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Gonçalves E Silva HC, da Silva JF, Cancelier ACL, Trevisol DJ, Sakae TAM, Atkinson RL, Schuelter-Trevisol FA. Adenovirus 36 Coinfection in People Living with HIV and its Impact on Lipohypertrophy. Curr HIV Res 2023; 21:140-146. [PMID: 37078357 DOI: 10.2174/1570162x21666230420090756] [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: 09/22/2022] [Revised: 02/04/2023] [Accepted: 02/24/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Previous studies have implicated human adenovirus 36 (Adv36) as a potential contributor to overweight and obesity. People living with HIV have an altered body composition compared to healthy individuals. There is still no evidence to confirm the relationship of Adv36 as one of the causes of lipohypertrophy. The main objective of this study was to verify the viral Adv36 infection as a factor associated with the presence of lipohypertrophy in HIV-infected individuals. METHODS A case-control study on people with HIV treated at a specialized public health service in southern Brazil. Subjects underwent interviews, diagnostic tests, and anthropometry to determine lipodystrophy and its classification. Demographic and clinical data were examined to investigate the presence of Adv36. The cases were participants with lipohypertrophy, and the controls were eutrophic participants. RESULTS 101 participants were included (38 cases and 63 controls), and the frequency of Adv36 infection was 10.9%. There was a statistically significant association between lipohypertrophy and the female sex (p < 0.001), and a trend for the presence of Adv36 (p = 0.059) and lipohypertrophy. After adjustment for confounders, Adv36 has not considered an independent risk factor for lipohypertrophy. Lower levels of glucose were associated with Adv36 infection. CONCLUSION There was a significant association between lipohypertrophy and the female sex, and no association with lipohypertrophy and Adv36, perhaps due to the small sample size.
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Affiliation(s)
| | - Jaime Fernandes da Silva
- Programa de Pós-Graduação em Ciências da Saúde, Universidade do Sul de Santa Catarina, Tubarão, Santa Catarina, Brazil
| | - Ana Carolina Lobor Cancelier
- Programa de Pós-Graduação em Ciências da Saúde, Universidade do Sul de Santa Catarina, Tubarão, Santa Catarina, Brazil
| | - Daisson José Trevisol
- Programa de Pós-Graduação em Ciências da Saúde, Universidade do Sul de Santa Catarina, Tubarão, Santa Catarina, Brazil
| | - Thiago Armando Mamôru Sakae
- Programa de Pós-Graduação em Ciências da Saúde, Universidade do Sul de Santa Catarina, Tubarão, Santa Catarina, Brazil
| | - Richard L Atkinson
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Fabiana Armando Schuelter-Trevisol
- Programa de Pós-Graduação em Ciências da Saúde, Universidade do Sul de Santa Catarina, Tubarão, Santa Catarina, Brazil
- Centro de Pesquisas Clínicas, Hospital Nossa Senhora da Conceição, Tubarão, Santa Catarina, Brazil
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Krankowska DC, Załęski A, Wiercińska-Drapało A. Frailty and prefrailty in people living with HIV, with focus on women living with HIV. Int J STD AIDS 2022; 33:1106-1110. [PMID: 36217985 DOI: 10.1177/09564624221127744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
With the increasing lifespan of people living with HIV (PLWH), frailty and prefrailty are becoming topics which require more attention. The reciprocal interactions between chronic inflammation, comorbidities and frailty demonstrate the complex pathophysiology of frailty and its consequences. Female sex, HIV infection without antiretroviral treatment, reduced CD4 cell count, depression and cardiovascular disease are some of the risk factors for frailty among PLWH. Frailty predisposes to falls and can therefore lead to more frequent fractures, hospitalization and death, especially in women with osteoporosis. Continuous antiretroviral treatment, prevention of comorbidities such as depression and diagnosis of prefrailty are crucial interventions to slow the development of frailty. This review summarizes the literature on frailty in people living with HIV and discusses frailty management strategies in order to improve the health outcomes in women living with HIV.
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Affiliation(s)
- Dagny C Krankowska
- Department of Infectious and Tropical Diseases and Hepatology, 37803Medical University of Warsaw, Poland.,Hospital for Infectious Diseases, Warsaw, Poland
| | - Andrzej Załęski
- Department of Infectious and Tropical Diseases and Hepatology, 37803Medical University of Warsaw, Poland.,Hospital for Infectious Diseases, Warsaw, Poland
| | - Alicja Wiercińska-Drapało
- Department of Infectious and Tropical Diseases and Hepatology, 37803Medical University of Warsaw, Poland.,Hospital for Infectious Diseases, Warsaw, Poland
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Effects of a Combined Exercise Training Program on Health Indicators and Quality of Life of People Living with HIV: A Randomized Clinical Trial. AIDS Behav 2020; 24:1531-1541. [PMID: 31552510 DOI: 10.1007/s10461-019-02678-3] [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] [Indexed: 02/08/2023]
Abstract
The aim of this study was to evaluate the effects of 16 weeks of combined exercise training (CET) on muscle strength, body composition, depression, anxiety and quality of life of people living with HIV (PLHIV). Twenty-three participants completed the study, 14 in trained group (TG) and 9 in control group (CG). TG consisted of resistance and aerobic training three times a week, while the CG was exposed to recreational activities twice a week. CET promoted increased muscle strength (25% in overall strength) and aerobic capacity (+ 20% in training speed and + 23% in VO2 during aerobic training; p < 0.05). In addition, TG had better quality of life and reduced depression rates (from 7 subjects with mild, moderate or severe depression to 1 post-training). In conclusion, this pilot data demonstrated that 16 weeks of CET increased muscle strength, and improved depression and quality of life indexes in a small sample of PLHIV.
