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Bantie B, Gebeyehu NA, Adella GA, Kassie GA, Mengstie MA, Abebe EC, Seid MA, Gesese MM, Tegegne KD, Anley DT, Zemene MA, Dessie AM, Feleke SF, Dejenie TA, Kebede YS, Chanie ES, Kerebeh G, Bayih WA, Moges N. Trends of Body Mass Index changes among adults on antiretroviral therapy in Northwest Ethiopia: a longitudinal data analysis. Sci Rep 2024; 14:5265. [PMID: 38438418 PMCID: PMC10912088 DOI: 10.1038/s41598-024-53701-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 02/03/2024] [Indexed: 03/06/2024] Open
Abstract
Nutritional status is considered a major diagnostic and prognostic indicator of HIV/AIDS in adults. In this aspect, current HIV-treatment guidelines, particularly in low-income countries, recommend the regular monitoring of body mass index (BMI) to determine patients' clinical response to antiretroviral therapy (ART). However, data regarding the change in BMI status of HIV-positive adults on ART following the implementation of the test and treat strategy were limited in Ethiopia. Hence, this study is aimed at investigating the trends of BMI change over time and its associated factors among HIV-positive adults in Northwest Ethiopia. A retrospective longitudinal study was conducted among 404 randomly selected HIV-positive adults receiving ART in Felegehiwot Comprehensive Specialized Hospital (FHCSH), Northern Ethiopia. Data were extracted from the medical record charts of study participants, entered into Epi-data 4.6 software, and exported to Stata 14.2 software for analysis. A generalized estimating equation (GEE) model was fitted to determine the change in BMI status over time and its predictors in HIV-positive adults. The level of significance was declared at a p-value of < 0.05. More than half (201, or 51.73%) of the total 404 participants were female. In the cohort, both the baseline and follow-up mean body mass index levels of the participants fell in the normal range and increased from 20.34 (standard deviation/SD ± 2.8) to 21.41 (SD ± 3.13). The individual profile plots of 50 participants indicated that there is considerable variability in weight change across individuals. Duration of ART follow-up (β = 0.203, 95% confidence interval (CI) 0.16 to 0.24), unemployment (β = - 0.96, 95% CI 1.67 to - 0.25), WHO stage III/IV HIV disease (β = - 0.92, 95% CI - 1.57 to - 0.35),and Tenofovir/Lamivudine/Dolutegravir (TDF/3TC/DTG)ART regimen (β = 0.95, 95% CI 0.32 to 1.57) were identified as significant predictors of change in the BMI status of participants. Likewise, the interaction of TDF/3TC/DTG ART regimen * follow-up duration (β = 2.16, 95% CI 1.84 to 2.84), WHO stage III/IV clinical disease * follow-up duration (β = - 1.43, 95% CI - 1.71 to - 1.15) and TB/HIV co-infection * follow-up duration (β = 1.89, 95% CI 1.57 to 2.87) significantly affects the trend in BMI change status of HIV-positive adults. In this study, the BMI status of HIV-positive adults receiving ART increased with a linear trend. Unemployment, stage III/IV HIV diseases, and Tenofovir/Lamivudine/Efavirenz (TDF/3TC/EFV) ART-drug regimen decreases the mean BMI status of HIV-positive adults. Special consideration and strict follow-up need to be given to those individuals with advanced HIV/AIDS diseases and other identified risk group.
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Affiliation(s)
- Berihun Bantie
- Department of Comprehensive Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia.
| | - Natnael Atnafu Gebeyehu
- Department of Midwifery, College of Medicine and Health Science, Wolaita Sodo University, Wolaita, Ethiopia
| | - Getachew Asmare Adella
- Department of Reproductive Health and Nutrition, School of Public Health, Woliata Sodo University, Sodo, Ethiopia
| | - Gizachew Ambaw Kassie
- Department of Epidemiology and Biostatistics, School of Public Health, Woliata Sodo University, Sodo, Ethiopia
| | - Misganaw Asmamaw Mengstie
- Department of Biochemistry, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Endeshaw Chekol Abebe
- Department of Biochemistry, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Mohammed Abdu Seid
- Unit of Physiology, Department of Biomedical Science, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Molalegn Mesele Gesese
- Department of Midwifery, College of Medicine and Health Science, Wolaita Sodo University, Wolaita, Ethiopia
| | - Kirubel Dagnaw Tegegne
- Department of Nursing, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Denekew Tenaw Anley
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Melkamu Aderajew Zemene
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Anteneh Mengist Dessie
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Sefineh Fenta Feleke
- Department of Public Health, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Tadesse Asmamaw Dejenie
- Department of Medical Biochemistry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yenealem Solomon Kebede
- Department of Medical Laboratory Science, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Ermias Sisay Chanie
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Gashaw Kerebeh
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Wubet Alebachew Bayih
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Natnael Moges
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Abu Jamra SR, Komatsu CG, Barbosa F, Roxo-Junior P, Navarro AM. Proposal to Screen for Zinc and Selenium in Patients with IgA Deficiency. Nutrients 2023; 15:2145. [PMID: 37432290 DOI: 10.3390/nu15092145] [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: 04/07/2023] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 07/12/2023] Open
Abstract
The increase in life expectancy can be a consequence of the world's socioeconomic, sanitary and nutritional conditions. Some studies have demonstrated that individuals with a satisfactory diet variety score present a lower risk of malnutrition and better health status. Zinc and selenium are important micronutrients that play a role in many biochemical and physiological processes of the immune system. Deficient individuals can present both innate and adaptive immunity abnormalities and increased susceptibility to infections. Primary immunodeficiency diseases, also known as inborn errors of immunity, are genetic disorders classically characterized by an increased susceptibility to infection and/or dysregulation of a specific immunologic pathway. IgA deficiency (IgAD) is the most common primary antibody deficiency. This disease is defined as serum IgA levels lower than 7 mg/dL and normal IgG and IgM levels in individuals older than four years. Although many patients are asymptomatic, selected patients suffer from different clinical complications, such as pulmonary infections, allergies, autoimmune diseases, gastrointestinal disorders and malignancy. Knowing the nutritional status as well as the risk of zinc and selenium deficiency could be helpful for the management of IgAD patients. OBJECTIVES to investigate the anthropometric, biochemical, and nutritional profiles and the status of zinc and selenium in patients with IgAD. METHODS in this descriptive study, we screened 16 IgAD patients for anthropometric and dietary data, biochemical evaluation and determination of plasma and erythrocyte levels of zinc and selenium. RESULTS dietary intake of zinc and selenium was adequate in 75% and 86% of the patients, respectively. These results were consistent with the plasma levels (adequate levels of zinc in all patients and selenium in 50% of children, 25% of adolescents and 100% of adults). However, erythrocyte levels were low for both micronutrients (deficiency for both in 100% of children, 75% of adolescents and 25% of adults). CONCLUSION our results highlight the elevated prevalence of erythrocyte zinc and selenium deficiency in patients with IgAD, and the need for investigation of these micronutrients in their follow-up.
