore, Maryland, USA
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Erlandson KM, Liu J, Johnson R, Dillon S, Jankowski CM, Kroehl M, Robertson CE, Frank DN, Tuncil Y, Higgins J, Hamaker B, Wilson CC. An exercise intervention alters stool microbiota and metabolites among older, sedentary adults. Ther Adv Infect Dis 2021; 8:20499361211027067. [PMID: 34262758 PMCID: PMC8246564 DOI: 10.1177/20499361211027067] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 06/03/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Physiologic aging has been associated with gut dysbiosis. Although short exercise interventions have been linked to beneficial changes in gut microbiota in younger adults, limited data are available from older populations. We hypothesized that exercise would produce beneficial shifts in microbiota and short-chain fatty acid (SCFA) levels in older persons. METHODS Stool samples were collected before and at completion of a supervised 24-week cardiovascular and resistance exercise intervention among 50-75-year-old participants. SCFA levels were analyzed by gas chromatography and microbiome by 16S rRNA gene sequencing. Negative binomial regression models compared pre- and post-differences using false discovery rates for multiple comparison. RESULTS A total of 22 participants provided pre-intervention samples; 15 provided samples at study completion. At baseline, the majority of participants were men (95%), mean age 58.0 (8.8) years, mean body mass index 27.4 (6.4) kg/m2. After 24 weeks of exercise, at the genus level, exercise was associated with significant increases in Bifidobacterium (and other unidentified genera within Bifidobacteriaceae), Oscillospira, Anaerostipes, and decreased Prevotella and Oribacterium (p < 0.001). Stool butyrate increased with exercise [5.44 (95% confidence interval 1.54, 9.24) mmol/g, p = 0.02], though no significant differences in acetate or propionate (p ⩾ 0.09) were seen. CONCLUSION Our pilot study suggested that an exercise intervention is associated with changes in the microbiome of older adults and a key bacterial metabolite, butyrate. Although some of these changes could potentially reverse age-related dysbiosis, future studies are required to determine the contribution of changes to the microbiome in the beneficial effect of exercise on overall health of older adults. Clinical Trials NCT02404792.
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Affiliation(s)
- Kristine M. Erlandson
- Department of Medicine, Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, 12700 E. 19th Avenue, Mail Stop B168, Aurora, CO 80045, USA
| | - Jay Liu
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Rachel Johnson
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA
| | - Stephanie Dillon
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Miranda Kroehl
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA
| | - Charles E. Robertson
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Daniel N. Frank
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Yunus Tuncil
- Food Engineering Department, Ordu University, Ordu, Turkey
| | - Janine Higgins
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Bruce Hamaker
- Department of Food Science, Purdue University, West Lafayette, IN, USA
| | - Cara C. Wilson
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Dinani A, Khan A, Dieterich D. Emerging prevalence of fatty liver disease in HIV. Future Virol 2021. [DOI: 10.2217/fvl-2020-0184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Fatty liver disease is a growing concern in people living with HIV, the main drivers are alcoholic liver disease and nonalcoholic fatty liver disease. It has shown to negatively impact HIV care continuum and result in notable non-HIV related morbidity and mortality. With the advancement in antiretroviral therapy and effective direct acting antivirals, fatty liver disease is surfacing as the next big challenge in this population like that observed in the general population. This review article summarizes the gravity of these two common diseases in HIV-infected people and aims to sheds light on an unmet need to develop effective methods to identify, screen and manage fatty liver disease in this unique population.
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Affiliation(s)
- Amreen Dinani
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Ali Khan
- Department of Internal Medicine, Icahn School of Medicine, Mount Sinai West, New York, NY 10019, USA
| | - Douglas Dieterich
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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Jankowski CM, Wilson MP, MaWhinney S, Reusch J, Knaub L, Hull S, Erlandson KM. Blunted muscle mitochondrial responses to exercise training in older adults with HIV. J Infect Dis 2020; 224:679-683. [PMID: 33378424 DOI: 10.1093/infdis/jiaa799] [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: 09/17/2020] [Accepted: 12/23/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Muscle mitochondrial dysfunction associated with HIV and antiretroviral therapy (ART) may improve with exercise. METHODS Muscle specimens obtained before and after 24 weeks of exercise in older PWH (n=18; ART >2 years) and uninfected controls (n=21) were analyzed for citrate synthase (CS) activity and complexes (C) I-V, manganese superoxide dismutase (MnSOD), peroxisome proliferator-activated receptor-γ coactivator-1 (PGC1α), and voltage-dependent anion channel 1 (VDAC1) content. RESULTS Only controls had increased CS, MnSOD, PGC1 and CIV (P≤0.01; P< 0.01 vs PWH) after training. CONCLUSIONS The blunted mitochondrial adaptations to training in PWH suggests the need for different types of exercise-induced stimulation.