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Chow FC, Makanjuola A, Wu K, Berzins B, Kim KYA, Ogunniyi A, Ellis RJ, Robertson K, Tassiopoulos K, Taiwo BO. Physical Activity Is Associated With Lower Odds of Cognitive Impairment in Women but Not Men Living With Human Immunodeficiency Virus Infection. J Infect Dis 2019; 219:264-274. [PMID: 30137500 DOI: 10.1093/infdis/jiy503] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 08/16/2018] [Indexed: 11/13/2022] Open
Abstract
Background Cardiovascular comorbidities are risk factors for human immunodeficiency virus (HIV)-associated cognitive impairment. Given differences in cardiometabolic risk profiles between women and men with HIV, we investigated whether associations between cardiometabolic risk factors and prevalent cognitive impairment differ by sex. Methods Separate logistic regression models were constructed for women and men at entry into a prospective study of older persons with HIV (PWH) to assess the association of cardiometabolic and other risk factors with cognitive impairment. Results Of 988 participants, 20% were women. Women had higher total cholesterol (194 vs 186 mg/dL; P = .027), hemoglobin A1c (5.9% vs 5.7%; P = .003), and body mass index (30.8 vs 27.4 kg/m2; P < .001) compared with men, and were less physically active (43% vs 55%; P = .005). In a multivariable model, physical activity was associated with lower odds of cognitive impairment in women (odds ratio, 0.35 [95% confidence interval, .15-.80]; P = .013) but not men. Conclusions Physical activity may have a greater positive impact on cognitive health in women than in men with HIV. This finding should be confirmed in studies examining the longitudinal association between physical activity and incident cognitive impairment in PWH and the effect of interventions that increase physical activity on cognitive impairment in women with HIV.
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Affiliation(s)
- Felicia C Chow
- Weill Institute for Neuroscience, University of California, San Francisco.,Department of Neurology and Division of Infectious Diseases, University of California, San Francisco
| | | | - Kunling Wu
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Baiba Berzins
- Division of Infectious Diseases and Center for Global Health
| | - Kwang-Youn A Kim
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois
| | - Adesola Ogunniyi
- Department of Medicine (Neurology), University of Ibadan, Nigeria
| | - Ronald J Ellis
- Departments of Neurosciences and Psychiatry, University of California, San Diego
| | - Kevin Robertson
- Department of Neurology, University of North Carolina, Chapel Hill
| | - Katherine Tassiopoulos
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
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Martins C, Coelho FMDC, Pinheiro RT, Motta JVDS, De Souza LDM, Pinheiro CAT, Kelbert EF, Souza MS, Pinheiro LMDS, Pinheiro KAT. People living with HIV/AIDS: body image and its important associations with mental health and BMI. PSYCHOL HEALTH MED 2019; 25:1020-1028. [PMID: 31735072 DOI: 10.1080/13548506.2019.1691244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Patients on antiretroviral therapy face new challenges, such as bodily changes. We conducted a cross-sectional study with people living with HIV/AIDS. We investigate the self-perception of body image and its associations. Most of the patients reported negative self-perception of body image (NSPBI), being mostly women, up to 40 years old and with changes in BMI. NSPBI was associated with depressive symptoms and punctual alterations in the redistribution of body fat: face, abdomen and legs, subjects still little elucidated. Assessing neglected aspects can improve the way these patients see themselves, and come to understand the disease as only a part of their lives.
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Affiliation(s)
- Clarissa Martins
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas , Pelotas, Brazil
| | | | | | | | | | | | - Evelin Franco Kelbert
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas , Pelotas, Brazil
| | - Marilia Silva Souza
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas , Pelotas, Brazil
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Nogueira LFR, da Fonseca TC, Paterlini PH, Duarte ADS, Pellegrino P, Barros CRDS, Moreno CRDC, Marqueze EC. Influence of nutritional status and gastrointestinal symptoms on sleep quality in people living with HIV. Int J STD AIDS 2019; 30:885-890. [PMID: 31179887 DOI: 10.1177/0956462419846723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sleep problems are frequent among people living with HIV (PLWH). Recent studies have found that inadequate nutritional status and presence of gastrointestinal symptoms are associated with sleep problems. Therefore, the objective of the present study was to evaluate the influence of nutritional status and gastrointestinal symptoms on sleep quality in PLWH receiving antiretroviral therapy (ART). A cross-sectional study evaluating the influence of nutritional and gastrointestinal aspects on the quality of sleep in 307 PLWH (age ≥18 years) receiving ART seen at the Specialized Care Service of Santos (SP, Brazil) was carried out. The Pittsburgh Sleep Quality Index (PSQI), body mass index and three questions from the Self-Reporting Questionnaire (SRQ-20) were used. Generalized linear models adjusted for gender, age, time in use of antiretrovirals, viral load, CD4+ T-lymphocyte cell count and CD4/CD8 ratio were built. Results showed that body mass index did not affect sleep quality. However, the interaction between poor appetite and not having poor digestion and uncomfortable feelings in the stomach negatively influenced sleep quality. The interaction of the three symptoms evaluated also affected sleep quality. Gastrointestinal symptoms were associated with reduced sleep quality, but there was no influence of BMI. Although the etiology of this relationship is unclear, there seems to be an important association between sleep quality, immune function and gastrointestinal disorders.