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Affiliation(s)
- Soraya Regina Abu Jamra
- Department of Pediatrics, Ribeirão Preto Medical School-University of São Paulo-FMRP/USP, Sao Paulo 05508-090, Brazil
| | - Camila Gomes Komatsu
- Department of Food and Nutrition, Faculty of Pharmaceutical Sciences, São Paulo State University UNESP, Araraquara 14800-060, Brazil
| | - Fernando Barbosa
- Laboratory of Toxicology and Metal Essentiality, Faculty of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo-USP, Sao Paulo 05508-090, Brazil
| | - Persio Roxo-Junior
- Department of Pediatrics, Ribeirão Preto Medical School-University of São Paulo-FMRP/USP, Sao Paulo 05508-090, Brazil
| | - Anderson Marliere Navarro
- Department of Health Sciences, Division of Nutrition and Metabolism, Ribeirão Preto Medical School-University of São Paulo-FMRP/USP, Sao Paulo 05508-090, Brazil
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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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Kure A, Abebe A, Baza D, Paulos W. Overweight and obesity and associated factors among adult ART patients at Hawassa University Comprehensive Specialized Hospital, Southern Ethiopia. BMC Nutr 2022; 8:62. [PMID: 35821078 PMCID: PMC9275139 DOI: 10.1186/s40795-022-00556-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Overweight and obesity complicates the care and treatment of ART patients and predispose them to chronic non-communicable diseases. However, there is a shortage of research evidence on overweight and obesity and its associated factors among adult ART patients in our setting. Therefore, this study aimed to asses overweight and obesity and associated factors among adult ART patients at Hawassa University Comprehensive Specialized Hospital, Southern Ethiopia. METHODS A facility-based cross-sectional study design was conducted by using systematic sampling technique. Primary and secondary data were collected from 369 adult ART patients from February to May 2017. Structured interviewer-administered questionnaire and laboratory outputs were used as primary data. The patient's baseline medical records were used as secondary data. Ethiopian Ministry of Health ART patient's follow-up tool was used to collect the required information. The standard laboratory and well-calibrated digital Seca Scale and portable Stadio-meter were used to collect medical and anthropometric data. Data were entered into Epi- data version 3.1 and exported to SPSS version 20 for analysis. Descriptive statistics were calculated and presented by tables, graphs and texts. Binary and multivariable logistic regression analyses were computed and the level of statistical significance was declared at p-value < 0.05. RESULTS The prevalence of overweight and obesity (BMI ≥ 25 kg/m2) was 43.4% (95% CI = 43.35, 43.45). The difference in the overweight and obesity between the study period and initial commencement of ART was 35%. The course of HIV chronic care since the commencement of ART and during the study was 35%. Higher recent CD4 counts (200-499cells/mm3) (AOR = 3.15, 95%CI = 1.04-9.49) and (≥ 500 cells/mm3) (AOR = 7.58, 95%CI = 2.49-23.08), hypertension (AOR = 2.57, 95%CI = 1.24-5.35), higher baseline BMI status (AOR = 5.93, 95%CI = 2.62-13.40) and abdominal obesity (AOR = 1.82, 95%CI = 1.07-3.10) were significantly associated with overweight and obesity. CONCLUSION In this study, a high prevalence of overweight and obesity among adult ART patients was reported compared to general adult population in Ethiopia. Overweight and obesity were significantly higher among hypertensive, with higher recent CD4 counts and abdominal obese ART patients. Thus, screening of overweight and obesity, incorporating nutritionist/dietician into the routine chronic care, and regular monitoring of the nutritional status of ART patients is recommended.
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Affiliation(s)
- Ashenafi Kure
- Public Health Laboratory, Health Bureau, Southern Nations Nationalities and People’s Regional State, Hawassa, Ethiopia
| | - Amene Abebe
- College of Medicine and Health Science, Department of Public Health, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Daniel Baza
- Department of Pediatrics and Neonatal Nursing, Wolaita Sodo University, WolaitaSodo University, Wolaita Sodo, Ethiopia
| | - Wondimagegn Paulos
- College of Medicine and Health Science, Department of Human Nutrition, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Wijaya IP, Karim B, Azizi MS, Ariyanto I, Mansjoer A, Yunihastuti E, Harimurti K, Alwi I, Lee S, Price P. Cytomegalovirus may influence vascular endothelial health in Indonesian HIV-infected patients after 5 years on ART. AIDS Res Ther 2021; 18:83. [PMID: 34763708 PMCID: PMC8582163 DOI: 10.1186/s12981-021-00410-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 10/27/2021] [Indexed: 12/13/2022] Open
Abstract
Objectives Accelerated atherosclerosis in older HIV-infected patients has been attributed to persistent immune activation and high burden cytomegalovirus (CMV), as demonstrated in transplant recipients and the general population. Here we assess CMV and inflammatory markers linked with vascular health in young adult patients treated in Indonesia. Study design HIV-infected adults (n = 32) were examined when they began antiretroviral therapy (ART) with < 200 CD4 T-cells/µl (V0) and after 60 months (V60). Age-matched healthy controls (HC, n = 32) were assessed once. Methods Flow Mediated Dilatation (FMD) was assessed by ultrasound on brachial arteries at V60 and in HC. Plasma markers of immune activation and endothelial activation, and CMV antibodies (lysate, gB, IE-1) were assessed in all samples. Results were assessed using bivariate (non-parametric) and multivariable analyses. Results Levels of inflammatory biomarkers and CMV antibodies declined on ART, but the antibodies remained higher than in HC. FMD values were similar in patients and HC at V60. In HIV patients, levels of CMV lysate antibody correlated inversely (r = − 0.37) with FMD. The optimal model predicting lower FMD values (adjusted R2 = 0.214, p = 0.012) included CMV lysate antibodies and chondroitin sulphate. In HC, levels of sTNFR correlated inversely with FMD (r = − 0.41) and remained as a risk factor in the optimal multivariable model, with CMV glycoprotein-B (gB) antibody predicting a healthier FMD (adjusted R2 = 0.248, p = 0.013). Conclusions Higher levels CMV antibodies optimally predict vascular health measured by FMD in HIV patients. However in healthy controls, sTNFR marks risk and CMV gB antibody may be protective.
