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Ramirez Bustamante CE, Agarwal N, Cox AR, Hartig SM, Lake JE, Balasubramanyam A. Adipose Tissue Dysfunction and Energy Balance Paradigms in People Living With HIV. Endocr Rev 2024; 45:190-209. [PMID: 37556371 PMCID: PMC10911955 DOI: 10.1210/endrev/bnad028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 07/09/2023] [Accepted: 08/07/2023] [Indexed: 08/11/2023]
Abstract
Over the past 4 decades, the clinical care of people living with HIV (PLWH) evolved from treatment of acute opportunistic infections to the management of chronic, noncommunicable comorbidities. Concurrently, our understanding of adipose tissue function matured to acknowledge its important endocrine contributions to energy balance. PLWH experience changes in the mass and composition of adipose tissue depots before and after initiating antiretroviral therapy, including regional loss (lipoatrophy), gain (lipohypertrophy), or mixed lipodystrophy. These conditions may coexist with generalized obesity in PLWH and reflect disturbances of energy balance regulation caused by HIV persistence and antiretroviral therapy drugs. Adipocyte hypertrophy characterizes visceral and subcutaneous adipose tissue depot expansion, as well as ectopic lipid deposition that occurs diffusely in the liver, skeletal muscle, and heart. PLWH with excess visceral adipose tissue exhibit adipokine dysregulation coupled with increased insulin resistance, heightening their risk for cardiovascular disease above that of the HIV-negative population. However, conventional therapies are ineffective for the management of cardiometabolic risk in this patient population. Although the knowledge of complex cardiometabolic comorbidities in PLWH continues to expand, significant knowledge gaps remain. Ongoing studies aimed at understanding interorgan communication and energy balance provide insights into metabolic observations in PLWH and reveal potential therapeutic targets. Our review focuses on current knowledge and recent advances in HIV-associated adipose tissue dysfunction, highlights emerging adipokine paradigms, and describes critical mechanistic and clinical insights.
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Affiliation(s)
- Claudia E Ramirez Bustamante
- Division of Diabetes, Endocrinology, and Metabolism, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Neeti Agarwal
- Division of Diabetes, Endocrinology, and Metabolism, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Aaron R Cox
- Division of Diabetes, Endocrinology, and Metabolism, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Sean M Hartig
- Division of Diabetes, Endocrinology, and Metabolism, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Jordan E Lake
- Division of Infectious Diseases, Department of Internal Medicine, McGovern Medical School at UTHealth, Houston, TX 77030, USA
| | - Ashok Balasubramanyam
- Division of Diabetes, Endocrinology, and Metabolism, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
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2
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Lu D, Wang YX, Geng ST, Zhang Z, Xu Y, Peng QY, Li SY, Zhang JB, Wang KH, Kuang YQ. Whole-protein enteral nutrition formula supplementation reduces Escherichia and improves intestinal barrier function in HIV-infected immunological nonresponders. Appl Physiol Nutr Metab 2024; 49:319-329. [PMID: 37922515 DOI: 10.1139/apnm-2022-0450] [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] [Indexed: 11/05/2023]
Abstract
People living with human immunodeficiency virus (PLWH) have persistent malnutrition, intestinal barrier dysfunction, and gut microbial imbalance. The interplay between gut microbiota and nutrients is involved in the immune reconstitution of PLWH. To evaluate the effects of whole-protein enteral nutrition formula supplementation on T-cell levels, intestinal barrier function, nutritional status, and gut microbiota composition in human immunodeficiency virus (HIV)-infected immunological nonresponders (INRs) who failed to normalize CD4+ T-cell counts, with a number <350 cells/µL, a pilot study was carried out in 13 HIV-infected INRs undergoing antiretroviral therapy who received a 3-month phase supplementation of 200 mL/200 kcal/45 g whole-protein enteral nutrition formula once daily. Our primary endpoint was increased CD4+ T-cell counts. Secondary outcome parameters were changes in intestinal barrier function, nutritional status, and gut microbiota composition. We showed that CD4+ T-cell counts of HIV-infected INRs increased significantly after the 3-month supplementation. Dietary supplementation for 3 months improved the intestinal barrier function and nutritional status of HIV-infected INRs. Furthermore, the enteral nutrition formula significantly decreased the relative abundance of Escherichia at the genus level and increased the alpha diversity of gut microbiota in HIV-infected INRs. The findings demonstrated that the whole-protein enteral nutrition formula aids in reducing Escherichia and improving intestinal barrier function in HIV-infected INRs. This study provides insight into the role of nutrients in the improvement of immune reconstitution in HIV-infected INRs. This study is registered in the Chinese Clinical Trial Registry (Document No. ChiCTR2000037839; http://www.chictr.org.cn/index.aspx).
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Affiliation(s)
- Danfeng Lu
- School of Medicine, Kunming University, Kunming, China
- NHC Key Laboratory of Drug Addiction Medicine and Research Center for Clinical Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, China
| | - Yue-Xin Wang
- NHC Key Laboratory of Drug Addiction Medicine and Research Center for Clinical Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, China
- Department of Gastrointestinal and Hernia Surgery, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Shi-Tao Geng
- NHC Key Laboratory of Drug Addiction Medicine and Research Center for Clinical Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, China
| | - Zunyue Zhang
- NHC Key Laboratory of Drug Addiction Medicine and Research Center for Clinical Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, China
- Yunnan Technological Innovation Centre of Drug Addiction Medicine, Yunnan University, Kunming, China
| | - Yu Xu
- NHC Key Laboratory of Drug Addiction Medicine and Research Center for Clinical Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, China
- Department of Gastrointestinal and Hernia Surgery, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Qing-Yan Peng
- NHC Key Laboratory of Drug Addiction Medicine and Research Center for Clinical Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, China
| | - Shao-You Li
- NHC Key Laboratory of Drug Addiction Medicine and Research Center for Clinical Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, China
| | - Jian-Bo Zhang
- Department of Dermatology, Second People's Hospital of Dali City, Dali, China
| | - Kun-Hua Wang
- Yunnan Technological Innovation Centre of Drug Addiction Medicine, Yunnan University, Kunming, China
| | - Yi-Qun Kuang
- NHC Key Laboratory of Drug Addiction Medicine and Research Center for Clinical Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, China
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3
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Bandara T, Martcheva M, Ngonghala CN. Mathematical model on HIV and nutrition. JOURNAL OF BIOLOGICAL DYNAMICS 2023; 17:2287087. [PMID: 38015715 DOI: 10.1080/17513758.2023.2287087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 11/17/2023] [Indexed: 11/30/2023]
Abstract
HIV continues to be a major global health issue, having claimed millions of lives in the last few decades. While several empirical studies support the fact that proper nutrition is useful in the fight against HIV, very few studies have focused on developing and using mathematical modelling approaches to assess the association between HIV, human immune response to the disease, and nutrition. We develop a within-host model for HIV that captures the dynamic interactions between HIV, the immune system and nutrition. We find that increased viral activity leads to increased serum protein levels. We also show that the viral production rate is positively correlated with HIV viral loads, as is the enhancement rate of protein by virus. Although our numerical simulations indicate a direct correlation between dietary protein intake and serum protein levels in HIV-infected individuals, further modelling and clinical studies are necessary to gain comprehensive understanding of the relationship.
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Affiliation(s)
- Tharusha Bandara
- Department of Mathematics, University of Florida, Gainesville, FL, USA
| | - Maia Martcheva
- Department of Mathematics, University of Florida, Gainesville, FL, USA
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4
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Bahji A, Gordon KS, Crystal S, Satre DD, Wiliams EC, Edelman EJ, Justice AC. Factors Associated with Bothersome Symptoms in Individuals With and Without HIV Who Report Alcohol Use. AIDS Behav 2023; 27:2455-2462. [PMID: 36622487 PMCID: PMC10225332 DOI: 10.1007/s10461-022-03972-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2022] [Indexed: 01/10/2023]
Abstract
Bothersome symptoms potentially related to drinking are commonly reported by people with and without HIV (PWH/PWoH). However, the relationship between bothersome symptoms and level of alcohol use is often not appreciated by patients or providers. Therefore, among persons reporting prior-year alcohol use, we assessed whether alcohol use level (AUDIT-C score), HIV status, and demographic covariates influenced the likelihood of the patient reporting a bothersome symptom. We used the Veterans Aging Cohort Study (VACS) surveys (2002-2018), including a validated symptoms index. Among 3679 PWH and 3830 PWoH currently drinking alcohol, the most commonly reported symptoms were muscle/joint pain (52%), sleep disturbance (51%), and fatigue (50%). Level of alcohol use was independently associated with 18 of 20 bothersome symptoms, including seven symptoms more common among PWH. Results can help inform PWH/PWoH who drink alcohol about the strong relationship between level of alcohol use and bothersome symptoms, potentially motivating reduced use.
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Affiliation(s)
- Anees Bahji
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Research in Addiction Medicine Scholars Program, Boston University Medical Centre, Boston, MA, USA
| | - Kirsha S Gordon
- VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Stephen Crystal
- Center for Health Services Research, Rutgers University, New Brunswick, NJ, USA
| | - Derek D Satre
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Emily C Wiliams
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
| | - E Jennifer Edelman
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA.