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Affiliation(s)
| | - Thais Carvalho da Fonseca
- 1 Department of Epidemiology, Public Health Graduate Program, Catholic University of Santos, São Paulo, Brazil
| | - Patrick Herman Paterlini
- 1 Department of Epidemiology, Public Health Graduate Program, Catholic University of Santos, São Paulo, Brazil
| | - Adriana de Sousa Duarte
- 1 Department of Epidemiology, Public Health Graduate Program, Catholic University of Santos, São Paulo, Brazil
| | - Pollyanna Pellegrino
- 1 Department of Epidemiology, Public Health Graduate Program, Catholic University of Santos, São Paulo, Brazil
| | | | | | - Elaine Cristina Marqueze
- 1 Department of Epidemiology, Public Health Graduate Program, Catholic University of Santos, São Paulo, Brazil
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Nogueira LFR, Pellegrino P, Duarte ADS, Inoue SRV, Marqueze EC. Transtornos Mentais Comuns estão associados a maior carga viral em Pessoas Vivendo com HIV. SAÚDE EM DEBATE 2019. [DOI: 10.1590/0103-1104201912114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO O presente estudo teve como objetivo investigar a associação entre Transtornos Mentais Comuns (TMC) e carga viral de Pessoas Vivendo com Vírus da Imunodeficiência Humana - HIV (PVHIV) em seguimento clínico. Foi realizado um estudo transversal com 307 PVHIV com ≥ 18 anos de idade que estavam em terapia antirretroviral no Serviço de Assistência Especializada do município de Santos (SP) em 2016. A variável dependente de estudo foi a quantificação da carga viral; e a variável independente compreendeu os transtornos mentais comuns, avaliados pelo Self-Reporting Questionnaire (SRQ-20). Para comparação das médias das variáveis, foram realizados modelos lineares generalizados com nível de significância de 5%. Conclui-se que os TMC estão associados a uma maior carga viral entre PVHIV em seguimento clínico.
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Systemic Inflammation Characterizes Lack of Metabolic Health in Nonobese HIV-Infected Men. Mediators Inflamm 2018; 2018:5327361. [PMID: 30356397 PMCID: PMC6176328 DOI: 10.1155/2018/5327361] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 09/05/2018] [Indexed: 12/11/2022] Open
Abstract
Background Increasing body mass index (BMI) is generally associated with loss of metabolic health, although some obese individuals remain metabolically healthy. Among nonobese men, HIV infection has been associated with a lower prevalence of metabolic health. Methods We conducted a cross-sectional analysis of 470 HIV-infected and 368 HIV-uninfected men enrolled in the Multicenter AIDS Cohort Study Cardiovascular substudy. Circulating biomarker levels were compared by BMI category and by HIV serostatus. Poisson regression with robust variance determined associations between metabolic health and circulating inflammatory biomarker levels after adjusting for factors previously associated with metabolic health. Results HIV-infected men were younger and less likely to be obese. Among HIV-infected, normal weight metabolically healthy men (compared to unhealthy) had significantly lower circulating levels of interleukin- (IL-) 6, soluble tumor necrosis factor receptors (sTNFR) I and II, and homeostatic model assessment of insulin resistance (HOMA-IR), higher adiponectin, less visceral fat, and more subcutaneous fat. Among HIV-uninfected normal weight men and obese men (regardless of HIV serostatus), metabolic health was associated only with higher levels of adiponectin, less visceral fat, and lower HOMA-IR values. In multivariate analyses restricted to HIV-infected men, lower hs-CRP, sTNFRI, sTNFRII, and HOMA-IR and higher adiponectin levels were associated with metabolic health. Additional adjustment for visceral adiposity did not alter results. Conclusions Among HIV-infected normal weight men, metabolic health was associated with less systemic inflammation, a relationship that, among normal weight men, was unique to HIV+ men and did not exist among obese men of either HIV serostatus.
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Silva LLG, Santos EMD, Nascimento LCPD, Cavalcanti MCDF, Arruda IKGD, Luz MCL, Cabral PC. Lipodystrophic syndrome of HIV and associated factors: a study in a university hospital. CIENCIA & SAUDE COLETIVA 2018; 25:989-998. [PMID: 32159668 DOI: 10.1590/1413-81232020253.11772018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 07/05/2018] [Indexed: 11/22/2022] Open
Abstract
The use of antiretroviral drugs has increased the survival of HIV patients, but may have side effects, such as lipodystrophic syndrome. This article aims to identify the frequency of the lipodystrophic syndrome and its associated factors in patients with HIV using antiretroviral therapy. It involved a cross-sectional study with HIV patients, monitored on an outpatient basis. The syndrome was evaluated by the association of two parameters: peripheral weight loss through the lipodystrophy severity scale and central fat accumulation, measured by the hip waist ratio. Poisson regression analysis was performed to identify the associated variables. Of the 104 patients evaluated, 27.9% presented the syndrome. After adjustment, the female sex (PRadjusted = 2.16 CI95% 1.43-3.39), being overweight (PRadjusted = 2.23 CI95% 1.35-2.65) and a longer period of use of antiretrovirals (PRadjusted = 1.64 CI95% 1.16-2.78), remained positively associated with the syndrome. On the other hand, a negative association with CD4 count £ 350 (PRadjusted = 0.39 CI95% 0.10-0.97) was observed The high prevalence of the syndrome and its association with specific groups reinforce the need for adequate follow-up and early identification to intervene in modifiable factors.