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Saito A, Karama M, Kamiya Y. HIV infection, and overweight and hypertension: a cross-sectional study of HIV-infected adults in Western Kenya. Trop Med Health 2020; 48:31. [PMID: 32398924 PMCID: PMC7203910 DOI: 10.1186/s41182-020-00215-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 04/23/2020] [Indexed: 12/13/2022] Open
Abstract
Background Non-communicable diseases (NCDs) are increasing in Kenya, where HIV/AIDS remains a leading cause of death; however, few studies have investigated obesity and hypertension among adults with HIV infection. We conducted a cross-sectional study in Homa Bay, Western Kenya, during 2015 to determine the prevalence of overweight/obesity and hypertension among HIV-infected adults and to identify their risk factors. Results Anthropometric measurements and a structured questionnaire were administered to adults with HIV infection receiving care at Mbita Sub-county Hospital. A total of 251 HIV-positive individuals were enrolled. More women were overweight (17.2%) and obese (3.6%) than underweight (8.3%). The prevalence of abdominal obesity was high in women (62.7%), especially those aged 30–39 years. The prevalence of hypertension was 9.8% and 11.8% in men and women, respectively. Male participants tended to develop hypertension at an early age. Multivariate analysis showed that female sex was significantly associated with abdominal obesity. Regarding clinical factors, we identified an association between overweight and a history of opportunistic infections, as well as between hypertension and World Health Organization clinical stage. Sixty percent of HIV-infected participants assumed that a very thin body size indicated HIV infection. Conclusions The main findings of this study include a greater prevalence of overweight than underweight as well as a high prevalence of abdominal obesity among women. Social perception toward body size among people with HIV infection might remain problematic. Individuals living with HIV in Kenya should receive preventive intervention for overweight and abdominal obesity, with consideration of relevant social and cultural aspects.
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Affiliation(s)
- Akiko Saito
- 1School of Tropical Medicine & Global Health, Nagasaki University, 1-12-4, Sakamoto, Nagasaki, 852-8523 Japan
| | - Mohamed Karama
- 2Center for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Yasuhiko Kamiya
- 1School of Tropical Medicine & Global Health, Nagasaki University, 1-12-4, Sakamoto, Nagasaki, 852-8523 Japan
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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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Adeoye I, Aridegbe M, Oguntade A. Obesity, hypertension, and dyslipidemia among human immunodeficiency virus patients in Abeokuta Ogun State, Nigeria. ACTA ACUST UNITED AC 2019. [DOI: 10.4103/njc.njc_10_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Pokharel P, Shettigar PG. Impact of counseling in knowledge, attitude and practice and association of nutritional status with CD4 count and opportunistic infections of HIV patients of Udupi, India. Clin Nutr ESPEN 2018; 29:154-159. [PMID: 30661681 DOI: 10.1016/j.clnesp.2018.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 09/24/2018] [Accepted: 11/02/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIMS HIV infection and insufficient nutritional intake form a malicious cycle which leads to immunodeficiency and malnutrition. Thus, this research was done to see the effect of nutritional counseling on knowledge, attitude and practice (KAP) of HIV patients of Udupi district. Also, the rational evidence of association of nutritional status with CD4 counts and opportunistic infections combined are limited which led to design of this study. METHODS This interventional study was done in ART Centre, Udupi, India with a sample size of 66 with 33 each in experimental and control group (EG and CG). At first, the biochemical parameters, KAP, 3 day dietary intake and food group intake over Food Frequency Questionnaire (FFQ) were recorded. PG-SGA (Scored Patient-Generated Subjective Global Assessment) scoring was used to categorize patients' nutritional status. Individual nutritional counseling was provided to EG and change in KAP of EG and CG were recorded after 1 month. RESULTS Pre-KAP mean of EG was 151.56 which increased to 169.13 after intervention. The mean KAP score of EG was statistically different from CG after counseling, P < 0.001. Of the total, 15 (22.7%) patients were found to be malnourished. The dietary intake of nutrients and food group was significantly lower than RDA. Tukey HSD post hoc analysis showed significant statistical difference for the CD4 count between moderate and severe malnourished category with P = 0.017. Statistically significant nutrient intake differences were also observed between PGSGA groups while odds ratio showed no significant association. CONCLUSIONS Improvement in KAP and poor nutritional status indicates that individual Nutrition and Health Education Counseling be made an integral part in the management of HIV in Udupi. Also, the difference in CD4 count across two PG-SGA stages depicts an association between nutritional status and immune status of HIV patients.
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Affiliation(s)
- Pratik Pokharel
- Dietetics and Applied Nutrition, Department of Allied Hospitality Studies, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India.
| | - Pallavi G Shettigar
- Dietetics and Applied Nutrition, Department of Allied Hospitality Studies, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India.