- Yale School of Medicine, 367 Cedar Street, ESH A, suite 401, New Haven, CT, 06510, USA.
| | - Amy C Justice
- VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Yale School of Public Health, New Haven, CT, USA
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5
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Littlefield KM, Schneider JM, Neff CP, Soesanto V, Siebert JC, Nusbacher NM, Moreno-Huizar N, Cartwright IM, Armstrong AJS, Colgen SP, Lozupone CA, Palmer BE. Elevated inflammatory fecal immune factors in men who have sex with men with HIV associate with microbiome composition and gut barrier function. Front Immunol 2022; 13:1072720. [PMID: 36605218 PMCID: PMC9808389 DOI: 10.3389/fimmu.2022.1072720] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction People living with HIV infection (PLWH) exhibit elevated levels of gastrointestinal inflammation. Potential causes of this inflammation include HIV infection and associated immune dysfunction, sexual behaviors among men who have sex with men (MSM) and gut microbiome composition. Methods To better understand the etiology of gastrointestinal inflammation we examined levels of 28 fecal soluble immune factors (sIFs) and the fecal microbiome in well-defined cohorts of HIV seronegative MSM (MSM-SN), MSM with untreated HIV infection (MSM-HIV) and MSM with HIV on anti-retroviral treatment (MSMART). Additionally, fecal solutes from these participants were used to stimulate T-84 colonic epithelial cells to assess barrier function. Results Both MSM cohorts with HIV had elevated levels of fecal calprotectin, a clinically relevant marker of GI inflammation, and nine inflammatory fecal sIFs (GM-CSF, ICAM-1, IL-1β, IL-12/23, IL-15, IL-16, TNF-β, VCAM-1, and VEGF). Interestingly, four sIFs (GM-CSF, ICAM-1, IL-7 and IL-12/23) were significantly elevated in MSM-SN compared to seronegative male non-MSM. Conversely, IL-22 and IL-13, cytokines beneficial to gut health, were decreased in all MSM with HIV and MSM-SN respectively. Importantly, all of these sIFs significantly correlated with calprotectin, suggesting they play a role in GI inflammation. Principal coordinate analysis revealed clustering of fecal sIFs by MSM status and significant associations with microbiome composition. Additionally, fecal solutes from participants in the MSM-HIV cohort significantly decreased colonic transcellular fluid transport in vitro, compared to non-MSM-SN, and this decrease associated with overall sIF composition and increased concentrations of eight inflammatory sIFs in participants with HIV. Lastly, elevated levels of plasma, sCD14 and sCD163, directly correlated with decreased transcellular transport and microbiome composition respectively, indicating that sIFs and the gut microbiome are associated with, and potentially contribute to, bacterial translocation. Conclusion Taken together, these data demonstrate that inflammatory sIFs are elevated in MSM, regardless of HIV infection status, and are associated with the gut microbiome and intestinal barrier function.
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Affiliation(s)
| | | | - Charles P. Neff
- Department of Medicine, University of Colorado, Aurora, CO, United States
| | - Victoria Soesanto
- Department of Medicine, University of Colorado, Aurora, CO, United States
| | - Janet C. Siebert
- Department of Medicine, University of Colorado, Aurora, CO, United States
- CytoAnalytics, Denver, CO, United States
| | - Nichole M. Nusbacher
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Nancy Moreno-Huizar
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Ian M. Cartwright
- Department of Medicine, University of Colorado, Aurora, CO, United States
| | - Abigail J. S. Armstrong
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Sean P. Colgen
- Department of Medicine, University of Colorado, Aurora, CO, United States
| | - Catherine A. Lozupone
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Brent E. Palmer
- Department of Medicine, University of Colorado, Aurora, CO, United States
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Panza E, Lillis J, Olson K, van den Berg JJ, Tashima K, Wing RR. HIV Status, Obesity, and Risk for Weight Stigma: Comparing Weight Stigma Experiences and Internalization Among Adults with Obesity with and Without HIV. AIDS Behav 2022; 26:686-697. [PMID: 34396464 PMCID: PMC8840952 DOI: 10.1007/s10461-021-03428-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2021] [Indexed: 10/20/2022]
Abstract
Little is known about weight stigma among people living with HIV (PLWH). This study examined whether levels of perceived weight stigma experiences and internalization, assessed retrospectively and naturalistically, differed among adults with obesity based on HIV status. 50 PLWH (BMI = 35 kg/m2) and 51 adults without HIV (BMI = 36 kg/m2) completed retrospective assessments of lifetime perceived weight stigma experiences/internalization. Next, participants were invited to complete an optional 2-week Ecological Momentary Assessment study. 28 PLWH and 39 adults without HIV completed five momentary assessments of perceived weight stigma experiences/internalization daily. In covariate-adjusted models, PLWH reported 1.2-2.8 times lower frequency of lifetime and momentary perceived weight stigma experiences than adults without HIV, but levels of retrospectively- and naturalistically-assessed internalized weight stigma did not differ between groups. Findings suggest that HIV status may buffer against perceptions of weight stigma events, but not internalized weight stigma, highlighting weight stigma as an important area for future research in PLWH.
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Affiliation(s)
- Emily Panza
- Weight Control and Diabetes Research Center, The Miriam Hospital, 196 Richmond Street, Providence, RI, 02903, USA.
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA.
| | - Jason Lillis
- Weight Control and Diabetes Research Center, The Miriam Hospital, 196 Richmond Street, Providence, RI, 02903, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - KayLoni Olson
- Weight Control and Diabetes Research Center, The Miriam Hospital, 196 Richmond Street, Providence, RI, 02903, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Jacob J van den Berg
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- The Providence/Boston Center for AIDS Research (CFAR), Providence, RI, USA
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Karen Tashima
- The Providence/Boston Center for AIDS Research (CFAR), Providence, RI, USA
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
- The Miriam Hospital Immunology Center, The Miriam Hospital, Providence, RI, USA
| | - Rena R Wing
- Weight Control and Diabetes Research Center, The Miriam Hospital, 196 Richmond Street, Providence, RI, 02903, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
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7
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Geng ST, Zhang JB, Wang YX, Xu Y, Lu D, Zhang Z, Gao J, Wang KH, Kuang YQ. Pre-Digested Protein Enteral Nutritional Supplementation Enhances Recovery of CD4 + T Cells and Repair of Intestinal Barrier in HIV-Infected Immunological Non-Responders. Front Immunol 2022; 12:757935. [PMID: 35003070 PMCID: PMC8741150 DOI: 10.3389/fimmu.2021.757935] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 12/13/2021] [Indexed: 12/12/2022] Open
Abstract
AIDS patients with immune non-response are prone to malnutrition, intestinal barrier damage, thus aggravating chronic immune activation and inflammation. However, nutritional interventions targeting malnutrition may be beneficial to restore immune function, improve clinical outcomes, and reduce mortality remains largely unclear. This work aimed to evaluate the efficacy of a nutritional supplement in HIV-infected immune non-responders (INRs). The subjects received oral supplementation of a pre-digested protein nutrition formula for three months. We show that the CD4+ T and CD8+ T cell counts were significantly increased after supplementation of the pre-digested enteral nutritional supplement. Among all pro-inflammatory cytokines in the serum, only IL-1β level was significantly decreased, while TNF-β was significantly increased (P < 0.05). The levels of intestinal mucosal damage markers, diamine oxidase (DAO), D-lactic acid (D-lactate), and lipopolysaccharide (LPS), decreased significantly (P < 0.05) after the nutritional intervention. Moreover, at month 3 after the intervention, the body weight, body mass index, albumin, and hemoglobin of all subjects were significantly increased (P < 0.05). The correlation analysis demonstrated a significantly negative correlation of CD4+ T cell count with levels of DAO (r = -0.343, P = 0.004), D-lactate (r = -0.250, P = 0.037), respectively, and a significantly positive correlation of IL-1β level with levels of DAO (r = 0.445, P < 0.001), D-lactate (r = 0.523, P < 0.001), and LPS (r = 0.622, P < 0.001). We conclude that the pre-digested enteral nutrition supplement is effective for HIV-infected INRs.
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Affiliation(s)
- Shi-Tao Geng
- National Health Commission (NHC) Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, China.,Scientific Research Laboratory Center, First Affiliated Hospital of Kunming Medical University, Kunming, China.,Department of Gastrointestinal and Hernia Surgery, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jian-Bo Zhang
- Department of Dermatology, Second People's Hospital of Dali City, Dali, China
| | - Yue-Xin Wang
- National Health Commission (NHC) Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, China.,Scientific Research Laboratory Center, First Affiliated Hospital of Kunming Medical University, Kunming, China.,Department of Gastrointestinal and Hernia Surgery, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yu Xu
- National Health Commission (NHC) Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, China.,Scientific Research Laboratory Center, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Danfeng Lu
- National Health Commission (NHC) Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, China.,Scientific Research Laboratory Center, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zunyue Zhang
- National Health Commission (NHC) Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, China.,Scientific Research Laboratory Center, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Ju Gao
- Department of Dermatology, Second People's Hospital of Dali City, Dali, China
| | - Kun-Hua Wang
- National Health Commission (NHC) Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, China.,Department of Gastrointestinal and Hernia Surgery, First Affiliated Hospital of Kunming Medical University, Kunming, China.,School of Medicine, Yunnan University, Kunming, China
| | - Yi-Qun Kuang
- National Health Commission (NHC) Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, China.,Scientific Research Laboratory Center, First Affiliated Hospital of Kunming Medical University, Kunming, China
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8
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Chang HH. Weight Gain and Metabolic Syndrome in Human Immunodeficiency Virus Patients. Infect Chemother 2022; 54:220-235. [PMID: 35706080 PMCID: PMC9259920 DOI: 10.3947/ic.2022.0061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 05/16/2022] [Indexed: 12/31/2022] Open
Abstract
While human immunodeficiency virus (HIV)-associated wasting has declined with significant advances in antiretroviral therapy (ART), weight gain and metabolic syndrome (MetS) are now becoming a problem for people living with HIV (PLWH) worldwide. The development of a new and more effective ART regimen has increased viral suppression and improved immunologic function recovery, leading to the extension of the lifespan of PLWH. It has recently been reported as one of the significant factors associated with weight gain, obesity, and long-term metabolic consequences in PLWH. This article reviewed the epidemiology of overweight and MetS among PLWH and the known risk factors for weight gain and its major comorbidities, such as dyslipidemia, diabetes mellitus, cardiovascular diseases, neurocognitive disorders, and liver diseases, in PLWH. In addition, reports on the pharmacological and surgical management of overweight and obesity in PLWH has been briefly summarized.
