1
|
Amiro K, Bowser M, Connell M, Desrosiers R, MacAlpine E, Shahzadi A, McArthur C, Quigley A. Gait Speed, Mobility, Balance, and Dual-Tasking Deficits Among People Living With HIV Globally: A Systematic Review and Meta-Analysis. J Assoc Nurses AIDS Care 2025; 36:3-42. [PMID: 39560216 DOI: 10.1097/jnc.0000000000000503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2024]
Abstract
ABSTRACT People living with HIV (PLWH) may experience premature physical deficits, including walking, mobility, and balance problems. The purpose was to measure deficits in walking, mobility, balance, and dual tasking in PLWH. The secondary objective was to make recommendations regarding the use of rehabilitation outcome measures. CINAHL, PubMed, and SPORTDiscus databases were searched. Two independent reviewers screened titles/abstracts and full-text articles, extracted data, and performed a quality assessment. Fifty-six articles with 14,053 PLWH and 8,454 uninfected controls were included. A meta-analysis revealed significantly worse performance among PLWH on the five times sit to stand mobility test versus controls (Cohen d = 0.68, 95% confidence interval [CI 0.08-1.29], p = .03). Meta-analyses revealed no differences between PLWH and controls for usual gait speed (Cohen d = -0.47, 95% CI [-1.10 to 0.15], p = .14) and fast gait speed (Cohen d = -0.39, 95% CI [-0.87 to 0.08], p = .10). Ten of 12 studies comparing PLWH with controls found differences in balance outcomes. PLWH have significantly worse mobility than uninfected controls.
Collapse
Affiliation(s)
- Kaylie Amiro
- Kaylie Amiro, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Miranda Bowser, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Madison Connell, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Remi Desrosiers, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Evangeline MacAlpine, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Anita Shahzadi, BSc, is a Physiotherapist and Masters Student, Dalhousie University, Halifax, Canada
- Caitlin McArthur, PhD, MScPT, BSc, is an Assistant Professor, Dalhousie University, Halifax, Canada
- Adria Quigley, PhD, MScPT, BSc, is an Assistant Professor, Dalhousie University, Halifax, Canada
| | - Miranda Bowser
- Kaylie Amiro, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Miranda Bowser, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Madison Connell, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Remi Desrosiers, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Evangeline MacAlpine, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Anita Shahzadi, BSc, is a Physiotherapist and Masters Student, Dalhousie University, Halifax, Canada
- Caitlin McArthur, PhD, MScPT, BSc, is an Assistant Professor, Dalhousie University, Halifax, Canada
- Adria Quigley, PhD, MScPT, BSc, is an Assistant Professor, Dalhousie University, Halifax, Canada
| | - Madison Connell
- Kaylie Amiro, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Miranda Bowser, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Madison Connell, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Remi Desrosiers, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Evangeline MacAlpine, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Anita Shahzadi, BSc, is a Physiotherapist and Masters Student, Dalhousie University, Halifax, Canada
- Caitlin McArthur, PhD, MScPT, BSc, is an Assistant Professor, Dalhousie University, Halifax, Canada
- Adria Quigley, PhD, MScPT, BSc, is an Assistant Professor, Dalhousie University, Halifax, Canada
| | - Remi Desrosiers
- Kaylie Amiro, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Miranda Bowser, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Madison Connell, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Remi Desrosiers, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Evangeline MacAlpine, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Anita Shahzadi, BSc, is a Physiotherapist and Masters Student, Dalhousie University, Halifax, Canada
- Caitlin McArthur, PhD, MScPT, BSc, is an Assistant Professor, Dalhousie University, Halifax, Canada
- Adria Quigley, PhD, MScPT, BSc, is an Assistant Professor, Dalhousie University, Halifax, Canada
| | - Evangeline MacAlpine
- Kaylie Amiro, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Miranda Bowser, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Madison Connell, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Remi Desrosiers, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Evangeline MacAlpine, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Anita Shahzadi, BSc, is a Physiotherapist and Masters Student, Dalhousie University, Halifax, Canada
- Caitlin McArthur, PhD, MScPT, BSc, is an Assistant Professor, Dalhousie University, Halifax, Canada
- Adria Quigley, PhD, MScPT, BSc, is an Assistant Professor, Dalhousie University, Halifax, Canada
| | - Anita Shahzadi
- Kaylie Amiro, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Miranda Bowser, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Madison Connell, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Remi Desrosiers, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Evangeline MacAlpine, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Anita Shahzadi, BSc, is a Physiotherapist and Masters Student, Dalhousie University, Halifax, Canada
- Caitlin McArthur, PhD, MScPT, BSc, is an Assistant Professor, Dalhousie University, Halifax, Canada
- Adria Quigley, PhD, MScPT, BSc, is an Assistant Professor, Dalhousie University, Halifax, Canada
| | - Caitlin McArthur
- Kaylie Amiro, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Miranda Bowser, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Madison Connell, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Remi Desrosiers, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Evangeline MacAlpine, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Anita Shahzadi, BSc, is a Physiotherapist and Masters Student, Dalhousie University, Halifax, Canada
- Caitlin McArthur, PhD, MScPT, BSc, is an Assistant Professor, Dalhousie University, Halifax, Canada
- Adria Quigley, PhD, MScPT, BSc, is an Assistant Professor, Dalhousie University, Halifax, Canada
| | - Adria Quigley
- Kaylie Amiro, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Miranda Bowser, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Madison Connell, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Remi Desrosiers, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Evangeline MacAlpine, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Anita Shahzadi, BSc, is a Physiotherapist and Masters Student, Dalhousie University, Halifax, Canada
- Caitlin McArthur, PhD, MScPT, BSc, is an Assistant Professor, Dalhousie University, Halifax, Canada
- Adria Quigley, PhD, MScPT, BSc, is an Assistant Professor, Dalhousie University, Halifax, Canada
| |
Collapse
|
2
|
Levitt DE, Bourgeois BL, Rodríguez-Graciani KM, Molina PE, Simon L. Alcohol Impairs Bioenergetics and Differentiation Capacity of Myoblasts from Simian Immunodeficiency Virus-Infected Female Macaques. Int J Mol Sci 2024; 25:2448. [PMID: 38397125 PMCID: PMC10888832 DOI: 10.3390/ijms25042448] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/06/2024] [Accepted: 02/13/2024] [Indexed: 02/25/2024] Open
Abstract
Alcohol misuse and HIV independently induce myopathy. We previously showed that chronic binge alcohol (CBA) administration, with or without simian immunodeficiency virus (SIV), decreases differentiation capacity of male rhesus macaque myoblasts. We hypothesized that short-term alcohol and CBA/SIV would synergistically decrease differentiation capacity and impair bioenergetic parameters in female macaque myoblasts. Myoblasts from naïve (CBA-/SIV-), vehicle [VEH]/SIV, and CBA/SIV (N = 4-6/group) groups were proliferated (3 days) and differentiated (5 days) with 0 or 50 mM ethanol (short-term). CBA/SIV decreased differentiation and increased non-mitochondrial oxygen consumption rate (OCR) versus naïve and/or VEH/SIV. Short-term alcohol decreased differentiation; increased maximal and non-mitochondrial OCR, mitochondrial reactive oxygen species (ROS) production, and aldolase activity; and decreased glycolytic measures, ATP production, mitochondrial membrane potential (ΔΨm), and pyruvate kinase activity. Mitochondrial ROS production was closely associated with mitochondrial network volume, and differentiation indices were closely associated with key bioenergetic health and function parameters. Results indicate that short-term alcohol and CBA non-synergistically decrease myoblast differentiation capacity. Short-term alcohol impaired myoblast glycolytic function, driving the bioenergetic deficit. Results suggest potentially differing mechanisms underlying decreased differentiation capacity with short-term alcohol and CBA, highlighting the need to elucidate the impact of different alcohol use patterns on myopathy.