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Beraldo RA, Santos APD, Guimarães MP, Vassimon HS, Paula FJAD, Machado DRL, Foss-Freitas MC, Navarro AM. Body fat redistribution and changes in lipid and glucose metabolism in people living with HIV/AIDS. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2018; 20:526-536. [PMID: 29160443 DOI: 10.1590/1980-5497201700030014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 02/23/2017] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The HIV lipodystrophy syndrome is characterized by changes in metabolism, and body composition that increase cardiovascular risk of people living with HIV/AIDS (PLWHA) using highly active antiretroviral therapy (HAART). OBJECTIVE To assess the prevalence of lipodystrophy and changes in lipid and glucose metabolism in PLWHA in use of HAART. METHODS For the anthropometric evaluation we measured weight, height and abdominal circumference (AC). For the lipodystrophy evaluation we conducted physical examination (subjective) and the (objective) examination of absorptiometry with X-ray dual energy (DEXA) by fat mass ratio (FMR). We also conducted lipid profile tests and fasting glucose and used the criteria suggested by The National Cholesterol Education Program III for metabolic disorders classification. RESULTS The final sample consisted of 262 patients with a mean age of 44.3 ± 10.2 years. Lipodystrophy, according to the physical examination, was present in 47.7% (95%CI 41.7 - 53.8) of patients, while the prevalence using FMR (DEXA) was 40.8% (95%CI 33.1 - 48.5). Most (53.0%; 95%CI 47.0 - 59.1) of the patients showed increased abdominal adiposity according to AC. The most prevalent metabolic alterations were reduced HDL (67.6%; 95%CI 61.9 - 73.2) and hypertriglyceridemia (55.7%; 95%CI 49.7 - 61.7). CONCLUSION The high prevalence of lipodystrophy and changes in lipid and glucose metabolism show the importance of early intervention in this group of patients to prevent cardiovascular complications.
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Affiliation(s)
- Rebeca Antunes Beraldo
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo - Ribeirão Preto (SP), Brasil
| | - André Pereira Dos Santos
- Programa Interunidades de Doutoramento, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo - Ribeirão Preto (SP), Brasil
| | - Mariana Palma Guimarães
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo - Ribeirão Preto (SP), Brasil
| | | | | | - Dalmo Roberto Lopes Machado
- Escola de Educação Física e Esporte de Ribeirão Preto, Universidade de São Paulo - Ribeirão Preto (SP), Brasil.,Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo - Ribeirão Preto (SP), Brasil
| | - Maria Cristina Foss-Freitas
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo - Ribeirão Preto (SP), Brasil
| | - Anderson Marliere Navarro
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo - Ribeirão Preto (SP), Brasil
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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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Derose KP, Ríos-Castillo I, Fulcar MA, Payán DD, Palar K, Escala L, Farías H, Martínez H. Severe food insecurity is associated with overweight and increased body fat among people living with HIV in the Dominican Republic. AIDS Care 2018; 30:182-190. [PMID: 28681631 PMCID: PMC5725241 DOI: 10.1080/09540121.2017.1348597] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Food insecurity is an important risk factor for overweight and obesity among low-income populations in high income countries, but has not been well-studied among people living with HIV (PLHIV), particularly in resource-poor settings. To explore the association between food insecurity and overweight and obesity among PLHIV in the Dominican Republic, we conducted a cross-sectional study of 160 HIV-infected adults between March-December 2012 in four geographically-dispersed health centers (Santo Domingo, Puerto Plata, San Juan, and Higuey). We collected information on household food insecurity, anthropometric measurements, and socio-demographic data and ran descriptive and multivariate analyses, controlling for fixed effects of clinics and using robust standard errors. Mean age ± SD of participants was 39.9 ± 10.5 years; 68% were women, and 78% were on antiretroviral therapy (ART). A total of 58% reported severe household food insecurity. After controlling for age, gender, income, having children at home, education, and ART status, severe food insecurity was associated with increased body mass index (BMI) (β = 1.891, p = 0.023) and body fat (β = 4.004, p = 0.007). Age and female gender were also associated with increased body fat (β = 0.259, p < 0.001 and β = 8.568, p < 0.001, respectively) and age and ART status were associated with increased waist circumference (β = 0.279, p = 0.011 and β = 5.768, p = 0.046, respectively). When overweight was examined as a dichotomous variable (BMI ≥ 25.0), severe food insecurity was associated with an increased odds of 3.060 (p = 0.013); no other covariates were independently associated with overweight. The association of severe food insecurity with increased BMI, body fat, and overweight among PLHIV has important implications for clinical care as well as food security and nutrition interventions in resource-poor settings. Integrated programs that combine nutrition education or counseling with sustainable approaches to addressing food insecurity among PLHIV are needed to improve long-term health outcomes of this vulnerable population.
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Affiliation(s)
| | - Israel Ríos-Castillo
- Food and Agriculture Organization (FAO) of the United Nations, Sub-Regional Office for Mesoamerica, Panama City, Panama
| | - María Altagracia Fulcar
- United Nations World Food Programme, Dominican Republic Country Office, Santo Domingo, Dominican Republic
| | - Denise D. Payán
- RAND Corporation, Santa Monica, CA, USA
- UCLA Fielding School of Public Health, Los Angeles, CA USA
| | - Kartika Palar
- Division of HIV/AIDS, University of California, San Francisco, CA, USA
| | - Lisbeth Escala
- United Nations World Food Programme, Regional Bureau for Latin America and the Caribbean, Panama City, Panama
| | - Hugo Farías
- United Nations World Food Programme, Regional Bureau for Latin America and the Caribbean, Panama City, Panama
| | - Homero Martínez
- RAND Corporation, Santa Monica, CA, USA
- Hospital Infantil de Mexico “Dr. Federico Gomez”, Mexico City, Mexico
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Body Composition and Metabolic Syndrome Components on Lipodystrophy Different Subtypes Associated with HIV. J Nutr Metab 2017; 2017:8260867. [PMID: 28540084 PMCID: PMC5429929 DOI: 10.1155/2017/8260867] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 04/05/2017] [Accepted: 04/09/2017] [Indexed: 12/19/2022] Open
Abstract
HIV-associated lipodystrophy syndrome (HALS) is characterized by body fat redistribution as a consequence of the antiretroviral therapy (ART) introduction, associated with an increased risk of cardiovascular disease development. Subjective diagnosis, classified between three subtypes according to the body region on which fat is lost and/or accumulated, named lipoatrophy, lipohypertrophy, and mixed lipodystrophy, is possibly accompanied with metabolic alterations. Forty people living with HIV/AIDS (PLHA), with clinical diagnosis of HALS and from both genders, were assessed. They performed ambulatorial follow-up and used ART regularly. The main findings were greater lipid profile alterations among women, while no metabolic profile differences were found between the HALS subtypes. The lipohypertrophy group showed major alterations, with higher values for total body fat percent, visceral fat area (VFA), body mass index (BMI), and abdominal and neck circumferences when compared to the other groups. Lean body mass was superior only compared to the mixed lipodystrophy group, and fat mass only compared to the lipoatrophy group. BMI showed strong correlation with the VFA. In conclusion, despite anthropometric alterations related to HALS these individuals present, those are not accompanied with metabolic alterations. Strategies, as behavioral changes and disorders prevention, are important to decrease the risk of cardiovascular disease development.
