Metabolic abnormalities and overweight in HIV/AIDS persons-treated with antiretroviral therapy

Overweight and obesity and associated factors among adult ART patients at Hawassa University Comprehensive Specialized Hospital, Southern Ethiopia

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.

People living with HIV/AIDS: body image and its important associations with mental health and BMI

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.

Treatment with a fixed dose combination antiretroviral therapy drug containing tenofovir, emtricitabine and efavirenz is associated with cardioprotection in high calorie diet-induced obese rats

HIV-infection, certain antiretroviral drug classes, especially protease inhibitors (PI), and obesity are associated with increased ischaemic heart disease (IHD) risk. However, the effect of PI-free fixed dose combination (FDC) antiretroviral therapy (ART) on hearts exposed to ischaemia-reperfusion injury (I/R) is unknown, particularly in obesity. This is becoming relevant as World Health Organisation guidelines recommend a FDC ART containing (non-) nucleoside reverse transcriptase inhibitors (tenofovir (TDF), emtricitabine (FTC) and efavirenz (EFV)) as first-line HIV treatment. Additionally, obesity rates are rising in HIV-infected populations, not only in ART-experienced individuals, but also at the time of ART initiation, which may further increase the risk of IHD. Therefore, we investigated the effects of PI-free FDC ART in myocardial I/R-exposed hearts from obese rats. Obesity was induced in male wistar rats via a 16-week high calorie diet. At week 10, treatment with a FDC ART drug containing TDF/FTC/EFV was initiated. Biometric and metabolic parameters, as well as myocardial functional recovery and infract size (IS), and myocardial signalling proteins following I/R were assessed after 16 weeks. Obese rats presented with increased body and intraperitoneal fat mass, elevated triglyceride and TBARS levels, whilst the hearts responded to I/R with impaired functional performance and increased IS. The FDC ART treatment did not alter biometric and metabolic parameters in obese rats. In a novel finding, ART protected obese hearts against I/R as shown by improved functional performance and smaller IS vs. untreated obese hearts. Cardioprotection was underscored by increased myocardial phosphorylated endothelial nitric oxide synthase (eNOS) and reduced AMP-kinase levels. In conclusion, these results demonstrate for the first time, that 6-weeks treatment of obese rats with a FDC ART drug specifically containing TDF/FTC/EFV conferred cardioprotection against I/R. The FDC ART-induced cardioprotection was seemingly unrelated to metabolic changes, but rather due to direct cardiac mechanisms including the up-regulation of myocardial eNOS.

Body fat redistribution and changes in lipid and glucose metabolism in people living with HIV/AIDS

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.

Mucin secreting cells in the stomach and colon are altered by combination antiretroviral treatment in an obese rat model

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.

Prevalence of obesity and cardiovascular risk in patients with HIV/AIDS in Porto Alegre, Brazil

OBJECTIVE

The aim of this study was to discover the prevalence of overweight, obesity and cardiovascular risk in our HIV/AIDS outpatients according to sex, antiretroviral therapy and other variables.

SUBJECTS AND METHODS

Patients underwent an anthropometric assessment. Body mass index and waist circumference were used to classify their nutritional status and their cardiovascular risk.

RESULTS

The majority of the 345 patients (58.8%) were males. Obesity was detected in 8.3% of them; 34.2% were overweight, and 5.2% malnourished. Near half of them (51.3%) had some cardiovascular risk, with increased risk in 24.6% of them, and substantially increased risk in 26.7% of them.

CONCLUSIONS

Overweight and obesity were highly prevalent. Women were more frequently obese (OR = 3.53; IC 95%, 1.47 < OR < 8.69), and their cardiovascular risk was often higher (OR = 6.97; IC 95%, 4.16 < OR < 11.76). The prevalence of obesity and cardiovascular risk did not change according to antiretroviral therapy or other variables.

Body mass index in individuals with HIV infection and factors associated with thinness and overweight/obesity

A cross-sectional study was conducted using body mass index (BMI) to estimate the prevalence of thinness and overweight/obesity and associated factors in 2,018 individuals with HIV/AIDS attending health services referral centers. The dependent variable was classified as thinness, overweight/obesity and eutrophy. Multinomial logistic regression analyses were performed considering eutrophy as the reference level. The prevalence of thinness was 8.8% and of overweight/obesity, 32.1%. The variables associated with thinness were anemia and CD4 cell count < 200mm³. The variables associated with risk of overweight/obesity were age > 40 years and diabetes, and the variables identified as decreasing likelihood of overweight/obesity were having no long-term partner, smoking, presence of an opportunistic disease, anemia, and albumin levels < 3.5mg/dL. The main nutritional problem observed in this population was overweight and obesity, which were much more prevalent than thinness. Older individuals with diabetes should be targeted for nutritional interventions and lifestyle changes.