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Affiliation(s)
- Lídia Laís Gomes Silva
- Programa de Residência em Nutrição Clínica, Hospital das Clínicas, Universidade Federal de Pernambuco. Av. Prof. Moraes Rego 1235, Cidade Universitária. 50670-901, Recife, PE, Brasil.
| | - Eryka Maria Dos Santos
- Programa de Residência em Nutrição Clínica, Hospital das Clínicas, Universidade Federal de Pernambuco. Av. Prof. Moraes Rego 1235, Cidade Universitária. 50670-901, Recife, PE, Brasil.
| | - Luciana Caroline Paulino do Nascimento
- Programa de Residência em Nutrição Clínica, Hospital das Clínicas, Universidade Federal de Pernambuco. Av. Prof. Moraes Rego 1235, Cidade Universitária. 50670-901, Recife, PE, Brasil.
| | - Mikaella Carla de França Cavalcanti
- Programa de Residência em Nutrição Clínica, Hospital das Clínicas, Universidade Federal de Pernambuco. Av. Prof. Moraes Rego 1235, Cidade Universitária. 50670-901, Recife, PE, Brasil.
| | - Ilma Kruze Grande de Arruda
- Programa de Residência em Nutrição Clínica, Hospital das Clínicas, Universidade Federal de Pernambuco. Av. Prof. Moraes Rego 1235, Cidade Universitária. 50670-901, Recife, PE, Brasil.
| | - Marcella Campos Lima Luz
- Programa de Residência em Nutrição Clínica, Hospital das Clínicas, Universidade Federal de Pernambuco. Av. Prof. Moraes Rego 1235, Cidade Universitária. 50670-901, Recife, PE, Brasil.
| | - Poliana Coelho Cabral
- Programa de Residência em Nutrição Clínica, Hospital das Clínicas, Universidade Federal de Pernambuco. Av. Prof. Moraes Rego 1235, Cidade Universitária. 50670-901, Recife, PE, Brasil.
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Adal M, Howe R, Kassa D, Aseffa A, Petros B. Malnutrition and lipid abnormalities in antiretroviral naïve HIV-infected adults in Addis Ababa: A cross-sectional study. PLoS One 2018; 13:e0195942. [PMID: 29672576 PMCID: PMC5908150 DOI: 10.1371/journal.pone.0195942] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 04/03/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Both under- and over-nutrition may occur among human immunodeficiency virus (HIV)-infected individuals and impact on the course of the acquired immune deficiency syndrome (AIDS) and its management due to the close interaction between immunity and nutrition. We investigated occurrence of undernutrition, excess weight and lipid abnormalities among antiretroviral naïve HIV-infected adults in Addis Ababa, Ethiopia. METHODS A cross-sectional study on 594 antiretroviral therapy (ART) naïve HIV-infected adults was conducted in four hospitals in Addis Ababa from February to September 2013. Hematological parameters (CD4+ T cell count and hemoglobin concentration), fasting serum glucose, total cholesterol (TC) and triglycerides (TG) were determined. Information on socio-demographic, anthropometric and World Health Organization (WHO) clinical stages was collected from patient clinical records, and triangulated by structured questionnaire. Height and weight measurements were taken and body mass index (BMI), undernutrition (BMI <18.5 kg/m2) and excess weight (BMI ≥25 kg/m2) determined. Statistical comparisons were made to identify significant factors associated with nutritional status and lipid profiles. RESULTS The prevalence of undernutrition was 15.1%, and the prevalence of excess weight was 22.1%, including 5.4% who were obese. The prevalence of hypercholesterolemia was 16.6% and it was higher in women (18.9%) than in men (11.0%) (p<0.05). However, the prevalence of hypertriglyceridemia was 29.8%. There was significant positive Spearman correlation between CD4+ T cell count and serum TC (r = 0.210, p<0.001), but no correlation was observed between CD4+ T cell count and TG (r = -0.007, p>0.05). Age categories 30-39 and 40-79, and WHO clinical stages III/IV for undernutrition; age categories 30-39 and 40-79, WHO clinical stages III/IV and TC ≥200 mg/dL for excess weight; and being female, age categories 30-39 and 40-79, and hypertriglyceridemia for hypercholesterolemia were found to be independent predictors by binomial logistic regression analysis. CONCLUSION Undernutrition, excess weight, hypercholesterolemia and hypertriglyceridemia were variably prevalent in ART naïve HIV-infected populations. This emphasizes the need for targeted nutritional programs as an integral part of HIV/AIDS care. Lipid levels need to be monitored regularly in patients whether on or off ART. In addition, improvement on household income and positive change in lifestyle and/or nutritional treatment to reduce morbidity and mortality are necessary interventions in HIV/AIDs patient management.