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Truter D, Strijdom H, Everson F, Kotzé SH. Mucin secreting cells in the stomach and colon are altered by combination antiretroviral treatment in an obese rat model. Acta Histochem 2017; 119:122-128. [PMID: 28017359 DOI: 10.1016/j.acthis.2016.11.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 11/10/2016] [Accepted: 11/10/2016] [Indexed: 02/08/2023]
Abstract
Mucins, secreted by intestinal goblet cells, form an integral part of the intestinal biofilm, which is important for the functioning of a healthy gastrointestinal tract (GIT). This mucous layer is sensitive to factors such as diet, drugs and inflammation. Histochemically, mucins can be classified as neutral or acidic, where acidic mucins can contain sulphate groups (sulphomucins) or sialic acid (sialomucins). The aim of the present study was to determine the composition of various mucin secreting cells using histochemical stains in rats fed on a high calorie diet (HCD) treated with antiretroviral therapy (ART). Wistar rats (N=24) were divided into a lean control group (C/ART-), high calorie diet group (C/HCD+), ART group (C/ART+) and HCD and ART group (HCD+/ART+). The body of the stomach as well as the colon were stained with Alcian Blue Periodic Schiff (ABPAS) to distinguish between neutral and acidic mucins and Alcian Blue Aldehyde Fuschin (ABAF) to distinguish between sialo-and sulphomucins. An increase of the total gastric mucous cells was observed in the HCD+/ART+ group compared to the C/ART- group using both ABPAS and ABAF. A decrease of neutral cells in the distal part of the colonic crypts in the C/HCD+ and C/ART+ groups compared to the C/ART- group were observed. Mixed goblet cells in the colonic crypts of the C/ART- and HCD+/ART+ groups were decreased in comparison to the C/ART+ group. The study showed that the total mean percentage of mucous cells in the stomach as well as the total amount of neutral goblet cells in the colon were most affected by ART and a HCD. These changes in a rat model suggest that the quality of the biofilm may be altered and should be considered when ART is prescribed to obese patients.
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Okafor CN, Kelso NE, Bryant V, Burrell LE, Míguez MJ, Gongvatana A, Tashima KT, de la Monte S, Cook RL, Cohen RA. Body mass index, inflammatory biomarkers and neurocognitive impairment in HIV-infected persons. PSYCHOL HEALTH MED 2017; 22:289-302. [PMID: 27319430 PMCID: PMC5173436 DOI: 10.1080/13548506.2016.1199887] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
To determine the relationships among body mass index (BMI), and HIV-associated neurocognitive impairment and the potential mediating effects of inflammatory cytokines. Among the HIV-infected individuals (N = 90) included in this study, obesity was associated with slower processing speed (β = -.229, standard error (SE) = 2.15, p = .033), compared to participants with a normal BMI, after controlling for psychosocial and HIV clinical factors. Serum concentrations of the interleukin-16 (IL-16) cytokine were significantly associated with slowed processing speed (β = -.235, SE = 1.62, p = .033) but did not mediate the relationship between obesity and processing speed These findings suggest that obesity may contribute to cognitive processing speed deficits in HIV-infected adults. Elevated concentrations of IL-16 are also associated with slowing, though the results suggest that obesity and IL-16 may exert independent effects.
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Affiliation(s)
- Chukwuemeka N. Okafor
- Department of Epidemiology - College of Public Health and Health Professions, College of Medicine, University of Florida, 2004 Mowry Road, PO Box 100231, Gainesville, FL 32610, United States of America
| | - Natalie E. Kelso
- Department of Epidemiology - College of Public Health and Health Professions, College of Medicine, University of Florida, 2004 Mowry Road, PO Box 100231, Gainesville, FL 32610, United States of America
| | - Vaughn Bryant
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, 1225 Center Drive, Room 3151, P.O. Box 100165, Gainesville, FL 32610, United States of America
| | - Larry E. Burrell
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, 1225 Center Drive, Room 3151, P.O. Box 100165, Gainesville, FL 32610, United States of America
| | - Maria Jose Míguez
- School of Integrated Science and Humanity (SISH), Florida International University, 11200 SW 8 Street, Miami, Florida, 33199, United States of America
| | - Assawin Gongvatana
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States of America
| | - Karen T. Tashima
- Departments of Medicine and Pathology, Warren Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Suzanne de la Monte
- Departments of Medicine and Pathology, Warren Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Robert L. Cook
- Department of Epidemiology - College of Public Health and Health Professions, College of Medicine, University of Florida, 2004 Mowry Road, PO Box 100231, Gainesville, FL 32610, United States of America
| | - Ronald A. Cohen
- Center for Cognitive Aging and Memory, Institute on Aging, and the, Departments of Neurology, Psychiatry, and Aging and Geriatric Research, University of Florida, 2004 Mowry Road, PO Box 100107, Gainesville, FL 32611, United States of America
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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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Gomes A, Reyes EV, Garduno LS, Rojas R, Mir Mesejo G, Del Rosario E, Jose L, Javier C, Vaughan C, Donastorg Y, Hammer S, Brudney K, Taylor BS. Incidence of Diabetes Mellitus and Obesity and the Overlap of Comorbidities in HIV+ Hispanics Initiating Antiretroviral Therapy. PLoS One 2016; 11:e0160797. [PMID: 27508301 PMCID: PMC4979961 DOI: 10.1371/journal.pone.0160797] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 07/25/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is a leading health threat for HIV+ patients on antiretroviral therapy (ART); cardiometabolic comorbidities are key predictors of risk. Data are limited on incidence of metabolic comorbidities in HIV+ individuals initiating ART in low and middle income countries (LMICs), particularly for Hispanics. We examined incidence of diabetes and obesity in a prospective cohort of those initiating ART in the Dominican Republic. METHODS Participants ≥18 years, initiating ART <90 days prior to study enrollment, were examined for incidence of impaired fasting glucose (IFG), diabetes mellitus (DM), overweight, and obesity. Fasting plasma glucose (FPG) 100-125mg/dl defined IFG; FPG ≥126 mg/dl, diagnosis per medical record, or use of hypoglycemic medication defined DM. Overweight and obesity were BMI 25-30 and ≥30kg/m2, respectively. Dyslipidemia was total cholesterol ≥240mg/dl or use of lipid-lowering medication. Framingham risk equation was used to determine ten-year CVD risk at the end of observation. RESULTS Of 153 initiating ART, 8 (6%) had DM and 23 (16%) had IFG at baseline, 6 developed DM (28/1000 person-years follow up [PYFU]) and 46 developed IFG (329/1000 PYFU). At baseline, 24 (18%) were obese and 36 (27%) were overweight, 15 became obese (69/1000 PYFU) and 22 became overweight (163/1000 PYFU). Median observation periods for the diabetes and obesity analyses were 23.5 months and 24.3 months, respectively. Increased CVD risk (≥10% 10-year Framingham risk score) was present for 13% of the cohort; 79% of the cohort had ≥1 cardiometabolic comorbidity, 48% had ≥2, and 13% had all three. CONCLUSIONS In this Hispanic cohort in an LMIC, incidences of IFG/DM and overweight/obesity were similar to or higher than that found in high income countries, and cardiometabolic disorders affected three-quarters of those initiating ART. Care models incorporating cardiovascular risk reduction into HIV treatment programs are needed to prevent CVD-associated mortality in this vulnerable population.