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Affiliation(s)
| | - Melissa P Wilson
- University of Colorado Anschutz Medical Campus, Colorado School of Public Health, Department of Biostatistics and Informatics, Aurora, CO, USA.,University of Colorado Anschutz Medical Campus, School of Medicine, Department of Bioinformatics and Personalized Medicine, Aurora, CO, USA
| | - Samantha MaWhinney
- University of Colorado Anschutz Medical Campus, Colorado School of Public Health, Department of Biostatistics and Informatics, Aurora, CO, USA
| | - Jane Reusch
- University of Colorado Anschutz Medical Campus, Department of Medicine, Division of Endocrinology, Metabolism & Diabetes, Aurora, CO, USA.,Rocky Mountain Regional VA Medical Center, Aurora, CO, USA.,University of Colorado Anschutz Medical Campus Center for Women's Health Research, Aurora, CO, USA
| | - Leslie Knaub
- University of Colorado Anschutz Medical Campus, Department of Medicine, Division of Endocrinology, Metabolism & Diabetes, Aurora, CO, USA.,Rocky Mountain Regional VA Medical Center, Aurora, CO, USA
| | - Sara Hull
- University of Colorado Anschutz Medical Campus, Department of Medicine, Division of Endocrinology, Metabolism & Diabetes, Aurora, CO, USA.,Rocky Mountain Regional VA Medical Center, Aurora, CO, USA
| | - Kristine M Erlandson
- University of Colorado Anschutz Medical Campus, Department of Medicine, Division of Infectious Diseases, Aurora, CO, USA.,University of Colorado Anschutz Medical Campus, Department of Medicine, Division of Geriatric Medicine, Aurora, CO, USA
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Ajidahun AT, Myezwa H, Ibeneme SC, Magobotha S, Fortwengel G, Jingo M, Milner B, Ravat S, Okoye I, Schnaid E, Bischoff F. Effects of exercise training on bone mineral density and some health-related outcomes in HIV conditions: A randomized controlled trial. Medicine (Baltimore) 2020; 99:e23206. [PMID: 33327237 PMCID: PMC7738028 DOI: 10.1097/md.0000000000023206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 10/17/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Human Immunodeficiency Virus (HIV) infection remains prevalent co-morbidity, and among fracture patients. Few studies have investigated the role of exercise interventions in preventing bone demineralization in people who have fractures and HIV. If exercise exposed, HIV-infected individuals may experience improved bone health outcomes (BMD), function, quality of life (QoL). The study will aim to assess the impact of home based exercises on bone mineral density, functional capacity, QoL, and some serological markers of health in HIV infection among Nigerians and South Africans. METHODS AND DESIGN The study is an assessor-blinded randomized controlled trial. Patients managed with internal and external fixation for femoral shaft fracture at the study sites will be recruited to participate in the study. The participants will be recruited 2 weeks post-discharge at the follow-up clinic with the orthopaedic surgeon. The study population will consist of all persons with femoral fracture and HIV-positive and negative (HIV-positive medically confirmed) aged 18 to 60 years attending the above-named health facilities. For the HIV-positive participants, a documented positive HIV result, as well as a history of being followed-up at the HIV treatment and care center. A developed home based exercise programme will be implemented in the experimental group while the control group continues with the usual rehabilitation programme. The primary outcome measures will be function, gait, bone mineral density, physical activity, and QoL. DISCUSSION The proposed trial will compare the effect of a home-based physical exercise-training programme in the management of femoral fracture to the usual physiotherapy management programmes with specific outcomes of bone mineral density, function, and inflammatory markers. TRIAL REGISTRATION The study was prospectively registered with the Pan African Clinical Trials Registry (Reference number - PACTR201910562118957) on October 21, 2019. (https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=9425).