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Affiliation(s)
- Melaku Adal
- Microbial, Cellular and Molecular Biology Department, Addis Ababa University, Addis Ababa, Ethiopia
| | - Rawleigh Howe
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Desta Kassa
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Abraham Aseffa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Beyene Petros
- Microbial, Cellular and Molecular Biology Department, Addis Ababa University, Addis Ababa, Ethiopia
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Salmazo PS, Bazan SGZ, Shiraishi FG, Bazan R, Okoshi K, Hueb JC. Frequency of Subclinical Atherosclerosis in Brazilian HIV-Infected Patients. Arq Bras Cardiol 2018; 110:402-410. [PMID: 29641646 PMCID: PMC5967130 DOI: 10.5935/abc.20180058] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 12/12/2017] [Indexed: 12/28/2022] Open
Abstract
Background AIDS as well as atherosclerosis are important public health problems. The
longer survival among HIV-infected is associated with increased number of
cardiovascular events in this population, and this association is not fully
understood. Objectives To identify the frequency of subclinical atherosclerosis in HIV-infected
patients compared to control subjects; to analyze associations between
atherosclerosis and clinical and laboratory variables, cardiovascular risk
factors, and the Framingham coronary heart disease risk score (FCRS). Methods Prospective cross-sectional case-control study assessing the presence of
subclinical atherosclerosis in 264 HIV-infected patients and 279 controls.
Clinical evaluation included ultrasound examination of the carotid arteries,
arterial stiffness by pulse wave velocity (PWV) and augmentation index
(AIx), laboratory analysis of peripheral blood, and cardiovascular risk
according to FCRS criteria. The significance level adopted in the
statistical analysis was p < 0.05. Results Plaques were found in 37% of the HIV group and 4% of controls (p < 0.001).
Furthermore, carotid intima-media thickness was higher in the HIV group than
in controls (p < 0.001). Patients with carotid plaque had higher fasting
glucose, total cholesterol, low-density lipoprotein cholesterol, and
triglycerides than those without plaques. The presence of HIV, adjusted for
age, overweight/obesity, and smoking increased by almost fivefold the risk
of atherosclerotic carotid plaque (OR: 4.9; 95%CI: 2.5-9.9; p < 0.001).
Exposure to protease inhibitors did not influence carotid intima-media
thickness, was not associated with carotid plaque frequency, and did not
alter the mechanical characteristics of the arterial system (PWV and
AIx). Conclusions HIV-infected patients are at increased risk of atherosclerosis in association
with classical cardiovascular risk factors. Treatment with protease
inhibitors does not promote functional changes in the arteries, and shows no
association with increased frequency of atherosclerotic plaques in carotid
arteries. The FCRS may be inappropriate for this population.
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Affiliation(s)
| | | | | | - Rodrigo Bazan
- Faculdade de Medicina de Botucatu (UNESP), Botucatu, SP - Brazil
| | - Katashi Okoshi
- Faculdade de Medicina de Botucatu (UNESP), Botucatu, SP - Brazil
| | - João Carlos Hueb
- Faculdade de Medicina de Botucatu (UNESP), Botucatu, SP - Brazil
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Solomon D, Sabin CA, Mallon PW, Winston A, Tariq S. Cardiovascular disease in women living with HIV: A narrative review. Maturitas 2018; 108:58-70. [DOI: 10.1016/j.maturitas.2017.11.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 11/09/2017] [Accepted: 11/13/2017] [Indexed: 12/14/2022]
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Abstract
OBJECTIVES In the general population, metabolic health often declines as BMI increases. However, some obese individuals maintain metabolic health. HIV and antiretroviral therapy have been associated with metabolic disturbances. We hypothesized that HIV-infected (HIV) men on suppressive antiretroviral therapy experience less metabolic health than HIV-uninfected (HIV) men across all BMI categories. DESIGN/METHODS In a cross-sectional analysis of 1018 HIV and 1092 HIV men enrolled in the multicenter AIDS cohort study, Poisson regression with robust variance determined associations between HIV serostatus and metabolic health prevalence (defined as meeting ≤2 of 5 National Cholesterol Education Program Adult Treatment Panel III metabolic syndrome criteria), adjusting for age, race, BMI category, smoking, and hepatitis C virus infection status. RESULTS HIV men were younger (54 vs. 59 years) and had lower median BMI (25 vs. 27 kg/m). Nonobese HIV men had lower metabolic health prevalence than HIV men (BMI ≤25 kg/m: 80 vs. 94%, P < 0.001; BMI 25-29 kg/m: 64 vs. 71%, P = 0.05), but metabolic health prevalence among obese men did not differ by HIV serostatus (BMI 30-34 kg/m: 35 vs. 39%, P = 0.48; BMI ≥35 kg/m: 27 vs. 25%, P = 0.79). In the adjusted model, nonobese HIV men were less likely to demonstrate metabolic health than nonobese HIV men. Among HIV men, per year darunavir, zidovudine, and stavudine use were associated with lower metabolic health likelihood. CONCLUSION Metabolically healthy obesity prevalence does not differ by HIV serostatus. However, among nonobese men, HIV infection is associated with lower metabolic health prevalence, with associations between lack of metabolic health and darunavir and thymidine analog nucleoside reverse transcriptase inhibitor exposure observed.