Collapse
Affiliation(s)
- Danielle E. Levitt
- Department of Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA; (D.E.L.); (B.L.B.); (K.M.R.-G.); (P.E.M.)
- Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, TX 79409, USA
| | - Brianna L. Bourgeois
- Department of Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA; (D.E.L.); (B.L.B.); (K.M.R.-G.); (P.E.M.)
- Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA
| | - Keishla M. Rodríguez-Graciani
- Department of Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA; (D.E.L.); (B.L.B.); (K.M.R.-G.); (P.E.M.)
- Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA
| | - Patricia E. Molina
- Department of Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA; (D.E.L.); (B.L.B.); (K.M.R.-G.); (P.E.M.)
- Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA
| | - Liz Simon
- Department of Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA; (D.E.L.); (B.L.B.); (K.M.R.-G.); (P.E.M.)
- Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA
| |
Collapse
|
3
|
Ahmed R, Khan S, Quddus N, Saher T, Fatima N. Physical performance among post-COVID and non-COVID individuals: a comparative study. COMPARATIVE EXERCISE PHYSIOLOGY 2022. [DOI: 10.3920/cep220002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
In this comparative cross-sectional study, we compare the physical performance among post-COVID and non-COVID subjects. A sample of 64 subjects recovered from COVID-19 and 64 subjects who were not infected with COVID-19 were recruited for the study. Both groups were tested for physical performance by 30-s sit-to-stand test, 6-min walk test, and HUMAC balance system. The findings of the present study reveal that there was a significant difference in physical performance between both the groups. In conclusion, this study demonstrated that physical performance is impaired in the post-COVID subjects as compared to the matched non-COVID subjects. Therefore, physical therapy exercise program/regimen should be a part of recovery from COVID-19.
Collapse
Affiliation(s)
- R. Ahmed
- Department of Rehabilitation Sciences, Jamia Hamdard University, 110025 New Delhi, India
| | - S.A. Khan
- Department of Rehabilitation Sciences, Jamia Hamdard University, 110025 New Delhi, India
| | - N. Quddus
- Department of Rehabilitation Sciences, Jamia Hamdard University, 110025 New Delhi, India
| | - T. Saher
- Department of Rehabilitation Sciences, Jamia Hamdard University, 110025 New Delhi, India
| | - N. Fatima
- Department of Molecular Medicine, Jamia Hamdard University, 110062 New Delhi, India
| |
Collapse
|
4
|
Quigley A, Brouillette MJ, Fellows LK, Mayo N. Action for better brain health among people living with HIV: protocol for a randomized controlled trial. BMC Infect Dis 2021; 21:843. [PMID: 34416849 PMCID: PMC8377450 DOI: 10.1186/s12879-021-06540-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 08/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lifestyle changes can protect or improve brain health in older adults. However, sustained lifestyle change is difficult for everyone and may be more difficult for those with executive dysfunction, including some people living with HIV. Thus, the key question is how we can improve adherence to the most promising interventions among people living with HIV experiencing cognitive difficulties. Goal management training is a cognitive rehabilitation program that targets executive dysfunction by teaching goal-directed behaviour and self-management. It is a promising means to improve adherence to lifestyle interventions. OBJECTIVE To estimate the extent to which goal management training before a healthy lifestyle program is associated with greater adherence to health recommendations, achievement of health-related goals, and better brain health and health outcomes compared to the healthy lifestyle program alone among people living with HIV. METHODS Brain Health Now cohort participants with cognitive difficulties or are not aging successfully are eligible. All participants will be given health resources, a health coach, a goal-setting digital application, and access to an online goal-setting workshop. The intervention group will participate in nine 2-h goal management training sessions and then will enter the healthy lifestyle program. Control participants will enter the healthy lifestyle program directly. A total sample of 100 participants will participate for 12 months. The main outcome is adherence to the healthy lifestyle program, defined as the number of weeks where physical activity adherence targets were met (150 min per week, measured with an activity monitor). Weekly social activities will be captured via self-report with confidential photo validation. We will send weekly health state reports to the participants. Downstream outcomes include cognitive ability, health-related quality of life, mobility, vascular risk profile, and social network size. We will analyze the data using a linear regression model. DISCUSSION This project is the first to test whether goal management training can augment adherence to health recommendations among individuals with cognitive difficulties. If successful, behavioural interventions such as goal management training could be implemented as an adjunct to lifestyle interventions in other clinical populations. TRIAL REGISTRATION This trial was registered on clinicaltrials.gov (NCT04345484) on April 14, 2020, https://clinicaltrials.gov/ct2/show/NCT04345484?term=NCT04345484&draw=2&rank=1 .