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Affiliation(s)
- Adedayo Tunde Ajidahun
- Department of Physiotherapy, University of the Witwatersrand, Johannesburg, South Africa
| | - Hellen Myezwa
- Department of Physiotherapy, University of the Witwatersrand, Johannesburg, South Africa
| | - Sam Chidi Ibeneme
- Department of Physiotherapy, University of the Witwatersrand, Johannesburg, South Africa
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria, Enugu Campus. Nigeria
| | - Sebastian Magobotha
- Department of Orthopaedic Surgery, University of the Witwatersrand, Johannesburg, South Africa
| | - Gerhard Fortwengel
- Hochschule Hannover – University of Applied Sciences and Arts, Hannover, Germany
| | - Maxwell Jingo
- Department of Orthopaedic Surgery, University of the Witwatersrand, Johannesburg, South Africa
| | - Brenda Milner
- Department of Orthopaedic Surgery, University of the Witwatersrand, Johannesburg, South Africa
| | - Sadiya Ravat
- Department of Physiotherapy, University of the Witwatersrand, Johannesburg, South Africa
| | - Ifeoma Okoye
- University of Nigeria Teaching Hospital Enugu (UNTH), Ituku-Ozalla, Enugu State, Nigeria
| | - Edward Schnaid
- Department of Orthopaedic Surgery, University of the Witwatersrand, Johannesburg, South Africa
| | - Faith Bischoff
- Department of Orthopaedic Surgery, University of the Witwatersrand, Johannesburg, South Africa
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Erlandson KM. Physical Function and Frailty in HIV. TOPICS IN ANTIVIRAL MEDICINE 2020; 28:469-473. [PMID: 34107206 PMCID: PMC8224243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Aging is associated with declines in physical function that can be influenced by many factors, including HIV. These limitations may manifest as increased vulnerability to stressors, or frailty. Functional limitations and frailty can be used to guide clinical decisions, protect people from harm, and avoid strategies that are not likely to provide benefits. Such limitations could also serve as clinically relevant endpoints for some clinical trials. Interventions should ideally focus on early impairments that begin to occur in midlife, well before an individual becomes frail or experiences disabilities. Overall, physical activity is safe and effective in improving physical function, and counseling about physical activity should be a routine component of HIV care to increase the lifespan and healthspan of individuals with HIV. There are some promising pharmaceutical options, but more research is needed to determine the safety and long-term efficacy. This article summarizes an International Antiviral Society-USA (IAS-USA) webinar presented by Kristine M. Erlandson, MD, MS, on July 24, 2020. This webinar is available on demand at https://www.iasusa.org/courses/on-demand-webinar-2020-erlandson/.
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Ghayomzadeh M, Earnest CP, Hackett D, SeyedAlinaghi S, Navalta JW, Gholami M, Hosseini Rouzbahani N, Mohraz M, Voltarelli FA. Combination of resistance and aerobic exercise for six months improves bone mass and physical function in HIV infected individuals: A randomized controlled trial. Scand J Med Sci Sports 2020; 31:720-732. [PMID: 33185897 DOI: 10.1111/sms.13871] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 10/28/2020] [Accepted: 11/04/2020] [Indexed: 02/05/2023]
Abstract
To evaluate the effect of combined resistance and aerobic training (RT+AT) on regional bone mineral density (BMD) and physical performance in people living with HIV (PLWH). Forty PLWH (20 men and 20 women) were randomized into RT+AT group (n = 20; age = 38.3 ± 4.9) or non-exercise control group (n = 20; age = 37.9 ± 5.1). The RT+AT group was required to perform a nonlinear periodized resistance training program targeting large muscle groups followed by 20 min aerobic exercise at 65-80% of maximal heart rate. Participants in RT+AT performed three supervised sessions per week for 6-months, whereas participants in the control group were instructed to continue with their current lifestyle habits. The primary outcome was bone mineral density (lumbar spine (L2-L4), femoral neck, and distal 1/3 radius). Secondary outcomes included physical function, anthropometry, inflammatory markers, and growth factors. The RT+AT group demonstrated a significant increase in BMD at follow-up for the Lumbar spine (L2-L4), femoral neck, and 1/3 radius (all, P < .05), and There were no gender differences in the training response between men and women for any of the BMD regions. Similar findings were also observed for lean body mass, IGF1and Adiponectin (P < .001). We observed a decrease in percent body fat, fat mass, IL-6, TNF-α, and myostatin in the RT+AT group (P < .001). Finally, there was a significant increase in handgrip strength and gait speed for both women and men in the RT+AT group (P < .001). A combination of resistance and aerobic training appears to be a feasible and effective means for counteracting bone loss and improving various inflammatory markers, physical function, and growth hormones in PLWH.