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Castro ADCO, Silveira EA, Falco MDO, Nery MW, Turchi MD. Overweight and abdominal obesity in adults living with HIV/AIDS. Rev Assoc Med Bras (1992) 2017; 62:353-60. [PMID: 27437682 DOI: 10.1590/1806-9282.62.04.353] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 08/30/2015] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To investigate the prevalence of overweight, abdominal obesity and associated factors in people living with HIV/AIDS (PLWHA). METHOD Cross-sectional study with 270 PLWHA. A questionnaire was applied to investigate sociodemographic, clinical and lifestyle characteristics. Weight, height and waist circumference were measured. BMI ≥25 kg/m2 was considered overweight, while abdominal obesity referred to waist circumference ≥102 cm for men and ≥88 cm for women. The authors used multiple Poisson regression with 5% significance level. RESULTS The prevalence of overweight and abdominal obesity was 33.7% and 12.6%, respectively, referring to 37.9% of women and 5.7% of men (p<0.001). Overweight was associated with age of 40-49 years and ≥50 years, non-use of ARV therapy, and lower tertile of consumption of risk foods. Abdominal obesity was associated with: female gender, age of 40-49 years and ≥50 years, income greater than four times the minimum wage, and CD4+ lymphocyte count >350 cells/mm3. CONCLUSION There was a high prevalence of overweight and abdominal obesity associated with sociodemographic and clinical conditions, and consumption of risk foods. This scenario indicates the need for reorientation of the health care focus in this population.
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Affiliation(s)
- Aline de Cássia Oliveira Castro
- MSc - Professor of Nutrition, Pontifícia Universidade Católica de Goiás (PUC Goiás). Nutritionist, Secretaria Municipal de Saúde de Goiânia, Goiânia, GO, Brazil
| | - Erika Aparecida Silveira
- PhD - Associate Professor, Posgraduation Program Health Science, Universidade Federal de Goiás (UFG), Goiânia, GO, Brazil
| | | | - Max Weyler Nery
- PhD - Cardiologist. Professor of Medicine, PUC Goiás, Goiânia, GO, Brazil
| | - Marília Dalva Turchi
- PhD - Associate Professor, Instituto de Patologia Tropical e Saúde Pública, UFG, Goiânia, GO, Brazil
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Bassichetto KC, Bergamaschi DP, Garcia VRS, Veras MADSM. Factors associated with undernourishment among people 20 years old or over with HIV/AIDS, attending public health services in the São Paulo municipality, Brazil. CAD SAUDE PUBLICA 2016; 30:2578-86. [PMID: 26247987 DOI: 10.1590/0102-311x00174513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Accepted: 07/16/2014] [Indexed: 11/22/2022] Open
Abstract
The study evaluated the nutritional status of 629 people living with HIV/AIDS attended at 12 specialized services of São Paulo's Municipal Health Department, Brazil. Data were obtained from medical records and through interviews during nutritional consultation. We used the classification criteria established by World Health Organization to assess malnourished individuals, a BMI < 18.5kg/m2. The prevalence of malnutrition in people with AIDS is 3.12 times that observed among people with HIV, and among people with co-infection it is 3.41 times that obtained among people without co-infection. This indicates how these conditions can harm the maintenance of the nutritional status, and shows that they demand a comprehensive understanding of the mechanisms involved in this phenomenon, as well as the development of strategies to improve the health care of individuals at nutritional risk.
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16
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HIV and metabolic, body, and bone disorders: what we know from low- and middle-income countries. J Acquir Immune Defic Syndr 2014; 67 Suppl 1:S27-39. [PMID: 25117959 DOI: 10.1097/qai.0000000000000256] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Globally, the HIV epidemic is evolving. Life expectancy for HIV-infected individuals has been extended because of more effective and more widely available antiretroviral therapy. As a result, chronic noncommunicable diseases (NCDs) have become important comorbid conditions. In particular, HIV-infected persons are increasingly at risk of developing metabolic (diabetes, dyslipidemias), body composition (lipodystrophy, overweight/obesity) and bone mineral density abnormalities. We have summarized the published epidemiological and clinical literature regarding these HIV-NCD comorbidities in low- and middle-income countries (LMICs). We found important gaps in knowledge. Specifically, there are few studies that use standardized methods and metrics; consequently, prevalence or incidence data are not comparable. There are very little or no data regarding the effectiveness or cost-effectiveness of clinical monitoring or therapeutic interventions for metabolic disorders in HIV-infected individuals. Also, although NCDs continue to grow in the HIV-negative population of most LMICs, there are few data comparing the incidence of NCD comorbidities between HIV-infected and HIV-negative populations. To address these gaps, we describe potential research and capacity development priorities for the future.