Collapse
Affiliation(s)
- Adria Quigley
- Centre for Outcome Research and Evaluation (CORE), McGill University Health Centre (MUHC), 5252 de Maisonneuve, Montreal, QC, H4A 3S5, Canada.
| | - Marie-Josée Brouillette
- Centre for Outcome Research and Evaluation (CORE), McGill University Health Centre (MUHC), 5252 de Maisonneuve, Montreal, QC, H4A 3S5, Canada
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada
| | - Lesley K Fellows
- Department of Neurology and Neurosurgery, McGill University, 3801 University St, Montreal, QC, H3A 2B4, Canada
| | - Nancy Mayo
- Centre for Outcome Research and Evaluation (CORE), McGill University Health Centre (MUHC), 5252 de Maisonneuve, Montreal, QC, H4A 3S5, Canada
- Department of Medicine, McGill University, 1001 Decarie Boulevard, Montreal, QC, H4A 3J1, Canada
- School of Physical and Occupational Therapy, McGill University, 3654 prom Sir-William-Osler, Montreal, QC, H3G 1Y5, Canada
| |
Collapse
|
5
|
Lima RBH, Barberiz TBDO, Daniel MDC, Seki KLM, Christofoletti G. Síndrome da fragilidade, capacidade pulmonar e funcional em pacientes infectados pelo HIV/AIDS. FISIOTERAPIA E PESQUISA 2021. [DOI: 10.1590/1809-2950/19029128012021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
RESUMO O objetivo deste estudo foi avaliar a prevalência da síndrome da fragilidade e a sua relação com a função pulmonar, a capacidade funcional e as variáveis relacionadas à pacientes infectados pelo vírus HIV. Trata-se de um estudo transversal e descritivo, com análises quantitativas de dados. A amostra foi composta por indivíduos diagnosticados com HIV/AIDS e sem limitações prévias de locomoção. A síndrome da fragilidade foi avaliada pela aplicação do fenótipo da fragilidade, pontuado nos seguintes itens: perda de peso não intencional, fadiga, redução da velocidade da marcha, redução do nível de atividade física e redução da força de preensão palmar. A função pulmonar e a força muscular ventilatória foram avaliadas por meio de espirometria e manovacuometria. A capacidade funcional foi mensurada pelo teste de caminhada de seis minutos (TC6). A análise dos dados foi realizada com testes estatísticos de comparação, adotando-se o nível de significância de 5%. Todos os pacientes incluídos neste estudo encontravam-se dentro dos critérios de fragilidade. Destes, 70% eram frágeis e 30% pré-frágeis. Verificou-se uma relação entre o comprometimento da capacidade funcional, a prevalência de distúrbio ventilatório restritivo e a presença de comorbidades na população frágil comparado com a pré-frágil. Os achados deste estudo permitem a conclusão de que a síndrome da fragilidade impacta a saúde de indivíduos com HIV/AIDS, com comprometimento da espirometria, redução da capacidade funcional e presença de comorbidades.
Collapse
|
6
|
Jankowski CM, Wilson MP, MaWhinney S, Reusch J, Knaub L, Hull S, Erlandson KM. Blunted muscle mitochondrial responses to exercise training in older adults with HIV. J Infect Dis 2020; 224:679-683. [PMID: 33378424 DOI: 10.1093/infdis/jiaa799] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 12/23/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Muscle mitochondrial dysfunction associated with HIV and antiretroviral therapy (ART) may improve with exercise. METHODS Muscle specimens obtained before and after 24 weeks of exercise in older PWH (n=18; ART >2 years) and uninfected controls (n=21) were analyzed for citrate synthase (CS) activity and complexes (C) I-V, manganese superoxide dismutase (MnSOD), peroxisome proliferator-activated receptor-γ coactivator-1 (PGC1α), and voltage-dependent anion channel 1 (VDAC1) content. RESULTS Only controls had increased CS, MnSOD, PGC1 and CIV (P≤0.01; P< 0.01 vs PWH) after training. CONCLUSIONS The blunted mitochondrial adaptations to training in PWH suggests the need for different types of exercise-induced stimulation.
Collapse
Affiliation(s)
| | - Melissa P Wilson
- University of Colorado Anschutz Medical Campus, Colorado School of Public Health, Department of Biostatistics and Informatics, Aurora, CO, USA.,University of Colorado Anschutz Medical Campus, School of Medicine, Department of Bioinformatics and Personalized Medicine, Aurora, CO, USA
| | - Samantha MaWhinney
- University of Colorado Anschutz Medical Campus, Colorado School of Public Health, Department of Biostatistics and Informatics, Aurora, CO, USA
| | - Jane Reusch
- University of Colorado Anschutz Medical Campus, Department of Medicine, Division of Endocrinology, Metabolism & Diabetes, Aurora, CO, USA.,Rocky Mountain Regional VA Medical Center, Aurora, CO, USA.,University of Colorado Anschutz Medical Campus Center for Women's Health Research, Aurora, CO, USA
| | - Leslie Knaub
- University of Colorado Anschutz Medical Campus, Department of Medicine, Division of Endocrinology, Metabolism & Diabetes, Aurora, CO, USA.,Rocky Mountain Regional VA Medical Center, Aurora, CO, USA
| | - Sara Hull
- University of Colorado Anschutz Medical Campus, Department of Medicine, Division of Endocrinology, Metabolism & Diabetes, Aurora, CO, USA.,Rocky Mountain Regional VA Medical Center, Aurora, CO, USA
| | - Kristine M Erlandson
- University of Colorado Anschutz Medical Campus, Department of Medicine, Division of Infectious Diseases, Aurora, CO, USA.,University of Colorado Anschutz Medical Campus, Department of Medicine, Division of Geriatric Medicine, Aurora, CO, USA
| |
Collapse
|
7
|
Bernard C, Font H, Diallo Z, Ahonon R, Tine JM, Abouo F, Tanon A, Messou E, Seydi M, Dabis F, de Rekeneire N, The IeDEA West Africa Cohort Collaboration. Prevalence and factors associated with physical function limitation in older West African people living with HIV. PLoS One 2020; 15:e0240906. [PMID: 33091061 PMCID: PMC7580884 DOI: 10.1371/journal.pone.0240906] [Citation(s) in RCA: 10] [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: 01/13/2020] [Accepted: 10/06/2020] [Indexed: 01/06/2023] Open
Abstract