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Affiliation(s)
- Hyun-Ha Chang
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
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9
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Abstract
Early in the HIV epidemic, lipodystrophy, characterized by subcutaneous fat loss (lipoatrophy), with or without central fat accumulation (lipohypertrophy), was recognized as a frequent condition among people living with HIV (PLWH) receiving combination antiretroviral therapy. The subsequent identification of thymidine analogue nucleoside reverse transcriptase inhibitors as the cause of lipoatrophy led to the development of newer antiretroviral agents; however, studies have demonstrated continued abnormalities in fat and/or lipid storage in PLWH treated with newer drugs (including integrase inhibitor-based regimens), with fat gain due to restoration to health in antiretroviral therapy-naive PLWH, which is compounded by the rising rates of obesity. The mechanisms of fat alterations in PLWH are complex, multifactorial and not fully understood, although they are known to result in part from the direct effects of HIV proteins and antiretroviral agents on adipocyte health, genetic factors, increased microbial translocation, changes in the adaptive immune milieu after infection, increased tissue inflammation and accelerated fibrosis. Management includes classical lifestyle alterations with a role for pharmacological therapies and surgery in some patients. Continued fat alterations in PLWH will have an important effect on lifespan, healthspan and quality of life as patients age worldwide, highlighting the need to investigate the critical uncertainties regarding pathophysiology, risk factors and management.
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10
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Emerole K, Kozhevnikova G, Isakov V, Voznesenskiy S, Konnov V, Pilipenko V, Golub V, Polovinkina N, Barysheva I, Kharlamova T, Konnov D. Clinical Assessment of Nutritional and Metabolic Status in HIV Outpatients. Open AIDS J 2020. [DOI: 10.2174/1874613602014010011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
After the World Health Organization’s first technical consultation on Nutrient Requirements for People Living with HIV/AIDS in Geneva, 2003, a lot of research questions that are considered crucial for enhancing our understanding of the interaction of nutrition and HIV infection were raised and until this moment, left unanswered. To gain a better understanding of HIV and nutrition, we implemented a comprehensive approach. The aim of our study was to assess the nutritional and metabolic status in order to enhance the provision of medical care to people living with HIV.
Methods:
45 HIV patients and 32 healthy volunteers were enrolled in the study. Within the HIV group, 32 (71%) were male and 13 (29%) female. Only 7 (15%) were ART naïve. Overall their median age, CD4 count and viral load were 30 years (IQR: 28-40), 407 (IQR: 357-490) cells/mm3 and 500 (IQR: 0-1000) copies/ml, respectively. None of the participants in the HIV group had any active infection. Food intake by monthly dietary recall was determined. Body composition was measured using bioelectrical impedance analysis. The selected biochemical parameters were evaluated and the resting metabolic rates were calculated using indirect calorimetry to accurately understand the metabolism of participants.
Results:
Participants in the HIV group did not meet the recommended daily allowance level (RDA) of carbohydrate requirements. The fat-free mass significantly decreased in the HIV group (P < 0.05). Resting energy expenditure was excessive in the HIV group compared to the control group (P < 0.05). Values of urea nitrogen concentration, fat and protein oxidation rates in the HIV group significantly increased (P < 0.01). The carbohydrate oxidation in the HIV group significantly decreased (P < 0.01)
Conclusions:
The study reveals a catabolic status in the HIV group and suggests an adjustment in the nutrient RDA to compensate such status. Further investigation should be extended to vulnerable population group particularly children.
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11
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Bottà G, Binelli G, Agostoni C, Aliverti A, Scarì G, Manenti R, La Vecchia C. Evaluating human basal metabolism: the erroneous and misleading use of so-called "prediction equations". Int J Food Sci Nutr 2019; 71:249-255. [PMID: 31313603 DOI: 10.1080/09637486.2019.1641472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Prediction (regression) equations are widely used, but their reliability as predictive tools is questionable as they provide contradicting results. The key point is that values calculated by regression equations are not precisely defined numbers but lie within a range of possible values in the standard deviation interval, none of which can be considered as the most probable. Ignoring this point leads to illicit/improper calculations, generating wrong results, which may have adverse consequences for human health. To demonstrate this, we applied the equations of Harris and Benedict in a reverse method, i.e. calculating (predicting) the daily energy expenditure in the same subjects used to obtain the equations and comparing values with the original measured data. We used the Bland-Altman and frequency distribution analyses. We found large differences in both individual data and population characteristics, showing that prediction equations are not predictive tools.
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Affiliation(s)
- G Bottà
- Department of Biosciences, University of Milan, Milano, Italy
| | - G Binelli
- Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - C Agostoni
- Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Pediatria Media Intensità di Cura, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy
| | - A Aliverti
- Department of Biosciences, University of Milan, Milano, Italy
| | - G Scarì
- Department of Biosciences, University of Milan, Milano, Italy
| | - R Manenti
- Department of Political and Environmental Sciences, University of Milan, Milano, Italy
| | - C La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy
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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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Huang YM, Hong XZ, Xu JH, Luo JX, Mo HY, Zhao HL. Autoimmunity and dysmetabolism of human acquired immunodeficiency syndrome. Immunol Res 2017; 64:641-52. [PMID: 26676359 DOI: 10.1007/s12026-015-8767-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Acquired immunodeficiency syndrome (AIDS) remains ill-defined by lists of symptoms, infections, tumors, and disorders in metabolism and immunity. Low CD4 cell count, severe loss of body weight, pneumocystis pneumonia, and Kaposi's sarcoma are the major disease indicators. Lines of evidence indicate that patients living with AIDS have both immunodeficiency and autoimmunity. Immunodeficiency is attributed to deficits in the skin- and mucosa-defined innate immunity, CD4 T cells and regulatory T cells, presumably relating human immunodeficiency virus (HIV) infection. The autoimmunity in AIDS is evident by: (1) overproduction of autoantibodies, (2) impaired response of CD4 cells and CD8 cells, (3) failure of clinical trials of HIV vaccines, and (4) therapeutic benefits of immunosuppression following solid organ transplantation and bone marrow transplantation in patients at risk of AIDS. Autoantibodies are generated in response to antigens such as debris and molecules de novo released from dead cells, infectious agents, and catabolic events. Disturbances in metabolic homeostasis occur at the interface of immunodeficiency and autoimmunity in the development of AIDS. Optimal treatments favor therapeutics targeting on the regulation of metabolism to restore immune homeostasis.
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Affiliation(s)
- Yan-Mei Huang
- Department of Immunology, Center for Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, 541004, China
| | - Xue-Zhi Hong
- Department of Immunology, Center for Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, 541004, China. .,Department of Rheumatology and Immunology, The Affiliated Hospital of the Guilin Medical University, Guilin, 541004, China.
| | - Jia-Hua Xu
- Fangchenggang Hospital of Traditional Chinese Medicine, Fangchenggang, 538021, Guangxi, China
| | - Jiang-Xi Luo
- Department of Immunology, Center for Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, 541004, China
| | - Han-You Mo
- Department of Rheumatology and Immunology, The Affiliated Hospital of the Guilin Medical University, Guilin, 541004, China
| | - Hai-Lu Zhao
- Department of Immunology, Center for Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, 541004, China.,Department of Immunology, Faculty of Basic Medicine, Guilin Medical University, Guilin, 541004, China
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Butorov EV. Influence of L-lysine amino acid on the HIV-1 RNA replication in vitro. Antivir Chem Chemother 2016; 24:39-46. [PMID: 26149265 DOI: 10.1177/2040206614566582] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Virus replication strongly depends on host metabolic machinery and essential cellular factors, in particular, on amino acid profiles. Amino acids play an important role in the pathogenesis of all virus-related infections both as basic substrates for protein synthesis and as regulators in many metabolic pathways, including gene expression. The inhibitory effects of deficiency or excess of these essential elements on virus replication are widely appreciated. Although the same interrelationship between host cellular factors and HIV have been recognized for a long time, the effects of amino acids on HIV-1 RNA replication dynamic is not yet well documented. Our aim was to determine in this pilot study the direct effect of L-lysine amino acid on HIV-1 RNA replication in vitro in HIV-infected patients. METHODS A total of 100 HIV-1-infected males without highly active antiretroviral therapy (HAART) were monitored in our center. The patients were in stage A of the disease according to the 1993 Centers for Disease Control (CDC) classification system for HIV-infection. Patients with HIV were enrolled in one stage (A) of the disease with the average amount CD4 lymphocytes in the range of 200-300 cells/µL at the time of sample acquisition. For evaluation of the effects of essential L-lysine amino acid on HIV-1 RNA replication level, we used a model of amino acid-excess system in vitro following incubation of plasma samples for 24 h at 25 °C. Quantitative HIV-1 RNA assay was performed using (RT-PCR) reverse-transcriptase polymerase chain reaction (Rotor-Gene Q, QIAGEN, Germany). RESULTS The mean HIV-1 RNA levels were significantly higher in the enriched peripheral blood mononuclear cells plasma samples HIV-infected subjects after 24 h incubation at 25 °C temperature than in the plasma samples the same patients studied on the date of blood tests (p < 0.0001). The number of HIV-1 RNA copies increased in 1.5 times. We observed that in plasma of the same HIV-infected patients after adding L-lysine and following incubation in vitro, viral load increased significantly in comparison with standard samples (p < 0.0001). The increased viral load was found in 100/92 (92%) of HIV-infected subjects. The average number of HIV-1 RNA copies in samples had increased by 4.0 times. However, we found no difference in HIV-1 RNA levels after replacement of L-lysine for L-arginine in comparison samples in the same HIV-infected patients. It is obvious that the addition of L-arginine does not increase viral replication in vitro as L-lysine amino acid supplement does. Additionally, no increase in viral load was determined after adding L-lysine and non toxic doses of its inhibitor (L-lysine alpha-oxidase) in plasma samples. CONCLUSIONS The results show that L-lysine amino acid excess is characterized by significant increased of HIV-1 RNA copies in enriched peripheral blood mononuclear cells plasma samples of HIV-infected patients. There was evidence for an association between L-lysine supplementation and HIV-1 RNA replication and the level changes of this host essential nutritional element play a key role in the synthesis of the virus proteins and in transcription initiation of the retrovirus life cycle. High intake of L-lysine amino acid may increase the risk of high viral load, subsequent acceleration of immunosuppression and HIV progression. Overall results demonstrate that the simple L-lysine-related model in vitro can be widely used for practical purposes to evaluate HIV-1 RNA replication dynamic, disease prognosis and new approaches in treatment of the patients with human immunodeficiency virus. Although the impact mechanism of L-lysine amino acid on the viral load in the pathogenesis of HIV-infection is at present conjectural and requires further development, the results highlight an interesting target in antiviral therapy, and this statement remains to be proved in further research and clinical trials.