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17
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Semu H, Zack RM, Liu E, Hertzmark E, Spiegelman D, Sztam K, Hawkins C, Chalamila G, Muya A, Siril H, Mwiru R, Mtasiwa D, Fawzi W. Prevalence and Risk Factors for Overweight and Obesity among HIV-Infected Adults in Dar es Salaam, Tanzania. J Int Assoc Provid AIDS Care 2014; 15:512-521. [PMID: 25146972 DOI: 10.1177/2325957414542574] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Overweight and obesity are increasingly prevalent among HIV-infected populations. We describe their prevalence and associated risk factors among HIV-infected adults in Dar es Salaam, Tanzania. METHODS A cross-sectional study was conducted to determine the proportion of patients who were overweight or obese at enrollment to care and treatment centres from 2004 to 2011. Multivariate relative risk regression models were fit to identify risk factors. RESULTS A total of 53 825 patients were included in the analysis. In all, 16% of women and 8% of men were overweight, while 7% and 2% were obese, respectively. In multivariate analyses, older age, higher CD4 count, higher hemoglobin levels, female sex, and being married were associated with obesity and overweight. World Health Organization HIV disease stage, tuberculosis history, and previous antiretroviral therapy were inversely associated with obesity and overweight. CONCLUSION Overweight and obesity were highly prevalent among HIV-infected patients. Screening for overweight and obesity and focused interventions should be integrated into HIV care.
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Affiliation(s)
- Helen Semu
- Department of Preventive Services, Ministry of Health and Social Welfare, Dar es Salaam, Tanzania
| | - Rachel M Zack
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | - Enju Liu
- Department of Nutrition, Harvard School of Public Health, Boston, MA, USA
| | - Ellen Hertzmark
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.,Department of Nutrition, Harvard School of Public Health, Boston, MA, USA.,Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA
| | - Donna Spiegelman
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.,Department of Nutrition, Harvard School of Public Health, Boston, MA, USA.,Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA
| | - Kevin Sztam
- Clinical Nutritional Service, Division of GI/Nutrition, Children's Hospital, Boston, MA, USA
| | - Claudia Hawkins
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | | | - Aisa Muya
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Hellen Siril
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Ramadhani Mwiru
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Deo Mtasiwa
- Prime Ministers' Office, Regional Authority and Local Government, Dar es Salaam, Tanzania
| | - Wafaie Fawzi
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.,Department of Nutrition, Harvard School of Public Health, Boston, MA, USA.,Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA
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Alves MD, Brites C, Sprinz E. HIV-associated lipodystrophy: a review from a Brazilian perspective. Ther Clin Risk Manag 2014; 10:559-66. [PMID: 25083134 PMCID: PMC4108257 DOI: 10.2147/tcrm.s35075] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The prognosis of human immunodeficiency virus (HIV)-infected individuals has dramatically improved worldwide since the introduction of highly antiretroviral therapy. Nevertheless, along with the decrease in mortality, several body modifications not initially related to HIV infection have been reported. Disorders in lipid and glucose metabolism, accompanied by body shape abnormalities and alterations in fat distribution, began to be described. A syndrome, named "HIV-associated lipodystrophy syndrome", was coined to classify these clinical spectrum aspects. This syndrome involves not only metabolic alterations but also fat redistribution, with lipoatrophy due to subcutaneous fat loss (predominantly in the face and lower limbs) and lipohypertrophy related to central fat gain. These changes in body shape are very important to be recognized, as they are associated with worse morbidity and mortality. Self-esteem difficulties related to body alterations might lead to treatment failures due to medication adherence problems. Moreover, these alterations have been associated with an increased risk of cardiovascular events. Therefore, it is extremely important to identify this syndrome early in order to provide an even better quality of life for this population, as the clinical approach is not easy. Treatment change, medications to treat dyslipidemia, and surgical intervention are instruments to be used to try to correct these abnormalities. The aim of this study is to review clinical presentation, diagnosis, and management of body shape and metabolic complications of HIV infection from a Brazilian perspective, a medium income country with a large number of patients on antiretroviral therapy.
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Affiliation(s)
- Marcelle D Alves
- Infectious Disease Department, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil
| | - Carlos Brites
- School of Medicine, Federal University of Bahia, Salvador, Brazil
| | - Eduardo Sprinz
- Infectious Disease Department, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil
- School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Lazzarotto AR, Pereira FB, Harthmann AD, Bazzo KO, Vicenzi FL, Sprinz E. Treinamento físico no risco de doença isquêmica cardíaca em sujeitos HIV/AIDS em uso de TARV. REV BRAS MED ESPORTE 2014. [DOI: 10.1590/1517-86922014200302064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
INTRODUÇÃO: A terapia antirretroviral combinada (TARV) foi introduzida no Brasil em 1996, como parte da política nacional de acesso gratuito aos serviços de saúde e medicamentos. Infelizmente, o seu uso contínuo tem sido associado com mudanças na distribuição da gordura corporal e com alterações metabólicas que podem aumentar a morbidade e mortalidade nesta população. O treinamento físico tem sido estudado como uma estratégia eficaz de intervenção não farmacológica para melhorar os parâmetros de aptidão física relacionados à saúde e para minimizar os efeitos indesejáveis da infecção pelo HIV e/ou o uso prolongado da TARV, no entanto, há poucos estudos sobre o treinamento físico, síndrome lipodistrófica e cardiologia.OBJETIVO: Avaliar o risco de doença isquêmica cardíaca em sujeitos HIV/AIDS em uso de TARV praticantes de treinamento concorrente com séries simples.MÉTODOS: Quatorze sujeitos foram avaliados através da circunferência abdominal, pressão arterial sistólica (PAS) e diastólica (PAD), colesterol total (CT), HDL, LDL, triglicerídeos (TG) e glicemia. Para a estimativa do risco coronariano em 10 anos utilizou-se o Escore de Framingham.RESULTADOS: A maioria dos sujeitos situou-se dentro dos valores de referência para as variáveis analisadas, exceto para os valores de LDL e TG. Treze sujeitos (92,7%) ficaram abaixo dos 10% de risco coronariano em 10 anos, e apenas um (7,3%) estava em risco moderado. Houve correlação significativa entre o tempo de treinamento e a PAS.CONCLUSÃO: Sugere-se a realização de ensaios clínicos randomizados para avaliar os mesmos desfechos deste estudo.