Although physical function decline is common with aging, the burden of this impairment remains underestimated in patients living with HIV (PLHIV), particularly in the older people receiving antiretroviral treatment (ART) and living in sub-Saharan Africa (SSA). PLHIV aged ≥50 years old and on ART since ≥6 months were included (N = 333) from three clinics (two in Côte d'Ivoire, one in Senegal) participating in the International epidemiological Databases to Evaluate AIDS (IeDEA) West Africa collaboration. Physical function was measured using the Short Physical Performance Battery (SPPB), the unipodal balance test and self-reported questionnaires. Grip strength was also assessed. Logistic regression was used to identify the factors associated with SPPB performance specifically. Median age was 57 (54-61) years, 57.7% were female and 82.7% had an undetectable viral load. The mean SPPB score was 10.2 ±1.8. Almost 30% had low SPPB performance with the 5-sit-to-stand test being the most altered subtest (64%). PLHIV with low SPPB performance also had significantly low performance on the unipodal balance test (54.2%, p = 0.001) and low mean grip strength (but only in men (p = 0.005)). They also showed some difficulties in daily life activities (climbing stairs, walking one block, both p<0.0001). Age ≥60 years (adjusted OR (aOR) = 3.4; CI95% = 1.9-5.9,), being a female (aOR = 2.1; CI95% = 1.1-4.1), having an abdominal obesity (aOR = 2.1; CI95% = 1.2-4.0), a longer duration of HIV infection (aOR = 2.9; CI95% = 1.5-5.7), old Nucleoside reverse transcriptase inhibitors (NRTIs) (i.e., AZT: zidovudine, ddI: didanosine, DDC: zalcitabine, D4T: stavudine) in current ART (aOR = 2.0 CI95% = 1.1-3.7) were associated with low SPPB performance. As in western countries, physical function limitation is now part of the burden of HIV disease complications of older PLHIV living in West Africa, putting this population at risk for disability. How to screen those impairments and integrate their management in the standards of care should be investigated, and specific research on developing adapted daily physical activity program might be conducted.
Collapse
Affiliation(s)
- Charlotte Bernard
- Univ. Bordeaux, INSERM, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
- Univ. Bordeaux, ISPED, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
| | - Hélène Font
- Univ. Bordeaux, INSERM, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
- Univ. Bordeaux, ISPED, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
| | - Zélica Diallo
- Service de maladies infectieuses et tropicales, CHU Treichville, Abidjan, Côte d’Ivoire
| | - Richard Ahonon
- Centre de prise en charge de recherche et de formation (CePReF), Yopougon Attié Hospital, Abidjan, Côte d’Ivoire
| | - Judicaël Malick Tine
- Service de maladies infectieuses et tropicales, CRCF, CHNU de Fann, Dakar, Senegal
| | - Franklin Abouo
- Service de maladies infectieuses et tropicales, CHU Treichville, Abidjan, Côte d’Ivoire
| | - Aristophane Tanon
- Service de maladies infectieuses et tropicales, CHU Treichville, Abidjan, Côte d’Ivoire
| | - Eugène Messou
- Centre de prise en charge de recherche et de formation (CePReF), Yopougon Attié Hospital, Abidjan, Côte d’Ivoire
| | - Moussa Seydi
- Service de maladies infectieuses et tropicales, CRCF, CHNU de Fann, Dakar, Senegal
| | - François Dabis
- Univ. Bordeaux, INSERM, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
- Univ. Bordeaux, ISPED, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
| | - Nathalie de Rekeneire
- Univ. Bordeaux, INSERM, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
- Univ. Bordeaux, ISPED, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
| | | |
Collapse
|
8
|
Berner K, Cockcroft J, Louw Q. Kinematics and temporospatial parameters during gait from inertial motion capture in adults with and without HIV: a validity and reliability study. Biomed Eng Online 2020; 19:57. [PMID: 32709239 PMCID: PMC7379351 DOI: 10.1186/s12938-020-00802-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 07/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inertial measurement unit (IMU)-based motion capture systems are gaining popularity for gait analysis outside laboratories. It is important to determine the performance of such systems in specific patient populations. We aimed to validate and determine within-day reliability of an IMU system for measuring lower limb gait kinematics and temporal-spatial parameters (TSP) in people with and without HIV. METHODS Gait was recorded in eight adults with HIV (PLHIV) and eight HIV-seronegative participants (SNP), using IMUs and optical motion capture (OMC) simultaneously. Participants performed six gait trials. Fifteen TSP and 28 kinematic angles were extracted. Intraclass correlations (ICC), root-mean-square error (RMSE), mean absolute percentage error and Bland-Altman analyses were used to assess concurrent validity of the IMU system (relative to OMC) separately in PLHIV and SNP. IMU reliability was assessed during within-session retest of trials. ICCs were used to assess relative reliability. Standard error of measurement (SEM) and percentage SEM were used to assess absolute reliability. RESULTS Between-system TSP differences demonstrated acceptable-to-excellent ICCs (0.71-0.99), except for double support time and temporophasic parameters (< 0.60). All TSP demonstrated good mean absolute percentage errors (≤7.40%). For kinematics, ICCs were acceptable to excellent (0.75-1.00) for all but three range of motion (ROM) and four discrete angles. RMSE and bias were 0.0°-4.7° for all but two ROM and 10 discrete angles. In both groups, TSP reliability was acceptable to excellent for relative (ICC 0.75-0.99) (except for one temporal and two temporophasic parameters) and absolute (%SEM 1.58-15.23) values. Reliability trends of IMU-measured kinematics were similar between groups and demonstrated acceptable-to-excellent relative reliability (ICC 0.76-0.99) and clinically acceptable absolute reliability (SEM 0.7°-4.4°) for all but two and three discrete angles, respectively. Both systems demonstrated similar magnitude and directional trends for differences when comparing the gait of PLHIV with that of SNP. CONCLUSIONS IMU-based gait analysis is valid and reliable when applied in PLHIV; demonstrating a sufficiently low precision error to be used for clinical interpretation (< 5° for most kinematics; < 20% for TSP). IMU-based gait analysis is sensitive to subtle gait deviations that may occur in PLHIV.