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Arbeitman LE, O’Brien RC, Somarriba G, Messiah SE, Neri D, Scott GB, Miller TL. Body mass index and waist circumference of HIV-infected youth in a Miami cohort: comparison to local and national cohorts. J Pediatr Gastroenterol Nutr 2014; 59:449-54. [PMID: 24709829 PMCID: PMC4524541 DOI: 10.1097/mpg.0000000000000394] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Human immunodeficiency virus (HIV)-infected youth are healthier because of effective antiretroviral therapies. We compared anthropometric measurements and prevalence of overweight and obesity between perinatally HIV-infected youth, a local HIV-uninfected comparison group, and 2007 to 2010 National Health and Nutrition Examination Survey (NHANES) data. In addition, we compared only African American HIV-infected youth with NHANES African Americans. METHODS Height, weight, body mass index (BMI), and waist circumference (WC) of HIV-infected youth, aged 10 to 19 years, were compared among groups. BMI percentiles were categorized as underweight (<5%), normal (5% to <85%), overweight (85% to <95%), and obese (≥ 95%). Clinical correlates were modeled as predictors of BMI and WC. RESULTS A total of 134 HIV-infected (including 103 African Americans) (mean age 16.5 years), 75 HIV-uninfected (mean age 14.2 years), and 3216 NHANES (including 771 NHANES African Americans) (mean age 15.0 years) youth were included in the analysis. Height and weight z scores of HIV-infected youth were lower than those of HIV-uninfected and NHANES (P ≤ 0.056) youth. BMI, WC, and BMI category were not statistically different between groups. In the HIV-infected African American group, BMI z score was lower (0.49 vs 0.76, P = 0.04) compared with NHANES African Americans. There were no significant predictors of BMI or WC for the HIV-infected group. CONCLUSIONS HIV-infected children have similar BMIs and WCs as uninfected children both locally and nationally and show similar high rates of obesity and overweight. When compared with a more racially similar African American national sample, HIV-infected children have a lower BMI, suggesting that there may be persistent anthropometric differences in HIV.
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Affiliation(s)
- Lori E. Arbeitman
- Division of Pediatric Clinical Research, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, United States
- Holtz Children’s Hospital/Jackson Memorial Hospital, Miami, FL, United States
| | - Robert C. O’Brien
- Division of Pediatric Clinical Research, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Gabriel Somarriba
- Division of Pediatric Clinical Research, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Sarah E. Messiah
- Division of Pediatric Clinical Research, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Daniela Neri
- Division of Pediatric Clinical Research, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, United States
- Infectious Disease, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Gwendolyn B. Scott
- Infectious Disease, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Tracie L. Miller
- Division of Pediatric Clinical Research, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, United States
- Holtz Children’s Hospital/Jackson Memorial Hospital, Miami, FL, United States
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Chetty T, Carter RJ, Bland RM, Newell ML. HIV status, breastfeeding modality at 5 months and postpartum maternal weight changes over 24 months in rural South Africa. Trop Med Int Health 2014; 19:852-62. [PMID: 24720779 PMCID: PMC4251550 DOI: 10.1111/tmi.12320] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine the effect of infant feeding practices on postpartum weight change among HIV-infected and -uninfected women in South Africa. METHODS In a non-randomised intervention cohort study of antiretroviral therapy-naïve women in South Africa, infants were classified as exclusive (EBF), mixed (MF) or non-breastfed (NBF) at each visit. We analysed infant feeding cumulatively from birth to 5 months using 24-hour feeding history (collected weekly for each of the preceding 7 days). Using generalised estimating equation mixed models, allowing for repeated measures, we compared postpartum weight change (kg) from the first maternal postpartum weight within the first 6 weeks (baseline weight) to each subsequent visit through 24 months among 2340 HIV-infected and -uninfected women with live births and at least two postpartum weight measurements. RESULTS HIV-infected (-0.2 kg CI: -1.7 to 1.3 kg; P = 0.81) and -uninfected women (-0.5 kg; 95% CI: -2.1 to 1.2 kg; P = 0.58) had marginal non-significant weight loss from baseline to 24 months postpartum. Adjusting for HIV status, socio-demographic, pregnancy-related and infant factors, 5-month feeding modality was not significantly associated with postpartum weight change: weight change by 24 months postpartum, compared to the change in the reference EBF group, was 0.03 kg in NBF (95% CI: -2.5 to +2.5 kg; P = 0.90) and 0.1 kg in MF (95% CI: -3.0 to +3.2 kg; P = 0.78). CONCLUSION HIV-infected and -uninfected women experienced similar weight loss over 24 months. Weight change postpartum was not associated with 5-month breastfeeding modality among HIV-infected and -uninfected women.
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Affiliation(s)
- Terusha Chetty
- Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa
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Ramlal RT, Tembo M, Soko A, Chigwenembe M, Tohill BC, Kayira D, King CC, Chasela C, Jamieson D, van der Horst C, Bentley ME, Adair LS. Patterns of body composition among HIV-infected, pregnant Malawians and the effects of famine season. Matern Child Health J 2013; 17:265-73. [PMID: 22395817 DOI: 10.1007/s10995-012-0970-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We describe change in weight, midupper arm circumference (MUAC), arm muscle area (AMA) and arm fat area (AFA) in 1130 pregnant HIV-infected women with CD4 counts > 200 as part of the BAN Study ( www.thebanstudy.org ), a randomized, controlled clinical trial to evaluate antiretroviral and nutrition interventions to reduce mother-to-child transmission of HIV during breast feeding. In a longitudinal analysis, we found a linear increase in weight with a mean rate of weight gain of 0.27 kgs/week, from baseline (12 to 30 weeks gestation) until the last follow-up visit (32-38 weeks). Analysis of weight gain showed that 17.1% of the intervals between visits resulted in a weight loss. In unadjusted models, MUAC and AMA increased and AFA declined during late pregnancy. Based on multivariable regression analysis, exposure to the famine season resulted in larger losses in AMA [-0.08, 95% CI -0.14, -0.02; p = 0.01] while AFA losses occurred irrespective of season [-0.55, 95%: -0.95, -0.14, p = 0.01]. CD4 was associated with AFA [0.21, 95% CI 0.01, 0.41, p = .04]. Age was positively associated with MUAC and AMA. Wealth was positively associated with MUAC, AFA, and weight. While patterns of anthropometric measures among HIV-infected, pregnant women were found to be similar to those reported for uninfected women in sub-Saharan Africa, effects of the famine season among undernourished, Malawian women are of concern. Strategies to optimize nutrition during pregnancy for these women appear warranted.
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Zulu RM, Byrne NM, Munthali GK, Chipeta J, Handema R, Musonda M, Hills AP. Assessing the impact of a food supplement on the nutritional status and body composition of HIV-infected Zambian women on ARVs. BMC Public Health 2011; 11:714. [PMID: 21936938 PMCID: PMC3188494 DOI: 10.1186/1471-2458-11-714] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Accepted: 09/21/2011] [Indexed: 11/24/2022] Open
Abstract
Background Zambia is a sub-Saharan country with one of the highest prevalence rates of HIV, currently estimated at 14%. Poor nutritional status due to both protein-energy and micronutrient malnutrition has worsened this situation. In an attempt to address this combined problem, the government has instigated a number of strategies, including the provision of antiretroviral (ARV) treatment coupled with the promotion of good nutrition. High-energy protein supplement (HEPS) is particularly promoted; however, the impact of this food supplement on the nutritional status of people living with HIV/AIDS (PLHA) beyond weight gain has not been assessed. Techniques for the assessment of nutritional status utilising objective measures of body composition are not commonly available in Zambia. The aim of this study is therefore to assess the impact of a food supplement on nutritional status using a comprehensive anthropometric protocol including measures of skinfold thickness and circumferences, plus the criterion deuterium dilution technique to assess total body water (TBW) and derive fat-free mass (FFM) and fat mass (FM). Methods/Design This community-based controlled and longitudinal study aims to recruit 200 HIV-infected females commencing ARV treatment at two clinics in Lusaka, Zambia. Data will be collected at four time points: baseline, 4-month, 8-month and 12-month follow-up visits. Outcome measures to be assessed include body height and weight, body mass index (BMI), body composition, CD4, viral load and micronutrient status. Discussion This protocol describes a study that will provide a longitudinal assessment of the impact of a food supplement on the nutritional status of HIV-infected females initiating ARVs using a range of anthropometric and body composition assessment techniques. Trial Registration Pan African Clinical Trial Registry PACTR201108000303396.