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Affiliation(s)
- Morteza Ghayomzadeh
- Physical Activity, Lifestyle, Ageing and Wellbeing Faculty Research Group, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Lidcombe, NSW, Australia.,Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Conrad P Earnest
- Health and Kinesiology, Texas A&M University College Station, College Station, TX, USA
| | - Daniel Hackett
- Physical Activity, Lifestyle, Ageing and Wellbeing Faculty Research Group, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Lidcombe, NSW, Australia
| | - SeyedAhmad SeyedAlinaghi
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - James Wilfred Navalta
- Department of Kinesiology and Nutrition Sciences, University of Nevada, Las Vegas, NV, USA
| | - Mohammad Gholami
- Department of Medical Microbiology, Faculty of Medicine, Aja University of Medical Sciences, Tehran, Iran
| | - Negin Hosseini Rouzbahani
- Department of Medical Immunology, Faculty of Medicine, Aja 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
| | - Fabrício Azevedo Voltarelli
- Graduate Program in Health Sciences, Faculty of Medicine, Federal University of Mato Grosso, Cuiab'a, Brazil
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41
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Effects of Supervised Exercise on Physical Health and Quality of Life Among Older Adults Living With HIV in Hong Kong. J Assoc Nurses AIDS Care 2020; 31:353-358. [PMID: 31094864 DOI: 10.1097/jnc.0000000000000099] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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42
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Jankowski CM, Mawhinney S, Wilson MP, Campbell TB, Kohrt WM, Schwartz RS, Brown TT, Erlandson KM. Body Composition Changes in Response to Moderate- or High-Intensity Exercise Among Older Adults With or Without HIV Infection. J Acquir Immune Defic Syndr 2020; 85:340-345. [PMID: 32701826 PMCID: PMC8040534 DOI: 10.1097/qai.0000000000002443] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND People with HIV (PWH) are at an increased risk for adiposity and sarcopenia, despite effective antiretroviral therapy. Our objective was to compare the effects of prescribed exercise on body composition in older PWH and uninfected controls. SETTING Academic medical center. METHODS Sedentary PWH (n = 27) and uninfected controls (n = 28) aged 50-75 years completed 24 weeks of cardiovascular and resistance exercise. Participants completed 12 weeks of moderate-intensity exercise and then were randomized to moderate- or high-intensity exercise for 12 additional weeks. Total lean (LEAN) and fat mass (FAT), and visceral adipose tissue area (VAT) were measured using dual-energy x-ray absorptiometry at baseline and 24 weeks; baseline and intervention differences were compared by HIV serostatus using multivariable regression analyses adjusted for baseline values, age, and exercise adherence. RESULTS At baseline, PWH had significantly lower FAT (P = 0.003), but no significant differences in LEAN or VAT compared with controls (P > 0.20). Changes over 24 weeks were not significantly different by HIV serostatus, although controls tended to gain more LEAN (0.8 kg; range, 0-1.6 kg; P = 0.04] than PWH (0.6 kg; range, -0.2 to 1.4 kg; P = 0.12) and lose less FAT and VAT (controls: (-0.9 kg; range, -1.8 to 0.0 kg and -10.3 cm; range, -19.6, 1.0) cm; both P = 0.03 vs PWH: -2.0 kg; range, -2.9 to -1.1 kg and -17.7 cm; range, -27.1 to -8.2 cm; both P < 0.001). Exercise intensity differences were not apparent for LEAN, FAT, or VAT. CONCLUSIONS Exercise reduced total and visceral fat in older PWH and controls. Minimal gains in lean mass suggest that greater emphasis on resistance exercise may be needed to more effectively increase muscle in PWH.
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Affiliation(s)
| | - Samantha Mawhinney
- Department of Biostatistics, University of Colorado Anschutz Medical Campus, School of Public Health, Aurora, CO
| | - Melissa P Wilson
- Department of Biostatistics, University of Colorado Anschutz Medical Campus, School of Public Health, Aurora, CO
| | - Thomas B Campbell
- Department of Medicine, Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Wendy M Kohrt
- Department of Medicine, Division of Geriatric Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Eastern Colorado VA Geriatric Research, Education and Clinical Center, Denver, CO; and
| | - Robert S Schwartz
- Department of Medicine, Division of Geriatric Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Eastern Colorado VA Geriatric Research, Education and Clinical Center, Denver, CO; and
| | - Todd T Brown
- Department of Medicine, Division of Endocrinology, Diabetes, & Metabolism, Johns Hopkins University, Baltimore, MD
| | - Kristine M Erlandson
- Department of Medicine, Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, CO
- Department of Medicine, Division of Geriatric Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
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Hixon B, Burgess HJ, Wilson MP, MaWhinney S, Jankowski CM, Erlandson KM. A supervised exercise intervention fails to improve subjective and objective sleep measures among older adults with and without HIV. HIV Res Clin Pract 2020; 21:121-129. [PMID: 33119991 DOI: 10.1080/25787489.2020.1839708] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Chronic sleep disruption can have significant negative health effects and prior studies suggest that people with HIV (PWH) have disproportionately higher rates of sleep problems. METHODS We evaluated baseline sleep of sedentary, older adults (50-75 years) with (n = 28) and without HIV (n = 29) recruited into a 24-week exercise study. Subjective sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI); objective sleep parameters were assessed using wrist-worn actigraphy. Regression models were used to investigate changes in outcomes. RESULTS Fifty-seven participants completed the intervention. At baseline, PWH had significantly lower sleep efficiency (88.7 [95% CI 86, 91]%) compared to controls (91.8 [95% CI 91, 93]%; p = 0.02); other sleep measures indicated poorer sleep among PWH but did not reach statistical significance (p ≥ 0.12). Overall, sleep outcomes did not significantly change with the exercise intervention (all p > 0.05). In adjusted analyses, PWH demonstrated a decrease in total sleep time (-22.1 [-43.7, -0.05] p = 0.045) and sleep efficiency (-1.3 [-2.5, -.01], p = 0.03) during the 24 weeks of exercise; these differences were attenuated and no longer significant after adjusting for exercise intensity. At the completion of the intervention, compared to controls, PWH had significantly poorer sleep by PSQI score (2.2 [0.6, 3.8]; p = 0.006) and sleep efficiency (-2.8 [-5.4,-0.2]%; p = 0.04). CONCLUSIONS In this study, sleep disturbance was more prevalent in sedentary older PWH compared to uninfected controls. An exercise intervention had minimal effect on sleep impairments among PWH nor controls. Among older adults, interventions beyond cardiovascular and resistance exercise may be needed to significantly alter subjective and objective sleep outcomes.