Collapse
Affiliation(s)
- Karina Berner
- Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000, South Africa.
| | - John Cockcroft
- Central Analytical Facilities, Neuromechanics Unit, Stellenbosch University, Private Bag X1, Matieland, 7602, South Africa
| | - Quinette Louw
- Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000, South Africa
| |
Collapse
|
9
|
Oliveira VHF, Borsari AL, Webel AR, Erlandson KM, Deminice R. Sarcopenia in people living with the Human Immunodeficiency Virus: a systematic review and meta-analysis. Eur J Clin Nutr 2020; 74:1009-1021. [PMID: 32341489 DOI: 10.1038/s41430-020-0637-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/01/2020] [Accepted: 04/02/2020] [Indexed: 01/05/2023]
Abstract
People living with HIV (PLHIV) experience greater loss of muscle mass and function than people without HIV. However, HIV is not routinely recognized as a sarcopenia risk factor outside of HIV literature. The purposes of this study were to establish the prevalence and predictors of sarcopenia among PLHIV, and to compare the prevalence of sarcopenia among PLHIV and people without HIV. A systematic literature search of the PubMed, Embase, Cinahl, and Scielo databases was performed following PRISMA and MOOSE guidelines. Identified articles were included if they evaluated sarcopenia among PLHIV using either the presence of low muscle mass only or low muscle mass in association with low muscle function. The pooled prevalence of sarcopenia among PLHIV and the odds ratio for sarcopenia in PLHIV compared with controls were calculated. From 13 studies and 2267 participants, the prevalence of sarcopenia among PLHIV was 24.1% (95% CI = 17.8-31.0%). PLHIV presented 6.1 greater odds (95% CI = 1.1-33.5) of sarcopenia compared with people without HIV, matched by age, sex, BMI, and ethnicity. Longer exposure to specific HIV drugs, tobacco and alcohol, lower education and employment rates, and greater HIV duration were associated with sarcopenia. In conclusion, PLHIV had a high prevalence of sarcopenia, related to both HIV and non-HIV risk factors. HIV should be considered a risk factor for sarcopenia in the general population. CRD42019131449.
Collapse
Affiliation(s)
- Vitor H F Oliveira
- Department of Physical Education, State University of Londrina, Londrina, Paraná, Brazil.
| | - Ana L Borsari
- Department of Physical Education, State University of Londrina, Londrina, Paraná, Brazil
| | - Allison R Webel
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | | | - Rafael Deminice
- Department of Physical Education, State University of Londrina, Londrina, Paraná, Brazil
| |
Collapse
|
10
|
Effects of a Combined Exercise Training Program on Health Indicators and Quality of Life of People Living with HIV: A Randomized Clinical Trial. AIDS Behav 2020; 24:1531-1541. [PMID: 31552510 DOI: 10.1007/s10461-019-02678-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The aim of this study was to evaluate the effects of 16 weeks of combined exercise training (CET) on muscle strength, body composition, depression, anxiety and quality of life of people living with HIV (PLHIV). Twenty-three participants completed the study, 14 in trained group (TG) and 9 in control group (CG). TG consisted of resistance and aerobic training three times a week, while the CG was exposed to recreational activities twice a week. CET promoted increased muscle strength (25% in overall strength) and aerobic capacity (+ 20% in training speed and + 23% in VO2 during aerobic training; p < 0.05). In addition, TG had better quality of life and reduced depression rates (from 7 subjects with mild, moderate or severe depression to 1 post-training). In conclusion, this pilot data demonstrated that 16 weeks of CET increased muscle strength, and improved depression and quality of life indexes in a small sample of PLHIV.
Collapse
|
11
|
Quigley A, MacKay-Lyons M. Physical deficits among people living with HIV: a review of the literature and implications for rehabilitation. PHYSICAL THERAPY REVIEWS 2019. [DOI: 10.1080/10833196.2019.1701763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Adria Quigley
- Department of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Marilyn MacKay-Lyons
- Department of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| |
Collapse
|
12
|
Araujo IR, Ferreira ACG, Vento DA, Guimarães VA. Déficits motores e preditores de perda de mobilidade ao final da internação em indivíduos com neurotoxoplasmose. FISIOTERAPIA E PESQUISA 2019. [DOI: 10.1590/1809-2950/18017926042019] [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
RESUMO A neurotoxoplasmose (NTX) é uma das principais doenças oportunistas presentes em indivíduos portadores do vírus da imunodeficiência humana (HIV). A doença promove lesões cerebrais focais com efeito de massa que podem gerar uma variedade de sequelas capazes de comprometer a realização das atividades da vida diária, dentre elas, a deambulação. O objetivo deste estudo foi verificar os principais déficits motores apresentados e identificar os fatores de risco para a perda de mobilidade ao final da internação. Trata-se de um estudo observacional cuja amostra foi composta por dados de prontuários de indivíduos portadores do vírus HIV e diagnóstico de NTX. Foi realizada a revisão de prontuários eletrônicos e a classificação da mobilidade hospitalar, além da coleta de dados clínicos e epidemiológicos. Aplicou-se estatística descritiva e regressão logística binária. Foram avaliados 161 prontuários, com prevalência do sexo masculino e mediana de idade de 39 anos. Os déficits motores na admissão foram a ausência de deambulação (42,9%), hemiparesia (42,3%), paresia de membros inferiores (37,3%), déficit de equilíbrio (35,4%). Ao final da internação 32,9% não deambulavam. Os preditores para perda da mobilidade ao final da internação foram: utilização de ventilação mecânica invasiva (VMI), inclusão no programa de cuidados paliativos e não deambular na admissão. Os principais déficits motores foram a ausência de deambulação, a hemiparesia à direita e o déficit de equilíbrio.