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Affiliation(s)
- Rodah M Zulu
- Mater Mother's Hospital, Mater Medical Research Institute, Raymond Terrace, South Brisbane, QLD, Australia
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de Pee S, Semba RD. Role of Nutrition in HIV Infection: Review of Evidence for more Effective Programming in Resource-Limited Settings. Food Nutr Bull 2010. [DOI: 10.1177/15648265100314s403] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background HIV infection and malnutrition negatively reinforce each other. Objective For program guidance, to review evidence on the relationship of HIV infection and malnutrition in adults in resource-limited settings. Results and conclusions Adequate nutritional status supports immunity and physical performance. Weight loss, caused by low dietary intake (loss of appetite, mouth ulcers, food insecurity), malabsorption, and altered metabolism, is common in HIV infection. Regaining weight, particularly muscle mass, requires antiretroviral therapy (ART), treatment of opportunistic infections, consumption of a balanced diet, physical activity, mitigation of side effects, and perhaps appetite stimulants and growth hormone. Correcting nutritional status becomes more difficult as infection progresses. Studies document widespread micronutrient deficiencies among HIV-infected people. However, supplement composition, patient characteristics, and treatments vary widely across intervention studies. Therefore, the World Health Organization (WHO) recommends ensuring intake of 1 Recommended Nutrient Intake (RNI) of each required micronutrient, which may require taking micronutrient supplements. Few studies have assessed the impact of food supplements. Because the mortality risk in patients receiving ART increases with lower body mass index (BMI), improving the BMI seems important. Whether this requires provision of food supplements depends on the patient's diet and food security. It appears that starting ART improves BMI and that ready-to-use fortified spreads and fortified-blended foods further increase BMI (the effect is somewhat less with fortified-blended foods). The studies are too small to assess effects on mortality. Once ART has been established and malnutrition treated, the nutritional quality of the diet remains important, also because of ART's long-term metabolic effects (dyslipidemia, insulin resistance, obesity). Food insecurity should also be addressed if it prevents adequate energy intake and reduces treatment initiation and adherence (due to the opportunity costs of obtaining treatment and mitigating side effects).
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Range NS, Malenganisho W, Temu MM, Changalucha J, Magnussen P, Krarup H, Andersen AB, Friis H. Body composition of HIV-positive patients with pulmonary tuberculosis: a cross-sectional study in Mwanza, Tanzania. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2010; 104:81-90. [PMID: 20149295 DOI: 10.1179/136485910x12607012373830] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
To estimate the weight deficit and body composition of cases of pulmonary TB (PTB), and assess the roles of HIV and the acute-phase response, a cross-sectional study was carried out in Tanzania. Weight, body mass index (BMI), arm muscle area (AMA), arm fat area (AFA) and the serum concentration of the acute-phase protein alpha(1)-antichymotrypsin (serum ACT) were evaluated for each of 532 cases of PTB and 150 'non-TB' controls. On average, the female cases of PTB not only weighed 7.8 kg less but also had BMI that were 3.1-kg/m(2) lower, AMA that were 14.8-cm(2) lower, and AFA that were 7.6-cm(2) lower than those seen in the female subjects without TB. Similarly, on average, the male cases of PTB weighed 7.1 kg less and had BMI that were 2.5-kg/m(2) lower, AMA that were 18.8-cm(2) lower and AFA that were 1.6-cm(2) lower than those seen in the male subjects without TB. Although HIV infection was associated with a 1.7-kg lower weight and a 0.6-kg/m(2) lower BMI (with deficits in both AMA and AFA) among males, it was not associated with any such deficits among the female subjects. Elevated serum ACT was found to be a negative predictor of BMI, AMA and AFA, partially explaining the effects of the PTB but not those of the HIV. There is need for a better understanding of the determinants and effects of loss of fat and lean body mass in HIV-positive tuberculosis.
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Affiliation(s)
- N S Range
- National Institute for Medical Research, Muhimbili Medical Research Centre, P.O. Box 3436, Dar es Salaam, Tanzania
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Diouf A, Gartner A, Dossou NI, Sanon DA, Bluck L, Wright A, Wade S. Validity of impedance-based predictions of total body water as measured by 2H dilution in African HIV/AIDS outpatients. Br J Nutr 2009; 101:1369-77. [PMID: 18845025 PMCID: PMC2740955 DOI: 10.1017/s0007114508067640] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Measurements of body composition are crucial in identifying HIV-infected patients at risk of malnutrition. No information is available on the validity of indirect body composition methods in African HIV-infected outpatients. Our first aim was to test the validity of fifteen published equations, developed in whites, African-Americans and/or Africans who were or not HIV-infected, for predicting total body water (TBW) from bioelectrical impedance analysis (BIA) in HIV-infected patients. The second aim was to develop specific predictive equations. Thirty-four HIV-infected patients without antiretroviral treatment and oedema at the beginning of the study (age 39 (SD 7) years, BMI 18.7 (SD3.7) kg/m2, TBW 30.4 (SD7.2) kg) were measured at inclusion then 3 and 6 months later. In the resulting eighty-eight measurements, we compared TBW values predicted from BIA to those measured by 2H dilution. Range of bias values was 0.1-4.3 kg, and errors showed acceptable values (2.2-3.4 kg) for fourteen equations and a high value (10.4) for one equation. Two equations developed in non-HIV-infected subjects showed non-significant bias and could be used in African HIV-infected patients. In the other cases, poor agreement indicated a lack of validity. Specific equations developed from our sample showed a higher precision of TBW prediction when using resistance at 1000 kHz (1.7 kg) than at 50 kHz (2.3 kg), this latter precision being similar to that of the valid published equations (2.3 and 2.8 kg). The valid published or developed predictive equations should be cross-validated in large independent samples of African HIV-infected patients.
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Affiliation(s)
- Adama Diouf
- Laboratoire de Nutrition, Département de Biologie Animale, Université Cheikh Anta Diop de Dakar, Dakar BP 5005, Sénégal.
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van der Horst C, Chasela C, Ahmed Y, Hoffman I, Hosseinipour M, Knight R, Fiscus S, Hudgens M, Kazembe P, Bentley M, Adair L, Piwoz E, Martinson F, Duerr A, Kourtis A, Loeliger AE, Tohill B, Ellington S, Jamieson D. Modifications of a large HIV prevention clinical trial to fit changing realities: a case study of the Breastfeeding, Antiretroviral, and Nutrition (BAN) protocol in Lilongwe, Malawi. Contemp Clin Trials 2008; 30:24-33. [PMID: 18805510 DOI: 10.1016/j.cct.2008.09.001] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2008] [Revised: 08/23/2008] [Accepted: 09/01/2008] [Indexed: 10/21/2022]
Abstract
In order to evaluate strategies to reduce HIV transmission through breast milk and optimize both maternal and infant health among HIV-infected women and their infants, we designed and implemented a large, randomized clinical trial in Lilongwe, Malawi. The development of protocols for large, randomized clinical trials is a complicated and lengthy process often requiring alterations to the original research design. Many factors lead to delays and changes, including study site-specific priorities, new scientific information becoming available, the involvement of national and international human subject committees and monitoring boards, and alterations in medical practice and guidance at local, national, and international levels. When planning and implementing a clinical study in a resource-limited setting, additional factors must be taken into account, including local customs and program needs, language and socio-cultural barriers, high background rates of malnutrition and endemic diseases, extreme poverty, lack of personnel, and limited infrastructure. Investigators must be prepared to modify the protocol as necessary in order to ensure participant safety and successful implementation of study procedures. This paper describes the process of designing, implementing, and subsequently modifying the Breastfeeding, Antiretrovirals, and Nutrition, (BAN) Study, a large, on-going, randomized breastfeeding intervention trial of HIV-infected women and their infants conducted at a single-site in Lilongwe, Malawi. We highlight some of the successes, challenges, and lessons learned at different stages during the conduct of the trial.
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Abstract
HIV/AIDS is associated with biological and social factors that affect the individual's ability to consume and utilize food and to acquire food. These biological and social factors lead to poor nutritional status and weight loss, which are an important cause of morbidity in individuals infected with HIV, resulting in a poor quality of life; weight loss is an important predictor of death from AIDS. The links between nutrition and HIV/AIDS amplify the negative effects of HIV infection on human development at individual, household, community and national levels. For many developing countries the incidence of HIV/AIDS and malnutrition is impeding progress towards achieving the UN millennium development goals. Aggressive interventions to curb the spread of HIV continue to be needed. Concurrent efforts to improve nutrition for populations living with HIV/AIDS should also be given priority.
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Chang E, Sekhar R, Patel S, Balasubramanyam A. Dysregulated Energy Expenditure in HIV-Infected Patients: A Mechanistic Review. Clin Infect Dis 2007; 44:1509-17. [PMID: 17479951 DOI: 10.1086/517501] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2006] [Accepted: 02/12/2007] [Indexed: 11/04/2022] Open
Abstract
Metabolic abnormalities are common in patients with human immunodeficiency virus (HIV) infection and range from protein catabolism to lipodystrophy and dyslipidemia associated with the use of highly active antiretroviral therapy. One abnormality is increased resting energy expenditure, which even occurs in clinically stable HIV-infected patients. Increased resting energy expenditure may aggravate the tendency towards weight loss and wasting, which are independent predictors of mortality. Despite much investigation, the factors associated with altered resting energy expenditure remain unclear; viral load, CD4 cell count, use of antiretroviral drugs, body composition, hormones, and proinflammatory cytokines have been imputed. Mechanisms that could explain increased resting energy expenditure include the HIV accessory protein viral protein R, antiretroviral drugs that affect mitochondrial function, and futile cycling within adipocytes. Other components of energy expenditure are also important to overall energy balance and may also be affected. Identifying unifying mechanisms will be an important step to finding effective treatments for HIV-related alterations in energy expenditure and to reversing metabolic risks in patients with HIV infection.