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Affiliation(s)
- Brian Hixon
- University of Colorado, Colorado School of Public Health, Aurora, CO, USA
| | - Helen J Burgess
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Melissa P Wilson
- Department of Biostatistics and Informatics, University of Colorado, Aurora, CO, USA
| | - Samantha MaWhinney
- Department of Biostatistics and Informatics, University of Colorado, Aurora, CO, USA
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Abstract
PURPOSE OF REVIEW Different factors contribute to the decreased overall long-term survival in treated people living with HIV (PLWH). This paper will review the state of physical frailty which limits successful aging in PLWH. RECENT FINDINGS Identifiable events on the continuum from clinical normality to heightened risk of adverse health outcomes contribute to frailty. These center on chronic inflammation leading to destabilization of autoregulated physiologic systems challenged by environmental and biologic challenges. Frailty assessment can inform the profile of aging PLWH at increased risk of common age-related disorders and geriatric syndromes. Biologic and psychosocial risk factors promoting progression to and reversion from a dynamic state of frailty are being investigated, allowing for preventative interventions to be considered. Insights gained from studying frail PLWH will help adapt an interdisciplinary geriatric model of health care for selected PLWH. This will improve the health and well-being of aging PLWH.
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Affiliation(s)
- Julian Falutz
- Division of Geriatrics, Director, Comprehensive HIV and Aging Initiative, McGill University Health Centre, Montreal, Quebec, Canada.
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45
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Briggs BC, Ryan AS, Sorkin JD, Oursler KK. Feasibility and effects of high-intensity interval training in older adults living with HIV. J Sports Sci 2020; 39:304-311. [PMID: 32962523 DOI: 10.1080/02640414.2020.1818949] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Adults with HIV on therapy can live a normal lifespan but exhibit advanced ageing which includes reduced cardiorespiratory fitness. Our objective was to determine the feasibility and effects of high-intensity interval training (HIIT) combined with resistance training (RT) in older adults with HIV. We conducted a cross-over pilot study within a randomized exercise trial in sedentary adults with HIV ≥50 years of age. First, participants were randomized to 4 months of continuous high-intensity aerobic exercise (AEX) and RT 3x/week or standard of care control. Then, the control group completed 4 months of HIIT + RT (3x/week). Among the 32 individuals enrolled, 26 eligible participants were randomized. Most participants were African American (63%) and male (95%) with a mean (SD) age of 61.5 (6.7) years and VO2peak of 24.5 (4.9) ml/kg/min. Attendance and adherence to both exercise training interventions were high. The clinically significant increases in VO2peak (ml/kg/min) after HIIT (3.09 ±1.04, p=0.02) and AEX (2.09 ±0.72, p=0.01) represented improvements of 17.1% and 7.7%, respectively. Both groups had improvements in exercise endurance (time on the treadmill) and strength (all p< 0.01). This pilot study supports HIIT as an efficient means to deliver high-intensity AEX to improve cardiorespiratory fitness toward the goal of attenuating the accelerated ageing process in adults with HIV.