Collapse
|
13
|
Berner K, Strijdom H, Essop MF, Webster I, Morris L, Louw Q. Fall History and Associated Factors Among Adults Living With HIV-1 in the Cape Winelands, South Africa: An Exploratory Investigation. Open Forum Infect Dis 2019; 6:ofz401. [PMID: 31660363 PMCID: PMC6785680 DOI: 10.1093/ofid/ofz401] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 09/06/2019] [Indexed: 02/06/2023] Open
Abstract
Background People with HIV-1 (PWH) exhibit a high fall incidence and increased fracture risk. As little is known about fall frequency and associated factors in PWH residing in lower-middle-income countries (LMIC), we investigated fall frequency, bone quality, and factors associated with fall history in a South African cohort. Methods Fifty PWH without obvious predisposing factors for mobility impairments attending 2 public primary care clinics in the Western Cape region participated. Demographic, clinical, and physical performance data were collected. Falls were assessed retrospectively over 12 months. Mobility and balance were evaluated using a physical performance battery. Bone mineral density was screened using quantitative ultrasound (QUS). Associations between variables and falls grouping were analyzed using chi-square tests, t tests, and Mann-Whitney U tests, and effect sizes (ES) were calculated. Results Thirty-four percent of PWH (median age, 36.6 years) reported falling during the past year, and 41.2% of fallers reported multiple falls. Fallers had more mobility problems (P = .013), higher fear of falling (P = .007), higher fracture history (P = .003), worse balance performance (P < .001), higher proportions of detectable viral loads (P = .021), and poorer bone quality (P = .040). Differences were of medium to large ES. Conclusions This exploratory study is the first to show that relatively young South African PWH without obvious predisposing factors for gait and balance impairments experience falls. The observed fall-associated factors warrant further research using larger samples and longitudinal designs to ascertain fall predictors within this population.
Collapse
Affiliation(s)
- Karina Berner
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Hans Strijdom
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - M Faadiel Essop
- Cardio-Metabolic Research Group (CMRG), Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Ingrid Webster
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Linzette Morris
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Quinette Louw
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| |
Collapse
|
14
|
Muscle Strength and Aerobic Capacity in HIV-Infected Patients: A Systematic Review and Meta-Analysis. J Acquir Immune Defic Syndr 2019; 79:491-500. [PMID: 30371532 DOI: 10.1097/qai.0000000000001835] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Physical impairment is highly prevalent in HIV-infected patients. We conducted a systematic review of published studies that included studies comparing muscle function in HIV-infected patients to matched healthy controls, and studies comparing aerobic capacity in HIV-infected patients with that observed in matched healthy controls. DESIGN Systematic review and meta-analysis. METHODS We searched for references on MEDLINE, SciELO, Cumulative Index to Nursing and Allied Health (CINAHL), and Scopus up to December 2017. Weighted mean differences and 95% confidence intervals (CIs) were calculated, and heterogeneity was assessed using the I test. RESULTS A total of 30 studies, covering 2148 healthy controls and 2161 HIV-infected patients, fulfilled the inclusion criteria. The average muscle strength and aerobic capacity were significantly lower in HIV-infected patients. Meta-analysis revealed moderate-quality evidence of weaker muscle strength and aerobic capacity in HIV-infected patients. A significant difference in lower-body strength of 1.07 (95% CI: 0.29 to 1.84) was found for participants in the healthy control group compared with HIV group. A significant difference in aerobic capacity (peak VO2) of 8.4 (95% CI: 4.8 to 12.0) was found for participants in the healthy control group compared with HIV group. CONCLUSIONS Muscle strength and aerobic capacity of HIV-infected patients are reduced in comparison with healthy controls. Additional studies are needed to define the best interventions to improve the physical function in HIV-infected patients.
Collapse
|
15
|
Oliveira VH, Wiechmann SL, Narciso AM, Webel AR, Deminice R. Muscle strength is impaired in men but not in women living with HIV taking antiretroviral therapy. Antivir Ther 2019; 23:11-19. [PMID: 28327461 DOI: 10.3851/imp3159] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND There is evidence that HIV antiretroviral therapy adverse effects may be sex-dependent, but data examining these sex differences in muscle strength is scarce. Our aim was to compare dynamic and isokinetic parameters of muscle strength between HIV-infected men and women to HIV-uninfected subjects. METHODS In this cross-sectional study, muscle strength was evaluated in 44 HIV-infected (20 men, 24 women) and 25 age-, race- and body mass index-matched HIV-uninfected subjects (11 men, 14 women). We assessed knee flexion and extension efforts in isokinetic dynamometer at angular velocities of 60° and 180°/s, and 1 repetition maximum test (1RM) for bench press, leg press and arm curl exercises, respectively. Lean body mass (LBM) was measured using bioelectrical impedance. RESULTS HIV-infected men had significantly less dynamic muscle strength for 1RM total (262.5 versus 357.2 kg), bench press (48.6 versus 60.3 kg), leg press (182.7 versus 261 kg) and arm curl (31.2 versus 36.5 kg) compared to HIV-uninfected men (P≤0.05); no differences were found among women. Men had lower values for peak torque in extension and flexion movements at 60°/s and 180°/s, while HIV-infected women presented higher peak torque in extension movement at 60°/s compared to controls. No differences were found in LBM. Moreover, isokinetic evaluation demonstrated that HIV-infected subjects showed greater acceleration and deceleration time in some variables, compared to controls, related to difficulty in activating motor units. CONCLUSIONS HIV infection is associated with impaired dynamic and isokinetic strength in men compared to HIV-uninfected controls, but not in women.