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Affiliation(s)
- Evelyn Chang
- Translational Metabolism Unit, Division of Diabetes, Endocrinology and Metabolism, Baylor College of Medicine, Houston, TX 77030, USA
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Abstract
AIM This paper reports an investigation of the effectiveness of nutritional counselling as an intervention to improve health outcomes for HIV-positive patients in Ghana, West Africa. BACKGROUND In Ghana, like many developing countries, more patients with HIV and AIDS die because of their poor nutritional status than from the disease itself. With the lack of highly active anti-retroviral therapy for most HIV-infected patients in developing countries, nutritional counselling about high protein diet can be an essential intervention to reduce weight loss and improve weight gain and survival outcomes. METHOD We used secondary-analytic data collected in summer 2003. Recorded monthly weights of HIV-positive patients were obtained and analysed for 25 people, whose ages ranged from 21 to 60 years, with a mean of 39.4 years (sd = 10.13). RESULTS HIV-positive patients responded favourably to nutritional counselling about protein dietary intake as an intervention to improve weight gain. Repeated measures showed a statistically significant weight gain (P = 0.008). CONCLUSION In the absence of anti-retroviral therapy, high protein nutrition can be an effective intervention for HIV-positive patients in developing countries. The health and nutritional status of the patients can be improved through nutritious food, allowing them to lead longer and better quality lives.
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Affiliation(s)
- Marian Tabi
- School of Nursing, Georgia Southern University, Statesboro, 30460, USA.
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Sevenoaks MJ, Stockley RA. Chronic Obstructive Pulmonary Disease, inflammation and co-morbidity--a common inflammatory phenotype? Respir Res 2006; 7:70. [PMID: 16669999 PMCID: PMC1479815 DOI: 10.1186/1465-9921-7-70] [Citation(s) in RCA: 159] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2005] [Accepted: 05/02/2006] [Indexed: 12/29/2022] Open
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is and will remain a major cause of morbidity and mortality worldwide. The severity of airflow obstruction is known to relate to overall health status and mortality. However, even allowing for common aetiological factors, a link has been identified between COPD and other systemic diseases such as cardiovascular disease, diabetes and osteoporosis. COPD is known to be an inflammatory condition and neutrophil elastase has long been considered a significant mediator of the disease. Pro-inflammatory cytokines, in particular TNF-α (Tumour Necrosis Factor alpha), may be the driving force behind the disease process. However, the roles of inflammation and these pro-inflammatory cytokines may extend beyond the lungs and play a part in the systemic effects of the disease and associated co-morbidities. This article describes the mechanisms involved and proposes a common inflammatory TNF-α phenotype that may, in part, account for the associations.
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Mangili A, Murman DH, Zampini AM, Wanke CA. Nutrition and HIV infection: review of weight loss and wasting in the era of highly active antiretroviral therapy from the nutrition for healthy living cohort. Clin Infect Dis 2006; 42:836-42. [PMID: 16477562 DOI: 10.1086/500398] [Citation(s) in RCA: 132] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2005] [Accepted: 12/06/2005] [Indexed: 12/14/2022] Open
Abstract
Despite major advances in the treatment and survival of patients infected with human immunodeficiency virus (HIV), weight loss and wasting remain common problems. In the HIV-infected population, weight loss is associated with lower CD4+ cell counts and is an independent predictor of mortality. The etiology of weight loss and wasting is complex and multifactorial. We discuss, on the basis of a large longitudinal cohort that examined nutritional status in HIV infection, data on weight loss and wasting from the present clinical era. The definition, prevalence, and significance of HIV-associated weight loss and wasting are summarized. The etiology of weight loss is discussed for 2 main categories: inadequate nutrient intake and altered metabolism. Finally, studies of interventions to treat HIV-associated weight loss and wasting are discussed. This information is intended to raise awareness among health care providers of HIV-infected patients that weight loss and wasting remain important acquired immunodeficiency syndrome-defining conditions, despite the advent of HAART.
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Affiliation(s)
- A Mangili
- Division of Geographic Medicine and Infectious Diseases, Department of Medicine, Tufts-New England Medical Center, Boston, MA, USA.
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Vorster HH, Kruger A, Margetts BM, Venter CS, Kruger HS, Veldman FJ, Macintyre UE. The nutritional status of asymptomatic HIV-infected Africans: directions for dietary intervention? Public Health Nutr 2005; 7:1055-64. [PMID: 15548344 DOI: 10.1079/phn2004643] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To compare the relationships between food (nutrient) intakes and biochemical markers of nutritional status of asymptomatic HIV-infected with HIV-uninfected subjects, to gain more information on the appropriate diet for HIV-infected persons at an early stage of infection. DESIGN Cross-sectional population-based survey. SETTING North West Province, South Africa. SUBJECTS Two hundred and sixteen asymptomatic HIV-infected and 1550 HIV-uninfected men and women volunteers aged 15 years and older, recruited as 'apparently healthy' subjects from 37 randomly selected sites. OUTCOME MEASURES Food and nutrient intakes, measured with a validated food-frequency questionnaire, and nutritional status indicated by anthropometric and biochemical variables, measured by a standardised methodology. RESULTS The prevalence of HIV infection in the study population was 11.9%. The anthropometric indices and nutrient intakes of HIV-infected and uninfected subjects did not differ significantly, indicating that these 216 HIV-infected subjects were at an early stage of infection. Of the biochemical nutritional status variables, high-density lipoprotein cholesterol and total cholesterol, haemoglobin, albumin and triglycerides were significantly lower in infected subjects. They also had higher globulin and liver enzyme levels than uninfected subjects. In infected subjects, serum albumin correlated significantly with serum lipids, serum vitamin A, serum vitamin E, serum iron, total iron-binding capacity and haemoglobin. The significant positive correlations of the liver enzymes with serum lipids, albumin, vitamin A and iron, observed in HIV-uninfected subjects, disappeared in the infected subjects. Polyunsaturated fat intake showed significant positive correlations with the increased liver enzymes in infected subjects. A principal components analysis indicated that, in infected subjects, increased liver enzymes correlated with higher consumption of maize meal and lower consumption of meat and vegetables. CONCLUSIONS AND RECOMMENDATIONS This survey indicated that asymptomatic HIV-infected subjects who followed a diet rich in animal foods had smaller decreases in serum albumin, haemoglobin and lipid variables, and smaller increases in liver enzymes, than those who consumed a diet based on staple foods. This suggests that animal foods are associated with improved nutritional status in HIV-infected persons. These results should be confirmed with intervention studies before dietary recommendations for asymptomatic HIV-infected individuals can be made.
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Affiliation(s)
- Hester H Vorster
- School of Physiology and Nutrition, Faculty of Health Sciences, North-West University Potchefstroom Campus, Private Bag X6001, Potchefstroom 2520, Republic of South Africa.
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Landry E, Frenette J, Guertin PA. Body weight, limb size, and muscular properties of early paraplegic mice. J Neurotrauma 2004; 21:1008-16. [PMID: 15319000 DOI: 10.1089/0897715041651060] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Patients with spinal cord injury (SCI) typically experience body weight loss, motor function deficits, and a general decline of physical fitness. Animal models with these characteristics can serve to study the detailed adaptive changes following SCI. In the present study, we report the use of an adult paraplegic mouse model to study SCI-induced changes. We characterized the early effects of complete thoracic spinal cord transection on (1) whole body weight, (2) forelimb and hindlimb weight and volume, and (3) contractile properties of hindlimb extensor muscle. Drastic changes were found at 7 days post-spinal cord transection. These included a 24% loss in whole body weight accompanied by a large decrease of weight and volume in the forelimbs and the hindlimbs. We also observed in the soleus muscle, a 32% decrease in mass and maximal tetanic tension (Po) as well as a 21% and 48% increase in time-to-peak tension (TPT) and half-relaxation time (1/2 RT) respectively. After 28 days, all of the changes remained, except for 1/2 RT and TPT which nearly returned to control levels. Altogether, the results reveal that large changes in body weight, limb size and musculoskeletal properties occur within only one week after complete spinal cord transection. The use of paraplegic mouse models may provide new therapeutic approaches to restore motor and locomotor functions after SCI.
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Affiliation(s)
- Eric Landry
- Neuroscience Research Center of Laval University Medical Center, Quebec City, Quebec, Canada
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HIV-infected US youth are at high risk of obesity and poor diet quality: A challenge for improving short- and long-term health outcomes. ACTA ACUST UNITED AC 2004; 104:1554-60. [DOI: 10.1016/j.jada.2004.07.031] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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de Repentigny L, Lewandowski D, Jolicoeur P. Immunopathogenesis of oropharyngeal candidiasis in human immunodeficiency virus infection. Clin Microbiol Rev 2004; 17:729-59, table of contents. [PMID: 15489345 PMCID: PMC523562 DOI: 10.1128/cmr.17.4.729-759.2004] [Citation(s) in RCA: 144] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Oropharyngeal and esophageal candidiases remain significant causes of morbidity in human immunodeficiency virus (HIV)-infected patients, despite the dramatic ability of antiretroviral therapy to reconstitute immunity. Notable advances have been achieved in understanding, at the molecular level, the relationships between the progression of HIV infection, the acquisition, maintenance, and clonality of oral candidal populations, and the emergence of antifungal resistance. However, the critical immunological defects which are responsible for the onset and maintenance of mucosal candidiasis in patients with HIV infection have not been elucidated. The devastating impact of HIV infection on mucosal Langerhans' cell and CD4(+) cell populations is most probably central to the pathogenesis of mucosal candidiasis in HIV-infected patients. However, these defects may be partly compensated by preserved host defense mechanisms (calprotectin, keratinocytes, CD8(+) T cells, and phagocytes) which, individually or together, may limit Candida albicans proliferation to the superficial mucosa. The availability of CD4C/HIV transgenic mice expressing HIV-1 in immune cells has provided the opportunity to devise a novel model of mucosal candidiasis that closely mimics the clinical and pathological features of candidal infection in human HIV infection. These transgenic mice allow, for the first time, a precise cause-and-effect analysis of the immunopathogenesis of mucosal candidiasis in HIV infection under controlled conditions in a small laboratory animal.