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Affiliation(s)
- Brandon C Briggs
- Geriatrics and Extended Care, Salem Veterans Affairs Medical Center , Salem, VA, USA.,Department of Health & Human Performance, Concordia University Chicago , Chicago, IL, USA
| | - Alice S Ryan
- Baltimore Geriatric Research, Education, and Clinical Center (GRECC), The Veterans Affairs Maryland Health Care System , Baltimore, MD, USA.,Department of Medicine, University of Maryland School of Medicine , Baltimore, MD, USA
| | - John D Sorkin
- Baltimore Geriatric Research, Education, and Clinical Center (GRECC), The Veterans Affairs Maryland Health Care System , Baltimore, MD, USA.,Department of Medicine, University of Maryland School of Medicine , Baltimore, MD, USA
| | - Krisann K Oursler
- Geriatrics and Extended Care, Salem Veterans Affairs Medical Center , Salem, VA, USA.,Department of Medicine, Virginia Tech Carilion School of Medicine , Roanoke, VA, USA
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Abstract
BACKGROUND To evaluate differences between older women and men with HIV regarding HIV variables, comorbidity, physical function, and quality of life (QOL). SETTING The Modena HIV clinic. METHODS Prospective cohort study. Cross-sectional analysis. Patients >50 years were included, stratified by sex. We recorded sociodemographic data, comorbidities, variables related to HIV infection, frailty, data on body composition, physical function, physical activity, and QOL. RESULTS We evaluated 1126 older adults with HIV, of which 284 (25.2%) were women. Median age was 55 (IQR 6) years. There were significant differences between women and men in the median current CD4 T-cell and the mean CD4/CD8 ratio. There were differences regarding alcohol consumption, cardiovascular (CV) disease, hypertension, diabetes mellitus, and renal failure. Sarcopenia and slower gait speed were found more prevalent among men, but without significant differences. Significant differences were found regarding lower extremity strength measured by the chair stand test and in the short physical performance battery score. Short physical performance battery <9 was detected for 11.1% women vs. 5.6% men (P = 0.002). EQ5D5L score was 0.87 in women vs. 0.89 in men (P = 0.002). CONCLUSIONS In our cohort, older women represented one in 4 of the total patients. Despite the fact that women have better immunological recovery measured by CD4 T-cell count and CD4/CD8 ratio, and fewer CV disease and CV risk factors than men, their physical function and their QOL are worse. Therefore, older HIV-infected women have special characteristics, and the assessment of physical function in this group seems to be crucial.
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Erlandson KM, Wilson MP, MaWhinney S, Rapaport E, Liu J, Wilson CC, Rahkola JT, Janoff EN, Brown TT, Campbell TB, Jankowski CM. The Impact of Moderate or High-Intensity Combined Exercise on Systemic Inflammation Among Older Persons With and Without HIV. J Infect Dis 2020; 223:1161-1170. [PMID: 32779711 DOI: 10.1093/infdis/jiaa494] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 07/31/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND We investigated whether higher-intensity exercise provided greater decrease in markers of inflammation, and whether responses differed by HIV serostatus. METHODS People with HIV (PWH; n = 32) and controls (n = 37) aged 50-75 years completed 12 weeks moderate-intensity exercise, then were randomized to moderate- or high-intensity exercise for 12 additional weeks (n = 27 and 29, respectively). Inflammation biomarkers were measured at 0, 12, 24 weeks. Mixed and multiple regression models were adjusted for baseline inflammation, age, and body mass index. RESULTS Baseline tumor necrosis factor-α (TNF-α), soluble TNF receptor 2 (sTNFR2), and soluble CD14 (sCD14) were significantly higher among PWH than controls (P < .04). From week 0-12, changes in interleukin-6 (IL-6), TNF-α, and sTNFR1 were not significantly different by HIV serostatus. We found no significant interaction between HIV serostatus/exercise intensity on week 12-24 changes in IL-6, TNF-α, and sTNFR1. Among high-intensity exercisers, PWH and controls had significant increases in sCD14 (P ≤ .003), controls significant increases in IL-10 (P = .01), and PWH nonsignificant decrease in highly sensitive C-reactive protein (P = .07). Other markers were not significantly different by serostatus or intensity. CONCLUSIONS Moderate and high-intensity exercise elicited similar effects on inflammation among PWH and controls, with additional beneficial effects seen among high-intensity exercisers. Increase in sCD14 and attenuated IL-10 increase (PWH only) merit further study. CLINICAL TRIALS REGISTRATION NCT02404792.