Collapse
Affiliation(s)
- Vitor Hf Oliveira
- Department of Physical Education, State University of Londrina, Londrina, Brazil
| | - Susana L Wiechmann
- University Hospital, Institute of Health Science, State University of Londrina, Londrina, Brazil
| | - Argéria Ms Narciso
- University Hospital, Institute of Health Science, State University of Londrina, Londrina, Brazil
| | - Allison R Webel
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Rafael Deminice
- Department of Physical Education, State University of Londrina, Londrina, Brazil
| |
Collapse
|
16
|
Abstract
PURPOSE OF REVIEW As a consequence of antiretroviral therapy, the proportion of older HIV-infected adults is increasing, with a concomitant shift in burden of illness to age-related syndromes and disease. Frailty is an age-related syndrome of increased vulnerability to stress, predictive of major adverse clinical outcomes among HIV-infected and uninfected persons alike. Understanding frailty pathogenesis is critical to developing interventions to improve health outcomes in HIV. Here, we review the current evidence for the relationship between inflammation and frailty in HIV, and the potential for novel, inflammation-targeted interventions. RECENT FINDINGS Dysregulated inflammation has been consistently associated with frailty in elderly HIV-uninfected persons. Dysregulated inflammation is also central to HIV pathophysiology and several recent studies have demonstrated the important association of inflammation with frailty in HIV. Some evidence suggests that anti-inflammatory therapies may be effective in ameliorating the adverse impact of frailty among aging HIV-infected adults, though further investigation is necessary. Inflammation has been implicated in frailty in HIV infection, and improved understanding of the role that inflammation plays in frailty pathogenesis is key to the development of effective therapies to slow or prevent frailty in the vulnerable HIV-infected population.
Collapse
|
17
|
Quigley A, O'Brien KK, Brouillette MJ, MacKay-Lyons M. Evaluating the Feasibility and Impact of a Yoga Intervention on Cognition, Physical Function, Physical Activity, and Affective Outcomes in People Living With HIV: Protocol for a Randomized Pilot Trial. JMIR Res Protoc 2019; 8:e13818. [PMID: 31115343 PMCID: PMC6547772 DOI: 10.2196/13818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/16/2019] [Accepted: 04/16/2019] [Indexed: 12/19/2022] Open
Abstract
Background Despite lower mortality rates due to combination antiretroviral therapy, people living with HIV (PLWH) are grappling with increasingly complex health issues, including cognitive impairments in areas such as memory, attention, processing speed, and motor function. Yoga has been shown to be an effective form of exercise and mindfulness-based stress reduction for many clinical populations. However, no randomized trials have evaluated the impact of yoga on cognitive and physical function among PLWH. Objective The aim of this pilot randomized trial was to determine the feasibility of a yoga intervention to lay the groundwork for a full-scale, multisite, community-based trial for PLWH. Specific objectives are to (1) assess the feasibility of study protocol and procedures, (2) compare cognition in the yoga group with the usual care control group after 12 weeks of the intervention in PLWH, and (3) compare the effects of the 12-week yoga intervention versus control on balance, walking speed, physical activity, mental health, medication adherence, and quality of life among PLWH. Methods We propose a pilot randomized trial with 2 parallel groups (yoga versus control). We will recruit 25 PLWH (>35 years) from community and health organizations in Halifax, Canada. After baseline assessment with blinded assessors, participants will be randomly assigned to the yoga or control group, using a random computer generator. Participants in the yoga group will engage in supervised 60-min group-based yoga sessions 3 times a week for 12 weeks at a yoga studio. Participants in the control group will maintain their current physical activity levels throughout the study. Results As per the Consolidated Standards of Reporting Trials extension for pilot studies, means of all outcomes, mean change, and 95% CIs will be calculated for each group separately. Two-tailed independent t tests and Fisher exact tests will be used to compare groups at baseline. We will analyze quantitative postintervention questionnaire responses using Chi-square tests, and open-ended responses will be analyzed thematically. Intention-to-treat and per-protocol analyses will be used to analyze secondary variables. Changes in outcome variables will be examined between groups and within groups. Effect sizes will be reported for each outcome. A priori adherence and satisfaction criteria will be met if participants attend >70% of the yoga sessions and if >70% of the participants are satisfied with the intervention as determined by a postparticipation questionnaire. Study enrollment began in January 2018, with results expected for October 2019. Conclusions This pilot randomized trial will be the first to investigate the feasibility and effect of a yoga intervention on cognitive and physical outcomes among PLWH. This work will inform the feasibility of further investigations in terms of capacity building, participant recruitment and retention, and assessment and intervention protocols. Trial Registration ClinicalTrials.gov NCT03071562; https://clinicaltrials.gov/ct2/show/NCT03071562 (Archived by WebCite at http://www.webcitation.org/785sfhWkw) International Registered Report Identifier (IRRID) DERR1-10.2196/13818
Collapse
Affiliation(s)
- Adria Quigley
- Department of Physiotherapy, Dalhousie University, Halifax, NS, Canada
| | - Kelly K O'Brien
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | | | - Marilyn MacKay-Lyons
- Department of Physiotherapy, Dalhousie University, Halifax, NS, Canada.,Department of Medicine, Dalhousie University, Halifax, NS, Canada.,Nova Scotia Health Authority, Halifax, NS, Canada
| |
Collapse
|
18
|
Duplanty AA, Simon L, Molina PE. Chronic Binge Alcohol-Induced Dysregulation of Mitochondrial-Related Genes in Skeletal Muscle of Simian Immunodeficiency Virus-Infected Rhesus Macaques at End-Stage Disease. Alcohol Alcohol 2018; 52:298-304. [PMID: 28069597 DOI: 10.1093/alcalc/agw107] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 01/04/2017] [Indexed: 12/19/2022] Open
Abstract
Aims Alcohol use disorders are more prevalent in HIV patients than the general population. Both chronic alcohol consumption and HIV infection have been linked to mitochondrial dysregulation; and this is considered an important mechanism in the pathogenesis of muscle myopathy. This study investigated if chronic binge alcohol (CBA) administration impairs the expression of genes involved in mitochondrial homeostasis in SIV-infected macaques. Methods Male rhesus macaques were administered daily CBA (to achieve peak blood alcohol concentrations of 50-60 mM within 2 h after start of infusion) or sucrose (SUC) intragastrically 3 months prior to intravenous SIVmac251 inoculation and continued until macaques met criteria for end-stage disease. Skeletal muscle (SKM) samples were obtained at necropsy. Muscle samples were obtained from a cohort of healthy uninfected macaque controls and used for comparison of analyzed variables. Total RNA was extracted and gene expression was analyzed by quantitative polymerase chain reaction. Results The relative expression of peroxisome proliferator-activated receptor gamma coactivator-1 beta (PGC-1β) was significantly decreased in the SKM of CBA/simian immunodeficiency virus (SIV) macaques compared to uninfected controls (P < 0.05). SIV infection resulted in a significant upregulation (P < 0.05) of mitophagy-related gene expression, which was prevented by CBA. CBA suppressed expression of anti-apoptotic genes and increased expression of pro-apoptotic genes (P < 0.05). Conclusions These findings suggest that SIV infection disrupts mitochondrial homeostasis and when combined with CBA, results in differential expression of genes involved in apoptotic signaling. We speculate that impaired mitochondrial homeostasis may contribute to the underlying pathophysiology of alcoholic and HIV/AIDS associated myopathy. Short summary This study investigated if CBA administration dysregulates gene expression associated with mitochondrial homeostasis in the SKM of SIV-infected macaques. The results suggest that SIV infection disrupts mitochondrial homeostasis and when combined with CBA, results in differential expression of genes involved in apoptotic signaling.