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Affiliation(s)
- Angelina Gomes
- Department of Medicine, Columbia University Medical Center, New York, New York, United States of America
| | - Emily V. Reyes
- Unidad de Tratamiento de ITS y VIH, Instituto Dermatológico y Cirugía de Piel “Dr. Humberto Bogaert Diaz”, Santo Domingo, Dominican Republic
| | - L. Sergio Garduno
- University of Texas Health Science Center San Antonio, San Antonio, Texas, United States of America
| | - Rita Rojas
- Unidad de Tratamiento de ITS y VIH, Instituto Dermatológico y Cirugía de Piel “Dr. Humberto Bogaert Diaz”, Santo Domingo, Dominican Republic
| | | | - Eliza Del Rosario
- Departamento de Medicina, Profamilia, Santo Domingo, Dominican Republic
| | - Lina Jose
- Unidad de Tratamiento de ITS y VIH, Instituto Dermatológico y Cirugía de Piel “Dr. Humberto Bogaert Diaz”, Santo Domingo, Dominican Republic
| | - Carmen Javier
- Unidad de Tratamiento de ITS y VIH, Instituto Dermatológico y Cirugía de Piel “Dr. Humberto Bogaert Diaz”, Santo Domingo, Dominican Republic
| | - Catherine Vaughan
- Department of Medicine, Columbia University Medical Center, New York, New York, United States of America
| | - Yeycy Donastorg
- Unidad de Vacunas, Instituto Dermatológico y Cirugía de Piel “Dr. Humberto Bogaert Diaz”, Santo Domingo, Dominican Republic
| | - Scott Hammer
- Department of Medicine, Columbia University Medical Center, New York, New York, United States of America
| | - Karen Brudney
- Department of Medicine, Columbia University Medical Center, New York, New York, United States of America
| | - Barbara S. Taylor
- Department of Medicine, Columbia University Medical Center, New York, New York, United States of America
- University of Texas Health Science Center San Antonio, San Antonio, Texas, United States of America
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Florêncio RS, Moreira TMM, Silva MRFD, Almeida ÍLSD. Overweight in young adult students: the vulnerability of a distorted self-perception of body image. Rev Bras Enferm 2016; 69:258-65. [PMID: 27280561 DOI: 10.1590/0034-7167.2016690208i] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 10/09/2015] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: analisar o excesso ponderal em adultos jovens escolares a partir da dimensão individual da vulnerabilidade, especificamente de seus marcadores interpessoais e subjetivos. Método: delineou-se um estudo analítico, quantitativo, realizado com 560 adultos jovens de 26 escolas de uma capital do nordeste brasileiro. Após obtenção dos dados pela aplicação de questionários específicos, utilizou-se a regressão logística para identificação dos marcadores de vulnerabilidade individual. Resultados: na análise bivariada, o excesso ponderal apresentou associação estatística significativa com autopercepção de saúde, satisfação corporal e autopercepção de excesso ponderal, esta permanecendo no modelo final da regressão. Conclusão: conclui-se, sobremaneira, que a autopercepção de excesso ponderal sofre distorções em relação à real situação corporal e por isso torna o adulto jovem vulnerável a estados disfuncionais de saúde. No entanto, ratifica-se que o agravo deve ser compreendido numa perspectiva individual e contextual.
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Affiliation(s)
- Raquel Sampaio Florêncio
- Universidade Estadual do Ceará, Centro de Ciências da Saúde, Programa de Pós-Graduação em Saúde Coletiva, Fortaleza CE , Brazil, Universidade Estadual do Ceará, Centro de Ciências da Saúde, Programa de Pós-Graduação em Saúde Coletiva. Fortaleza-CE, Brasil., Universidade Estadual do Ceará
| | - Thereza Maria Magalhães Moreira
- Universidade Estadual do Ceará, Centro de Ciências da Saúde, Programa de Pós-Graduação em Saúde Coletiva, Fortaleza CE , Brazil, Universidade Estadual do Ceará, Centro de Ciências da Saúde, Programa de Pós-Graduação em Saúde Coletiva. Fortaleza-CE, Brasil., Universidade Estadual do Ceará
| | - Maria Rocineide Ferreira da Silva
- Universidade Estadual do Ceará, Centro de Ciências da Saúde, Programa de Pós-Graduação em Saúde Coletiva, Fortaleza CE , Brazil, Universidade Estadual do Ceará, Centro de Ciências da Saúde, Programa de Pós-Graduação em Saúde Coletiva. Fortaleza-CE, Brasil., Universidade Estadual do Ceará
| | - Ítalo Lennon Sales de Almeida
- Universidade Estadual do Ceará, Centro de Ciências da Saúde, Fortaleza CE , Brazil, Universidade Estadual do Ceará, Centro de Ciências da Saúde. Fortaleza-CE, Brasil., Universidade Estadual do Ceará
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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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Development of predictive equations for total and segmental body fat in HIV-seropositive patients. Nutrition 2014; 31:127-31. [PMID: 25466656 DOI: 10.1016/j.nut.2014.05.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 04/17/2014] [Accepted: 05/24/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The central point of the HIV lipodystrophy syndrome is changes in body composition that mainly involve the loss of fat in the limbs and face (lipoatrophy) and/or fat gain in the abdominal region and back neck (lipohypertrophy). Currently, the determination of fat per body segment in this group can be obtained by imaging methods such as dual-energy X-ray absorptiometry (DXA) but not by methods that would be more feasible in the practical clinics. The aim of this study was to develop equations to estimate total body fat and fat in each segment using anthropometric and bioelectrical impedance analysis (BIA) variables in HIV-seropositive patients. METHODS We measured circumferences (arm, waist, hip, thigh, calf), skinfolds (biceps, triceps, subscapular, suprailiac) and conducted examinations of BIA, segmental BIA, and DXA in 100 HIV-seropositive men on highly active antiretroviral therapy. Equations were developed by linear regression from these variables to estimate total and segmental fat (arm, leg, and trunk). RESULTS We developed a model for estimation of total body fat with BIA variables and a model based on anthropometric variables. To estimate segmental fat, we developed one model for each segment using anthropometric variables. The coefficients of determination for models of total fat-free mass (BIA and anthopometry), arm fat, trunk fat, and leg fat were 0.87, 0.84, 0.66, 0.76, and 0.5, respectively. CONCLUSIONS The equations proposed in this study allow the assessment of total body fat and fat per body segment with data obtained from accessible, accurate, and reliable methods used in clinical practice.