Insatisfação com imagem corporal e adesão à terapia antirretroviral entre indivíduos com HIV/AIDS

OBJETIVO: Este estudo teve como objetivo avaliar a associação entre insatisfação com a imagem corporal e adesão à terapia antirretroviral. MÉTODOS: Participaram do estudo 80 indivíduos infectados com o vírus da imunodeficiência humana/síndrome da imu-nodeficiência adquirida. Foi administrado questionário de autopreenchimento para avaliar o nível de adesão à medicação, com metodologia de escalas de silhuetas para avaliar a satisfação com a imagem corporal. As aná-lises incluíram estatística descritiva, teste t de Student, Qui-quadrado e estimativa de Odds ratio. RESULTADOS: Os resultados mostraram elevada insatisfação com a imagem corporal tanto entre os homens quanto entre as mulheres (75,0%). A insatisfação corporal foi mais prevalente no grupo com sobrepeso (40,0% vs 15,0%; p=0,041) e entre os indivíduos com queixas de depressão, mas tais diferenças não foram significativas (28,3% vs. 15,0%; p=0,233). No grupo de insatisfeitos com a imagem corporal, 62,0% das mulheres tinham sobrepeso e 58,0% dos homens eram eutróficos. A adesão irregular aos antirretrovirais foi mais prevalente entre as mu-lheres, em comparação aos homens (77,8% vs 47,7; p=0,006). Existiu uma associação positiva e significativa entre insatisfação com a imagem corporal e baixos níveis de adesão (OR=4,69 IC:1,491-17,792; p=0,003). CONCLUSÃO: Este estudo mostrou associação entre insatisfação com a imagem corporal, sobrepeso e baixa adesão à terapia antirretroviral. Intervenções que objetivem reduzir a insatisfação com a imagem corporal são recomendadas para indivíduos infectados com o vírus da imunodeficiência humana/síndrome da imunodeficiência adquirida, sob tratamento antirretroviral.

Dietary calcium, dairy food intake and metabolic abnormalities in HIV-infected individuals

BACKGROUND

Epidemiological data suggest that calcium intake may influence lipid metabolism. It is unknown whether this influence also occurs in individuals with HIV/AIDS. The present study aimed to assess the relationship between dietary calcium, dairy food intake and metabolic parameters in individuals with HIV/AIDS.

METHODS

A cross-sectional study was conducted with 100 individuals with HIV/AIDS. Calcium intakes and food group consumption were determined by a food 24-h dietary recall and a food frequency questionnaire, respectively. The level of physical activity was determined with the international physical activity questionnaire and metabolic syndrome (MS) was defined by National Cholesterol Education Program Adult Treatment Panel III (2001). Student's t-test, one-way analysis of variance and chi-square were used to compare the groups.

RESULTS

The mean (SD) calcium intake was 559.5 (298.84) mg day(-1) and dairy food consumption was 1.73 (0.78) servings per day. Dietary calcium intake below 700 mg day(-1) had greater waist circumference, body mass index (BMI) but not significant and higher systolic blood pressure (SBP) (P < 0.05) and diastolic blood pressure (DBP) (P = 0.07). Dairy food consumers (>2 servings per day) showed lower BMI (P < 0.01), waist circumference (P = 0.05), SBP and DBP (P < 0.05). There was a significant association between calcium intake, MS and hypertension. The odds ratio for MS was 2.0 [95% confidence interval (CI) = 1.23-3.32] and for hypertension was 2.25 (95% CI = 1.44-4.44). Only 21% of the individuals were categorised in the moderate/intense physical activity level.

CONCLUSIONS

The results obtained suggest that a dietary pattern with higher proportion of calcium and fruits/vegetables may protect against abdominal obesity and hypertension in HIV-infected individuals.

Risco cardiovascular: marcadores antropométricos, clínicos e dietéticos em indivíduos infectados pelo vírus HIV

OBJETIVO: Descrever marcadores antropométricos, clínicos e dietéticos associados ao risco cardiovascular em indivíduos infectados pelo vírus HIV. MÉTODOS: Realizou-se um estudo transversal com 100 indivíduos, adultos, com HIV/Aids, da cidade do Rio de Janeiro. O risco cardiovascular foi estimado pelo escore de risco de Framingham. O consumo alimentar foi avaliado por meio de um recordatório de 24 horas e de uma lista de frequência de consumo de alimentos. Para comparar variáveis, foram utilizados o teste t de Student e o teste Qui-quadrado. RESULTADOS: Dentre os indivíduos avaliados, 63% eram homens, com idade média de 41,8, DP=9,6 anos, 77% faziam uso de antirretrovirais. Escore de risco de Framingham >10% foi identificado em 53% dos indivíduos. Os principais fatores de risco cardiovascular potencialmente modificáveis identificados foram: lipoproteína de alta densidade baixo (70%), hipercolesterolemia (35%), hipertensão arterial (35%), seguidos de tabagismo (23%) e glicose alta (21%). Indivíduos com escore de risco de Framingham >10% apresentavam uma tendência para consumir dietas mais ricas em colesterol (p=0,720), em sódio (p=0,898), em açúcares/doces (p=0,032) e pobres em fibras (p=0,273), associadas a um maior consumo de bebidas alcoólicas (p=0,053). A avaliação dos hábitos de vida revelou maior prevalência de tabagismo e maior nível de sedentarismo no grupo com escore de risco de Framingham >10, porém não significativos. CONCLUSÃO: Os resultados deste estudo mostram que pacientes com HIV/Aids sob terapia Highly Active Antiretroviral Therapy e com mais altos escore de risco de Framingham não seguem as medidas preventivas contra doenças cardiovasculares e devem ser permanentemente encorajados a fazer escolhas alimentares saudáveis, parar de fumar e aumentar a atividade física.