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Affiliation(s)
- Louis de Repentigny
- Department of Microbiology and Immunology, Faculty of Medicine, University of Montreal, 3175 Côte Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada.
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Bates I, Fenton C, Gruber J, Lalloo D, Medina Lara A, Squire SB, Theobald S, Thomson R, Tolhurst R. Vulnerability to malaria, tuberculosis, and HIV/AIDS infection and disease. Part 1: determinants operating at individual and household level. THE LANCET. INFECTIOUS DISEASES 2004; 4:267-77. [PMID: 15120343 DOI: 10.1016/s1473-3099(04)01002-3] [Citation(s) in RCA: 144] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
A high burden of malaria, tuberculosis, and HIV infection contributes to national and individual poverty. We have reviewed a broad range of evidence detailing factors at individual, household, and community levels that influence vulnerability to malaria, tuberculosis, and HIV infection and used this evidence to identify strategies that could improve resilience to these diseases. This first part of the review explores the concept of vulnerability to infectious diseases and examines how age, sex, and genetics can influence the biological response to malaria, tuberculosis, and HIV infection. We highlight factors that influence processes such as poverty, livelihoods, gender discrepancies, and knowledge acquisition and provide examples of how approaches to altering these processes may have a simultaneous effect on all three diseases.
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Affiliation(s)
- Imelda Bates
- Liverpool School of Tropical Medicine, Liverpool, UK.
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Heckmann A, Waltzinger C, Jolicoeur P, Dreano M, Kosco-Vilbois MH, Sagot Y. IKK2 inhibitor alleviates kidney and wasting diseases in a murine model of human AIDS. THE AMERICAN JOURNAL OF PATHOLOGY 2004; 164:1253-62. [PMID: 15039214 PMCID: PMC1615343 DOI: 10.1016/s0002-9440(10)63213-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/15/2003] [Indexed: 12/20/2022]
Abstract
Wasting and renal diseases are frequent complications of HIV (human immunodeficiency virus) infection and are associated with accelerated disease progression and increased mortality. Transgenic mice expressing HIV1 under control of the CD4 promoter develop an AIDS-like disease and were used in the present work to study HIV1-induced wasting and kidney pathology. In this study, we reported that disease evolution paralleled increases in serum urea and creatinine levels, indicating an early and progressive deterioration of kidney function; meanwhile the wasting syndrome characterized by up-regulation of the ubiquitine-proteasome pathway and increased level of serum 3-methyl-histidine levels occurred at later stages just prior to death. Further examination of kidney and muscle pathologies revealed a progressive accumulation of CD45(+) cells, first affecting the kidneys. In addition, the onset of disease is accompanied by elevated levels of circulating "regulated on activation, normal and secreted T cell expressed and secreted" (RANTES). These results prompted us to assess the effects of AS602868, a specific small molecule inhibitor of IkappaB kinase 2 (IKK2) on disease progression. Inhibition of the NF-kappaB pathway indeed resulted in increased lifespan, kidney and lean body mass preservation. These beneficial results were associated with a reduction of CD45(+) cells infiltrating the kidneys, amelioration of the renal architecture, and reduced level of circulating RANTES. Together our data provide evidence that IKK2 inhibitors have therapeutic relevance in the treatment of HIV1-associated disorders.
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Villamor E, Msamanga G, Spiegelman D, Peterson KE, Antelman G, Fawzi WW. Pattern and predictors of weight gain during pregnancy among HIV-1-infected women from Tanzania. J Acquir Immune Defic Syndr 2003; 32:560-9. [PMID: 12679710 DOI: 10.1097/00126334-200304150-00015] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Progression of HIV disease is often accompanied by weight loss and wasting. Gestational weight gain is a strong determinant of maternal and neonatal outcomes; however, the pattern and predictors of weight gain during pregnancy among HIV-positive women are unknown. We obtained monthly anthropometric measurements in a cohort of 957 pregnant women from Tanzania who were HIV infected. We estimated the weekly rate of weight gain at various points during the second and third trimesters of pregnancy and computed rate differences between levels of sociodemographic, nutritional, immunologic, and parasitic variables at the first prenatal visit. The change in mid-upper arm circumference (MUAC) from baseline to delivery was also examined. The rate of weight gain decreased progressively during pregnancy. There was an average decline of 1 cm in MUAC between weeks 12 and 38. Lower level of education and helminthic infections at first visit were associated with decreased adjusted rates of weight gain during the third trimester. High baseline MUAC, not contributing to household income, lower serum retinol and selenium concentrations, advanced clinical stage of HIV disease, and malaria infection were related to decreased rates of weight gain during the second trimester. Low baseline CD4 T-cell counts were related to a poorer pattern of weight gain throughout pregnancy. Prevention and treatment of parasitic infections and improvement of nutritional status are likely to enhance the pattern of gestational weight gain among HIV-infected women.
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Affiliation(s)
- Eduardo Villamor
- Department of Nutrition, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115, U.S.A.
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Villamor E, Msamanga G, Spiegelman D, Antelman G, Peterson KE, Hunter DJ, Fawzi WW. Effect of multivitamin and vitamin A supplements on weight gain during pregnancy among HIV-1-infected women. Am J Clin Nutr 2002; 76:1082-90. [PMID: 12399282 DOI: 10.1093/ajcn/76.5.1082] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The pattern of weight gain during pregnancy among HIV-infected women is largely unknown. Multivitamin supplementation was shown to be effective in preventing adverse pregnancy outcomes among HIV-positive women. These protective effects could be mediated in part by an improvement in the pattern of gestational weight gain. OBJECTIVE We examined the effects of multivitamin and vitamin A supplements on weight gain during the second and third trimesters of pregnancy among HIV-infected women. DESIGN We enrolled 1075 pregnant, HIV-1-positive women from Dar es Salaam, Tanzania, in a randomized, placebo-controlled trial. Using a 2-by-2 factorial design, we assigned each woman to 1 of 4 regimens: multivitamins (thiamine, riboflavin, niacin, folic acid, and vitamins B-6, B-12, C, and E), vitamin A, multivitamins including vitamin A, or placebo. The women took these oral supplements daily and were weighed monthly until the end of pregnancy. RESULTS The mean rate of weight gain was 306 g/wk during the second trimester and 247 g/wk during the third trimester. During the third trimester, average weight gain was significantly greater (by 304 g; 95% CI: 17, 590; P = 0.04) and the risk of low rate of weight gain (<or= 100 g/wk) was significantly lower (relative risk: 0.73; 95% CI: 0.58, 0.93) in women who received multivitamins than in women who did not. Multivitamins including vitamin A were protective against low weight gain during the second trimester compared with multivitamins alone. CONCLUSION Multivitamin supplementation during pregnancy improves the pattern of weight gain among HIV-infected women.
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Affiliation(s)
- Eduardo Villamor
- Department of Nutrition, Harvard School of Public Health, Boston, MA 02115, USA.
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Villamor E, Msamanga G, Spiegelman D, Coley J, Hunter DJ, Peterson KE, Fawzi WW. HIV status and sociodemographic correlates of maternal body size and wasting during pregnancy. Eur J Clin Nutr 2002; 56:415-24. [PMID: 12001012 DOI: 10.1038/sj.ejcn.1601328] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2001] [Revised: 08/10/2001] [Accepted: 09/06/2001] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine HIV status and sociodemographic variables as correlates of body size (height, body mass index (BMI), and mid-upper-arm circumference (MUAC)) and wasting (MUAC <22 cm) in pregnant women. DESIGN Cross-sectional study. SETTING Four antenatal clinics in Dar es Salaam, Tanzania. SUBJECTS Women presenting for first prenatal visit before the 23rd week of gestation, between April 1995 and July 1997 (n=13 760). RESULTS Mean MUAC, BMI and height were 25.5 cm, 23.5 kg/m(2) and 155.1 cm, respectively. The prevalence of HIV infection was 13.1% and the overall prevalence of wasting was 4.7%. Wasting was 34% (95% CI=3%, 73%) more prevalent among HIV-infected than in uninfected mothers, after adjusting for week of gestation, height and sociodemographic indicators. The risk of wasting associated with HIV infection was highest among women with low level of education or unable to contribute to the household income. From a multiple linear regression model, BMI was positively associated with mother's age, level of education and money spent on food, but not with HIV infection, after adjusting for week of gestation. In multivariate analysis, height increased monotonically by categories of maternal age and level of education, and was also positively correlated with the ability to contribute to household income, the amount of money spent on food per person per day, and having a professional partner. CONCLUSION HIV infection is a significant risk factor for wasting among pregnant women, particularly in groups of low socioeconomic status (SES). SES indicators are strongly correlated with maternal height and with BMI during the first and second trimesters of pregnancy independently of HIV status. SPONSORSHIP The National Institute of Child Health and Human Development (NICHD R01 32257), and the Fogarty International Center (NIH D43 TW00004).
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Affiliation(s)
- E Villamor
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts 02115, USA.