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Affiliation(s)
- Kristine M Erlandson
- Department of Medicine, Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Melissa P Wilson
- School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Samantha MaWhinney
- School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Eric Rapaport
- Department of Medicine, Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jay Liu
- Department of Medicine, Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Cara C Wilson
- Department of Medicine, Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jeremy T Rahkola
- Department of Medicine, Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Edward N Janoff
- Department of Medicine, Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado, USA
| | - Todd T Brown
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University, Baltimore, Maryland, USA
| | - Thomas B Campbell
- Department of Medicine, Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Catherine M Jankowski
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Webel AR, Perazzo J, Phillips JC, Nokes KM, Rentrope C, Schnall R, Musanti R, Adams Tufts K, Sefcik E, Hamilton MJ, Portillo C, Chaiphibalsarisdi P, Orton P, Davis L, Rose CD. The Relationship Between Physical Activity and Cardiorespiratory Fitness Among People Living With Human Immunodeficiency Virus Throughout the Life Span. J Cardiovasc Nurs 2020; 34:364-371. [PMID: 31343620 PMCID: PMC6690753 DOI: 10.1097/jcn.0000000000000589] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND People living with human immunodeficiency virus (PLHIV) are at an increased risk for developing cardiovascular disease (CVD). Physical activity and cardiorespiratory fitness in PLHIV are poorly understood. OBJECTIVE The aims of this study were to describe physical activity and cardiorespiratory fitness by sex and age and to examine the association between physical activity and cardiorespiratory fitness in PLHIV, controlling for covariates. METHODS Seven hundred two PLHIV participated in a cross-sectional study and completed validated measures of self-reported physical activity (7-day Physical Activity Recall) and cardiorespiratory fitness (6-minute walk test). Participants were recruited from 7 diverse sites in the United States and Thailand, and data were analyzed using descriptive statistics and multiple regression to examine the relationship between physical activity and cardiorespiratory fitness. RESULTS On average, participants self-reported engaging in 115 minutes of, mostly light (75%), physical activity. Men reported twice the amount of physical activity as women (155 vs 73 minutes, P = .01). Participants' ability to achieve their predicted 6-minute walk test distances was similar between men (68%) and women (69%) (P > .01). For women, vigorous physical activity was associated with a 6.6% increase in cardiorespiratory fitness and being temporarily unemployed was associated with an 18% decline in cardiorespiratory fitness. Cardiorespiratory fitness increased with age (P < .01). CONCLUSIONS Weekly physical activity of people living with human immunodeficiency virus averaged 85 minutes of mostly light activity, well below the recommended 150 minutes of moderate activity. Vigorous physical activity was associated with improved cardiorespiratory fitness in women, but not men. Although PLHIV would benefit from interventions to increase physical activity, our data suggest a need to develop sex-specific physical activity strategies.
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Affiliation(s)
- Allison R Webel
- Allison R. Webel, PhD, RN, FAAN Assistant Professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio; and International Nursing Network for HIV Research. Joseph Perazzo, PhD, RN, ACRN Assistant Professor, International Nursing Network for HIV Research; and University of Cincinnati, Ohio. J. Craig Phillips, PhD, LLM, RN, APRN, ACRN, FAAN Vice-Dean Governance and Secretary and Associate Professor, Faculty of Health Sciences, School of Nursing, University of Ottawa, Ontario, Canada; and International Nursing Network for HIV Research. Kathleen M. Nokes, PhD, RN, FAAN Honorary Research Professor, Durban University of Technology, South Africa; and International Nursing Network for HIV Research. Cynthia Rentrope, MPH, MSSA Research Assistant, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio. Rebecca Schnall, PhD, RN Associate Professor, Columbia University School of Nursing, New York City, New York; and International Nursing Network for HIV Research. Rita Musanti, PhD, RN Rutgers University, Newark, New Jersey; and International Nursing Network for HIV Research. Kimberly Adams Tufts, ND, WHNP-BC, FAAN Professor, School of Nursing, Old Dominion University, Norfolk, Virginia; and International Nursing Network for HIV Research. Elizabeth Sefcik, PhD, RN Professor, Texas A &M University, Corpus Christi; and International Nursing Network for HIV Research. Mary Jane Hamilton, PhD, RN Professor, Texas A &M University, Corpus Christi; and International Nursing Network for HIV Research. Carmen Portillo, PhD, RN Executive Deputy Dean & Professor, Yale School of Nursing, Orange, Connecticut; and International Nursing Network for HIV Research. Puangtip Chaiphibalsarisdi, PhD, RN Associate Professor, Faculty of Nursing, Saint Louis College, Bangkok, Thailand; and International Nursing Network for HIV Research. Penelope Orton, PhD Senior Lecturer, Durban University of Technology, South Africa; and International Nursing Network for HIV Research. Liana Davis, PhD Assistant Professor, Department of Kinesiology, Texas A &M University, Corpus Christi. Carol Dawson Rose, PhD, RN Professor, University of California, San Francisco; and International Nursing Network for HIV Research
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Erlandson KM, Travison TG, Zhu H, Magaziner J, Correa-de-Araujo R, Cawthon PM, Bhasin S, Manini T, Fielding RA, Palella FJ, Kingsley L, Lake JE, Sharma A, Tien PC, Weber KM, Yin MT, Brown TT. Application of Selected Muscle Strength and Body Mass Cut Points for the Diagnosis of Sarcopenia in Men and Women With or at Risk for HIV Infection. J Gerontol A Biol Sci Med Sci 2020; 75:1338-1345. [PMID: 32301484 PMCID: PMC7302174 DOI: 10.1093/gerona/glaa083] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Persons with HIV may experience greater mobility limitations than uninfected populations. Accurate tools are needed to identify persons at greatest risk of decline. We evaluated the performance of novel muscle weakness metrics (grip, grip/body mass index [BMI], grip/weight, grip/total body fat, grip/arm lean mass) and association with slowness and falls in older persons with or at risk for HIV infection as part of the work of the Sarcopenia Definitions and Outcomes Consortium (SDOC). METHODS We assessed the prevalence of sarcopenia among 398 men (200 HIV+, 198 HIV-) from the Multicenter AIDS Cohort Study and 247 women (162 HIV+, 85 HIV-) from the Women's Interagency HIV Study using previously validated muscle weakness metrics discriminative of slowness. Sensitivity and specificity were used to compare new muscle weakness and slowness criteria to previously proposed sarcopenia definitions. RESULTS The prevalence of muscle weakness ranged from 16% to 66% among men and 0% to 47% among women. Grip/BMI was associated with slowness among men with HIV only. Grip/BMI had low sensitivity (25%-30%) with moderate to high specificity (68%-89%) for discriminating of slowness; all proposed metrics had poor performance in the discrimination of slowness (area under the curve [AUC] < 0.62) or fall status (AUC < 0.56). The combination of muscle weakness and slowness was not significantly associated with falls (p ≥ .36), with a low sensitivity in identifying those sustaining one or more falls (sensitivity ≤ 16%). DISCUSSION Clinical utility of new sarcopenia metrics for identification of slowness or falls in men and women with or at risk for HIV is limited, given their low sensitivity.