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Alo C, Ogbonnaya LU, Azuogu BN. Effects of nutrition counseling and monitoring on the weight and hemoglobin of patients receiving antiretroviral therapy in Ebonyi State, Southeast Nigeria. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2014; 6:91-7. [PMID: 24876794 PMCID: PMC4035309 DOI: 10.2147/hiv.s60429] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Introduction The relationship between human immunodeficiency virus (HIV) and malnutrition is easily explained, and the etiology of malnutrition in HIV disease is believed to be multifactorial. It therefore follows that ongoing assessment of nutritional and medical status is crucial to quality nutrition care for every person living with HIV. The aim of this study was to find out the effect of nutritional counseling and monitoring, using personalized dietary prescriptions, on the body mass index (BMI) and hemoglobin of patients who are HIV-infected and also receiving highly active antiretroviral drugs. Methods A total of 84 patients were selected using simple random sampling and allocated into intervention and control groups. Nutritional counseling and monitoring was done for the intervention group, while only weight, height, and hemoglobin concentration were monitored for the control group. At the end of 6 months, the differences in mean body mass index (BMI) and hemoglobin concentrations of the intervention and control groups were compared using the Student’s t-test. Statistical level of significance was put at P<0.05. Results Among respondents, 30.96% were males and 69.04% were females, and the mean age of the intervention group was 33.8 years and was 35.3 in the control group. After 6 months of study, the difference in the mean BMI among the males of both groups (24.9 kg/m2 [intervention] and 24.3 kg/m2 [control]) was not significant (P=0.53) but was significant among the females (24.9 kg/m2 [intervention group] versus 21.8 kg/m2 [control group]) (P=0.0005). The difference in mean hemoglobin concentration between the intervention and control groups for both males and females were statistically significant (12.2 mg/dL for males in the intervention group and 11.0 mg/dL for males in the control group [P=0.005]; 11.9 mg/dL for females in the intervention group and 11.0 mg/dL for females in the control group [P=0.010 Conclusion Nutrition intervention is important in the management of people living with HIV/acquired immunodeficiency disease (AIDS) while on antiretroviral therapy. This can be achieved through nutritional counseling and monitoring.
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Affiliation(s)
- Chihurumnanya Alo
- Department of Community Medicine, Ebonyi State University, Abakaliki, Ebonyi State, Nigeria
| | - Lawrence U Ogbonnaya
- Department of Community Medicine, Ebonyi State University, Abakaliki, Ebonyi State, Nigeria
| | - Benedict N Azuogu
- Department of Community Medicine, Ebonyi State University, Abakaliki, Ebonyi State, Nigeria
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Abstract
BACKGROUND Obesity and HIV disproportionately affect minorities and have significant health risks, but few studies have examined disparities in weight change in HIV-seropositive (HIV+) cohorts. OBJECTIVE To determine racial and health insurance disparities in significant weight gain in a predominately Hispanic HIV+ cohort. METHODS Our observational cohort study of 1214 nonunderweight HIV+ adults from 2007 to 2010 had significant weight gain [≥3% annual body mass index (BMI) increase] as the primary outcome. The secondary outcome was continuous BMI over time. A 4-level race-ethnicity/insurance predictor reflected the interaction between race-ethnicity and insurance: insured white (non-Hispanic), uninsured white, insured minority (Hispanic or black), or uninsured minority. Logistic and mixed-effects models adjusted for baseline BMI, age, gender, household income, HIV transmission category, antiretroviral therapy type, CD4 count, plasma HIV-1 RNA, observation months, and visit frequency. RESULTS The cohort was 63% Hispanic and 14% black; 13.3% were insured white, 10.0% uninsured white, 40.9% insured minority, and 35.7% uninsured minority. At baseline, 37.5% were overweight, 22.1% obese. Median observation was 3.25 years. Twenty-four percent of the cohort had significant weight gain, which was more likely for uninsured minority patients than insured whites [adjusted odds ratio = 2.85, 95% confidence intervals (CIs): 1.66 to 4.90]. The rate of BMI increase in mixed-effects models was greatest for uninsured minorities. Of 455 overweight at baseline, 29% were projected to become obese in 4 years. CONCLUSIONS AND RELEVANCE In this majority Hispanic HIV+ cohort, 60% were overweight or obese at baseline, and uninsured minority patients gained weight more rapidly. These data should prompt greater attention by HIV providers for prevention of obesity.