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Abstract
The treatment of metabolic disease is becoming an increasingly important component of the long-term management of patients with well controlled HIV on antiretroviral therapy (ART). Metabolic diseases probably develop at the intersection of traditional risk factors (such as obesity, tobacco use, and genetic predisposition) and HIV-specific and ART-specific contributors (including chronic inflammation and immune activation). This Review discusses present knowledge on adipose tissue dysfunction, insulin-glucose homoeostasis, lipid disturbances, and cardiovascular disease risk in people with HIV on ART. Although new antiretroviral drugs are believed to induce fewer short-term metabolic perturbations than do older drugs, the long-term effects of these drugs are not fully understood. Additionally, patients remain at increased risk of cardiovascular disease and other metabolic comorbidities. Research and treatment should focus on selection of ART that is both virologically effective and has minimum metabolic effects, minimisation of traditional risk factors for metabolic disease, and development of novel therapies to treat metabolic disease in patients with HIV, including use of anti-inflammatory and immunomodulatory drugs.
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Affiliation(s)
- Jordan E Lake
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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Santos ACOD, Almeida AMR. Nutritional status and CD4 cell counts in patients with HIV/AIDS receiving antiretroviral therapy. Rev Soc Bras Med Trop 2013; 46:698-703. [DOI: 10.1590/0037-8682-0125-2013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Indexed: 11/22/2022] Open
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Andrade CS, Jesus RP, Andrade TB, Oliveira NS, Nabity SA, Ribeiro GS. Prevalence and characteristics associated with malnutrition at hospitalization among patients with acquired immunodeficiency syndrome in Brazil. PLoS One 2012; 7:e48717. [PMID: 23144941 PMCID: PMC3492415 DOI: 10.1371/journal.pone.0048717] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Accepted: 09/27/2012] [Indexed: 12/02/2022] Open
Abstract
Background Brazil’s National STD/AIDS Program is considered a model of success worldwide. However, AIDS-associated malnutrition continues in subgroups of Brazilian patients despite access to free highly active antiretroviral therapy (HAART). We aimed to identify the prevalence of malnutrition and associated factors among patients hospitalized with AIDS. Methods We conducted a cross-sectional nutritional assessment among 127 adults hospitalized with AIDS in Brazil’s third largest city. Using anthropometric measurements, we determined the prevalence of malnutrition (body mass index <18.5 kg/m2) at hospitalization. Prevalence ratios of malnutrition by demographic, socioeconomic, and clinical conditions were estimated using log-binomial regression. Results One-third of participants were first informed of their HIV disease during the current hospitalization and recent treatment interruption was common (71%) among those on HAART. Forty-three percent were malnourished and 35% had severe weight loss at admission. Patient characteristics independently associated with malnutrition were older age (2% increased prevalence for each year; 95% confidence interval [CI] 0–4%) and very low daily per capita household income. Living on <USD 2.00, USD 2.00–4.99 or USD 5.00–9.99 increased the prevalence of malnutrition by 2.01 (95% CI 1.06–3.81), 1.75 (95% CI 0.92–3.35) and 1.42 (95% CI 0.76–2.65) times, respectively, compared to ≥USD 10.00 per day. Chronic diarrhea was marginally associated with malnutrition (RR 1.42; 95% CI 0.99–2.04). Overall, 16% of the patients died during hospitalization. We observed a trend toward higher in-hospital case fatality among malnourished patients (22% vs. 12% for patients with and without malnutrition, respectively; chi square P = 0.14). Conclusions Unacceptably high rates of malnutrition persist in Brazilians hospitalized with AIDS and our results reinforce the importance of nutritional evaluations in these patients. Improved early testing and treatment adherence strategies may continue to help reduce AIDS-related morbidity and mortality in Brazil, yet novel interventions to disrupt the cycle of poverty, HIV, and malnutrition are also urgently needed.
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Affiliation(s)
- Carine S. Andrade
- School of Nutrition, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Rosângela P. Jesus
- School of Nutrition, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Taciana B. Andrade
- School of Nutrition, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Neyara S. Oliveira
- School of Nutrition, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Scott A. Nabity
- School of Medicine, Duke University, Durham, North Carolina, United States of America
- Gonçalo Moniz Research Center, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Salvador, Bahia, Brazil
| | - Guilherme S. Ribeiro
- Gonçalo Moniz Research Center, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Salvador, Bahia, Brazil
- Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil
- * E-mail:
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