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Affiliation(s)
- Kristine M Erlandson
- Department of Medicine, University of Colorado-Anschutz Medical Campus, Aurora, Colorado
| | - Thomas G Travison
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
| | - Hao Zhu
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
| | - Jay Magaziner
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Rosaly Correa-de-Araujo
- Division of Geriatrics and Clinical Gerontology, National Institutes of Health, National Institute on Aging, Bethesda, Maryland
| | - Peggy M Cawthon
- California Pacific Medical Research Institute, San Francisco
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Shalender Bhasin
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Todd Manini
- Department of Aging and Geriatric Research, University of Florida, Gainesville
| | - Roger A Fielding
- Jean Mayer USDA Human Nutrition Research Center, Tufts University, Boston, Massachusetts
| | - Frank J Palella
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lawrence Kingsley
- Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | - Jordan E Lake
- Department of Medicine, University of Texas Health Science Center at Houston
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Phyllis C Tien
- Department of Medicine, University of California San Francisco
- Department of Veterans Affairs Medical Center, San Francisco, California
| | - Kathleen M Weber
- Cook County Health and Hektoen Institute of Medicine, Chicago, Illinois
| | - Michael T Yin
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Todd T Brown
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
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50
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Stabell AC, Wilson M, Jankowski CM, MaWhinney S, Erlandson KM. The Impact of a Structured, Supervised Exercise Program on Daily Step Count in Sedentary Older Adults With and Without HIV. J Acquir Immune Defic Syndr 2020; 84:228-233. [PMID: 32084050 PMCID: PMC7228846 DOI: 10.1097/qai.0000000000002326] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND People with HIV (PWH) may have lower daily activity levels compared with persons without HIV. We sought to determine the impact of initiating a supervised exercise program on the daily step count of sedentary PWH and uninfected controls. METHODS PWH and controls, aged 50-75, were enrolled in a 24-week supervised exercise program. All individuals were given a pedometer and instructed in regular use. A linear mixed model taking into account random effects was used to model daily step count. RESULTS Of 69 participants that began the study, 55 completed and 38 (21 PWH, 17 controls) had complete pedometer data. Baseline daily step count on nonsupervised exercise day was (estimated geometric mean, 95% confidence interval) 3543 (1306 to 9099) for PWH and 4182 (1632 to 10,187) for controls. Both groups increased daily steps on supervised [43% (20 to 69)%, P < 0.001] but not unsupervised exercise days [-12% (-24 to 1)%, P = 0.071]. Compared with controls, PWH had 26% [(-47 to 4)%, P = 0.08] fewer daily steps on days with supervised exercise and 35% [-53 to -10)%, P = 0.011] fewer daily steps on days without supervised exercise. Higher body mass index (per 1 unit) and smoking were associated with fewer daily steps [-5% (-9 to -1)%; -49% (-67 to -23)%; P ≤ 0.012]. Days with precipitation [-8% (-13 to -3)%, P = 0.002] or below freezing [-10% [-15 to -4)%, P < 0.001] were associated with fewer steps. CONCLUSION Supervised exercise increased daily step counts in sedentary individuals, but at the expense of fewer steps on nonsupervised exercise days.
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Affiliation(s)
- Alex C. Stabell
- University of Colorado, School of Medicine, Aurora, CO
- New York Presbyterian Hospital-Columbia University, New York, NY (current position)
| | - Melissa Wilson
- University of Colorado, School of Public Health, Department of Biostatistics and Informatics, Aurora, CO
| | | | - Samantha MaWhinney
- University of Colorado, School of Public Health, Department of Biostatistics and Informatics, Aurora, CO
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