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Albuquerque VMG, Zírpoli JC, de Barros Miranda-Filho D, Albuquerque MDFPM, Montarroyos UR, de Alencar Ximenes RA, Lacerda HR. Risk factors for subclinical atherosclerosis in HIV-infected patients under and over 40 years: a case-control study. BMC Infect Dis 2013; 13:274. [PMID: 23773229 PMCID: PMC3686657 DOI: 10.1186/1471-2334-13-274] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2012] [Accepted: 06/14/2013] [Indexed: 01/29/2023] Open
Abstract
Background Cardiovascular diseases (CVD) are a major cause of death in people with AIDS. Factors contributing to atherosclerosis include traditional risk factors, antiretrovirals and inflammatory factors related to HIV infection. This study set out to compare risk factors associated with subclinical atherosclerosis in individuals under and over 40 years of age. Methods Case–control study with 697 HIV/AIDS individuals without HAART or who remain on their first antiretroviral regimen. Of the total, 351 individuals under 40 years and 346 over 40 years were analyzed separately. Subclinical atherosclerosis was assessed by carotid intima-media thickness, using B-mode ultrasound. Multivariate logistic regression was performed to find predictors of subclinical atherosclerosis in the entire group. Subsequent analysis excluded patients with major risk factors for CVD. Magnitudes of associations were expressed by odds ratio (OR) statistical significance, using a 95% confidence interval and p-value <0.05. Results In the <40 years group subclinical atherosclerosis was associated with male gender (OR: 2.77, 95% CI: 1.43–5.34), nonwhite race (OR: 3.01, 95% CI: 1.23-6.53), obesity (OR: 5.13, 95% CI: 1.79–14.7) and metabolic syndrome (OR: 3.30, 95% CI: 1.44–7.58). In the group ≥40 years predictors of subclinical atherosclerosis were overweight and obesity (OR = 2.53, 95% CI, 0.85–7.54), current CD4 ≥350 cells/mL (OR: 2.81, 95% CI: 1.22–6.47) and NNRTI use ≥ 5 years (OR: 2.65, 95% CI: 1.10-6.37) or PI use >5 years (OR: 1.81, 95% CI: 0.38-8.59). In the multivariate model excluding patients with major risk factors for CVD, age, male sex and nonwhite race were associated with subclinical atherosclerosis in the <40 y group, while in the ≥40 y group, age, HIV viral load >10,000 copies and the use of NNRTI (OR: 7.60, 95% CI: 1.61-35.8) or PI ≥5 years (OR: 3.62, 95% CI: 0.48-26.8) were associated with subclinical atherosclerosis. Conclusions In young people the fight against obesity and metabolic syndrome is the main aim in the prevention of CVD. In individuals aged ≥40 y, the prevention of obesity is also of great importance. Moreover, the effects of uncontrolled viremia and the prolonged use of HAART appear to be more harmful in the older group.
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Batista JDL, de Albuquerque MDFPM, Maruza M, Ximenes RADA, Santos ML, Montarroyos UR, de Barros Miranda-Filho D, Lacerda HR, Rodrigues LC. Incidence and risk factors for tuberculosis in people living with HIV: cohort from HIV referral health centers in Recife, Brazil. PLoS One 2013; 8:e63916. [PMID: 23675515 PMCID: PMC3651200 DOI: 10.1371/journal.pone.0063916] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Accepted: 04/08/2013] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To identify the incidence of and risk factors for tuberculosis in people living with HIV (PLHIV). DESIGN Observational, prospective cohort study. METHODS A total of 2069 HIV-infected patients was observed between July 2007 and December 2010. The Kaplan-Meier method was used to estimate the probability of survival free of tuberculosis, and Cox regression analysis to identify risk factors associated with the development of tuberculosis. RESULTS Survival free of tuberculosis (TB) was 91%. The incidence rate of tuberculosis was 2.8 per 100 persons/years. Incidence of tuberculosis was higher when subjects had CD4 cell count <200 cells/mm(3); were not on antiretroviral therapy; in those who had, a body mass index <18.5 kg/m(2), anemia (or were not tested for it), were illiterate or referred previous tuberculosis treatment at entry into the cohort. Those not treated for latent TB infection had a much higher risk (HR = 7.9) of tuberculosis than those with a negative tuberculin skin test (TST). Having a TST≥5 mm but not being treated for latent TB infection increased the risk of incident tuberculosis even in those with a history of previous tuberculosis. CONCLUSIONS Preventive actions to reduce the risk of TB in people living with HIV should include an appropriate HAART and treatment for latent TB infection in those with TST≥5 mm. The actions towards enabling rigorous implementation of treatment of latent TB infection and targeting of PLHIV drug users both at the individual and in public health level can reduce substantially the incidence of TB in PLHIV.
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Predictors of change in CD4 lymphocyte count and weight among HIV infected patients on anti-retroviral treatment in Ethiopia: a retrospective longitudinal study. PLoS One 2013; 8:e58595. [PMID: 23573191 PMCID: PMC3616015 DOI: 10.1371/journal.pone.0058595] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 02/07/2013] [Indexed: 12/04/2022] Open
Abstract
Background Antiretroviral treatment (ART) has been introduced in Ethiopia a decade ago and continues to be scaled up. However, there is dearth of literature on the impact of ART on changes in CD4 lymphocyte count and weight among patients on treatment. Objective To determine the predictors of change in CD4 lymphocyte count and weight among HIV/AIDS infected patients taking antiretroviral treatment in eastern Ethiopia. Methods A retrospective cohort study was conducted among HIV/AIDS patients taking ART from 2005 to 2010. A sample of 1540 HIV infected adult patients who started antiretroviral therapy in hospitals located in eastern Ethiopia were included in the study. The primary outcomes of interest were changes in CD4 count and weight. Descriptive statistics and multivariable regression analyses were performed to examine the outcomes among the cohort. Results Both the median CD4 lymphocyte counts and weight showed improvements in the follow up periods. The multivariate analysis shows that the duration of ART was an important predictor of improvements in CD4 lymphocyte count (beta 7.91; 95% CI 7.48–8.34; p 0.000) and weight (beta 0.15; 95% CI 0.13–0.18; p 0.000). Advanced WHO clinical stage, lower baseline CD4 cell count, and baseline hemoglobin levels were factors associated with decline in weight. Actively working patients had higher CD4 lymphocyte count and weight compared to those that were ambulatory (p<0.05). Conclusion We detected a substantial increment in weight and CD4 lymphocyte count among the patients who were taking ART in eastern Ethiopia. Patients who are of older age, with low initial CD4 lymphocyte count, late stage of the WHO clinical stages and lower hemoglobin level may need special attention. The reasons for the improved findings on CD4 count and weight throughout the five years of follow up merit further investigation.
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