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Abstract
Sickness behaviour represents the expression of the adaptive reorganization of the priorities of the host during an infectious episode. This process is triggered by pro-inflammatory cytokines produced by peripheral phagocytic cells in contact with invading micro-organisms. The peripheral immune message is relayed to the brain via a fast neural pathway and a slower humoral pathway, resulting in the expression of pro-inflammatory cytokines in macrophage-like cells and microglia in the brain. The cellular and molecular components of this previously unsuspected system are being progressively identified. These advances are opening new avenues for understanding brain disorders, including depression.
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Affiliation(s)
- Jan Pieter Konsman
- Laboratory of Integrative Neurobiology, INRA-INSERM U 394, Rue Camille Saint-Saens, Bordeaux, France
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Welch K, Morse A. The clinical profile of end-stage AIDS in the era of highly active antiretroviral therapy. AIDS Patient Care STDS 2002; 16:75-81. [PMID: 11874639 DOI: 10.1089/10872910252806126] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
The purpose of this study was to describe the clinical profile of end-stage acquired immune deficiency syndrome (AIDS) since the advent of highly active antiretroviral therapy (HAART). A cross-sectional examination of human immunodeficiency virus (HIV)-infected patients who attended a public HIV outpatient clinic and died between 1996 and 2001 was conducted (n = 669). All clinical and demographic data were collected from the Centers for Disease Control (CDC) Adult Spectrum of Disease database. The prevalence of first-time acquisition of AIDS-defining conditions 12 months before death were evaluated. The prevalence of renal disease, hepatic disease and substance use were also evaluated. The majority of the patients were 35 years old or older, male, African American and HAART-experienced. The six AIDS-defining conditions with the highest percentages of first-time acquisition in the last 12 months of life were HIV dementia (91.8%), progressive multifocal leukoencephalopathy (PML) (91.7%), wasting (90.9%), Mycobacterium avium complex infection (MAC) (80.0%), lymphoma (78.6%), and cytomegalovirus infection (CMV) (78.1%). Forty-four percent of the patients were diagnosed with at least one of these six conditions 12 months before death. More than one third of the patients had renal or hepatic failure, injecting drug use (IDU) as the HIV risk factor, and history of substance use. AIDS-defining conditions continue to have an impact on mortality, especially the neurologic conditions and wasting. However, other conditions, such as renal and hepatic disease, are becoming important causes of mortality because the HIV-infected population now includes more drug users, and HIV-infected patients are surviving for longer periods. These results should help clinicians better time the discussion of end-stage options and improve the patient's quality of life.
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Affiliation(s)
- Kathleen Welch
- Louisiana Office of Public Health, Centers for Disease Control and Prevention, New Orleans, Louisiana, USA.
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Debigaré R, Côté CH, Maltais F. Peripheral muscle wasting in chronic obstructive pulmonary disease. Clinical relevance and mechanisms. Am J Respir Crit Care Med 2001; 164:1712-7. [PMID: 11719314 DOI: 10.1164/ajrccm.164.9.2104035] [Citation(s) in RCA: 143] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- R Debigaré
- Centre de Recherche, Hôpital Laval, Institut Universitaire de Cardiologie et de Pneumologie de l'Université Laval and Centre de Recherche, CHUL, Centre Hospitalier Universitaire de l'Université Laval, Sainte-Foy, Canada
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Abstract
Abnormalities in energy, protein, lipid and glucose metabolism have been described in HIV patients since the beginning of the epidemic. With the new antiretroviral agents, nutritional status and survival have improved dramatically. However, since these therapies were introduced, there have been more descriptions of metabolic abnormalities, some of which were similar to and others of which were in conflict with those reported in previous years. This paper reviews the complexity of the metabolic abnormalities in HIV infections before and after the introduction of highly active antiretroviral therapy, and discusses such etiopathogenic mechanisms as secondary infections, antiretroviral drugs and persistent immune activation, which may be involved in these derangements.
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Affiliation(s)
- J Salas-Salvadó
- Human Nutrition Unit, Facultat de Medicina i Ciències de la Salut de Reus, Universitat Rovira i Virgili, Reus, Spain
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Castetbon K, Anglaret X, Attia A, Toure S, Dakoury-Dogbo N, Messou E, N'Dri-Yoman T, Dabis F, Salamon R. Effect of early chemoprophylaxis with co-trimoxazole on nutritional status evolution in HIV-1-infected adults in Abidjan, Côte d'Ivoire. AIDS 2001; 15:869-76. [PMID: 11399959 DOI: 10.1097/00002030-200105040-00007] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In sub-Saharan Africa, malnutrition is a major complication of HIV disease. Measuring accurately the nutritional benefits of a therapeutic intervention could be an easy-to-monitor secondary outcome. METHODS Anthropometric data were analysed from patients participating in a placebo-controlled trial of co-trimoxazole prophylaxis in adults recruited at early stages of HIV-1 infection in Côte d'Ivoire (COTRIMO-CI ANRS 059 trial). Body mass index (BMI), arm muscle circumference (AMC) and percentage of fat mass (FM) were measured at baseline and quarterly during the follow up. Percentage of variation from the baseline value was compared between treatment groups and within the groups using Student t-test. RESULTS An improvement of all anthropometric indicators was observed in the first 3 months of follow up in both treatment groups, significant in the co-trimoxazole group (P < or = 0.0006) but not in the placebo group (P > or = 0.06). In the co-trimoxazole group, this improvement was maintained for up to 24 months for BMI (P = 0.007), 21 months for AMC (P = 0.02) and only up to 12 months for FM (P = 0.04). The placebo group had a stable anthropometric status up to the end of the trial. Differences between treatment groups were significant for up to 15 months for BMI and AMC and 12 months for FM. CONCLUSION As co-trimoxazole prophylaxis is now recommended in Africa as part of a minimum package of care for HIV-infected symptomatic subjects, the short-term improvement of these anthropometric indicators in adults who start co-trimoxazole prophylaxis should be considered as an effective clinical outcome.
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Affiliation(s)
- K Castetbon
- INSERM U.330, Université Victor Segalen Bordeaux 2, Bordeaux, France
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Keithley JK, Swanson B. Oral Nutritional Supplements in Human Immunodeficiency Virus Disease: A Review of the Evidence. Nutr Clin Pract 2001. [DOI: 10.1177/088453360101600206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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García-Lorda P, Serrano P, Jiménez-Expósito MJ, Fraile J, Bulló M, Alonso C, Bonada A, Viciana P, Luna PP, Salas-Salvadó J. Cytokine-driven inflammatory response is associated with the hypermetabolism of AIDS patients with opportunistic infections. JPEN J Parenter Enteral Nutr 2000; 24:317-22. [PMID: 11071589 DOI: 10.1177/0148607100024006317] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND To assess a possible role of systemic inflammation in the resting metabolic response in AIDS patients with active secondary infections. METHODS Fifty-two patients with AIDS-defined criteria and concomitant active infections and 19 healthy subjects were studied. Measurements were as follows: body composition assessed by bioelectrical impedance; resting energy expenditure (REE) by 30-minute indirect calorimetry; cytokine concentrations (IL-6, IFNalpha, TNFalpha, sTNF-R1) by ELISA; C-reactive protein (CRP), erythrocyte sedimentation rate, fibrinogen, and nutritional parameters by standard techniques. RESULTS REE adjusted for fat-free mass (REEFFM) was significantly increased in AIDS patients despite 39% of them not being hypermetabolic. The patients were undernourished and were found to have increased levels of acute-phase proteins and increased concentrations of IL-6 and sTNF-R1 relative to controls. REE parameters were positively related to CRP, ESR, ferritin, IL-6, and sTNF-R1 and negatively related to albumin, prealbumin, and transferrin. CRP was an independent predictor of REEFFM in AIDS patients and explained 25% of its variability. Patients with severe inflammation (CRP > or = 37 mg/dL) were significantly hypermetabolic with respect to patients without inflammation (CRP < 6 mg/dL) and had higher levels of IL-6 and sTNF-R1 and lower levels of albumin and prealbumin. Although no significant differences were observed with respect to the infection type, patients with tuberculosis and Pneumocystis carinii infections had higher resting metabolic and inflammatory responses, whereas patients with recurrent bacterial pneumonia were normometabolic and had lower levels of inflammatory markers. CONCLUSIONS Resting hypermetabolism observed in AIDS patients with concurrent active infections is related to the presence and severity of systemic cytokine-driven inflammatory response, which could reflect the type of secondary infection.
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Affiliation(s)
- P García-Lorda
- Human Nutrition Unit, Faculty of Medicine and Health Sciences, Rovira i Virgili University, Reus, Spain
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Taiwo BO. HIV-associated wasting: brief review and discussion of the impact of oxandrolone. AIDS Patient Care STDS 2000; 14:421-5. [PMID: 10977971 DOI: 10.1089/108729100416632] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
This is a brief review of human immunodeficiency virus (HIV)-associated wasting with expanded discussion of one treatment agent, oxandrolone. HIV-associated wasting is the involuntary loss of more than 10% of baseline body weight in the presence of chronic diarrhea, weakness, or fever lasting longer than 30 days. For patients, this clinical syndrome has special importance because it affects not only their survival but also their physical appearance and social interactions. Pharmacologic treatment is only one of the many approaches that need to be explored in every patient who presents with this condition. In 1964, oxandrolone became the first drug approved for the treatment of wasting. Since then its role has expanded to HIV-associated wasting. As an anabolic agent oxandrolone reverses many of the metabolic abnormalities characteristic of HIV-associated wasting leading to dose dependent increase in nitrogen retention. Similar to many other HIV treatments, gaps exist in our knowledge of the role of oxandrolone in HIV-associated wasting. These gaps will be filled only by years of field exposure and further clinical research.
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Affiliation(s)
- B O Taiwo
- Lincoln Health Center, Early Intervention Clinic, Durham Regional Hospital, North Carolina, USA.
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