Collapse
Affiliation(s)
- Anthony A Duplanty
- Department of Physiology, Comprehensive Alcohol Research Center, Alcohol and Drug Abuse Center of Excellence, Louisiana State University Health Sciences Center, 1901 Perdido Street, New Orleans, LA 70112, USA
| | - Liz Simon
- Department of Physiology, Comprehensive Alcohol Research Center, Alcohol and Drug Abuse Center of Excellence, Louisiana State University Health Sciences Center, 1901 Perdido Street, New Orleans, LA 70112, USA
| | - Patricia E Molina
- Department of Physiology, Comprehensive Alcohol Research Center, Alcohol and Drug Abuse Center of Excellence, Louisiana State University Health Sciences Center, 1901 Perdido Street, New Orleans, LA 70112, USA
| |
Collapse
|
19
|
Quigley A, Baxter L, Keeler L, MacKay-Lyons M. Using the Theoretical Domains Framework to identify barriers and facilitators to exercise among older adults living with HIV. AIDS Care 2018; 31:163-168. [PMID: 30021454 DOI: 10.1080/09540121.2018.1499860] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
People with HIV are living longer. However, co-morbidities are often more prevalent and severe than in the general population and have greater impacts on health status. Although compelling evidence exists about the health benefits of exercise in the HIV literature, many people living with HIV tend to be physically inactive. The purpose of this study was to use the Theoretical Domains Framework to investigate the barriers and facilitators to participation in exercise of older people living with HIV. This qualitative study involved in-depth, semi-structured interviews with 12 adults aged 45 years and older recruited from HIV organizations and health centres. Data were analyzed thematically using the Theoretical Domains Framework, and two investigators independently coded transcripts. Six prominent domains were identified from the interviews: Social influences, environmental context and resources, reinforcement, intentions, social and professional role, and knowledge. Themes emerging from the interviews fit into all 14 domains of the Theoretical Domains Framework, and 67% of themes fit into the six most prominent domains. The participants had a working knowledge of exercise and its health benefits but were unfamiliar with specific exercise parameters. The majority identified environmental or resource constraints as salient barriers for participation in exercise programmes. Co-morbidities, injuries, and the side effects of HIV disease and medication were also acknowledged as barriers. Stigma and discrimination from friends, family, people within the LGBTQ community, and health care providers were commonly discussed. Participants spoke of the importance of social support to facilitate participation in exercise programmes. Other facilitators included using technology and incorporating exercise into day-to-day activities. People aging with HIV experience many barriers to exercise. Those designing exercise interventions for people aging with HIV should incorporate strategies to address these obstacles.
Collapse
Affiliation(s)
- Adria Quigley
- a Department of Health , Dalhousie University , Halifax , Canada
| | | | - Laura Keeler
- c Department of Community Health & Epidemiology , Dalhousie University , Halifax , Canada
| | - Marilyn MacKay-Lyons
- d Department of Physiotherapy , Dalhousie University , Halifax , Canada.,e Department of Medicine , Dalhousie University , Halifax , Canada.,f Nova Scotia Health Authority , Halifax , Canada
| |
Collapse
|
20
|
Duplanty AA, Siggins RW, Allerton T, Simon L, Molina PE. Myoblast mitochondrial respiration is decreased in chronic binge alcohol administered simian immunodeficiency virus-infected antiretroviral-treated rhesus macaques. Physiol Rep 2018; 6:e13625. [PMID: 29504290 PMCID: PMC5835494 DOI: 10.14814/phy2.13625] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 01/30/2018] [Accepted: 01/31/2018] [Indexed: 12/29/2022] Open
Abstract
Work from our group demonstrated that chronic binge alcohol (CBA)-induces mitochondrial gene dysregulation at end-stage disease of simian immunodeficiency virus (SIV) infection in antiretroviral therapy (ART) naïve rhesus macaques. Alterations in gene expression can disrupt mitochondrial homeostasis and in turn contribute to the risk of metabolic comorbidities characterized by loss of skeletal muscle (SKM) functional mass that are associated with CBA, human immunodeficiency virus (HIV) infection, and prolonged ART. The aim of this study was to examine the interaction of CBA and ART on SKM fiber oxidative capacity and myoblast mitochondrial respiration in asymptomatic SIV-infected macaques. SKM biopsies were obtained and myoblasts isolated at baseline and 11 months post-SIV infection from CBA/SIV/ART+ and from sucrose (SUC)-treated SIV-infected (SUC/SIV/ART+) macaques. CBA and ART decreased succinate dehydrogenase (SDH) activity in type 1 and type 2b fibers as determined by immunohistochemistry. Myoblasts isolated from CBA/SIV/ART+ macaques showed decreased maximal oxygen consumption rate (OCR) compared to myoblasts from control macaques. Maximal OCR was significantly increased in control myoblasts following incubation with formoterol, a beta adrenergic agonist, and this was associated with increased PGC-1α expression and mtDNA quantity. Additionally, formoterol treatment of myoblasts isolated from CBA/SIV/ART+ macaques partially restored maximal OCR to levels not significantly different from control. These results show that CBA in combination with ART impairs myoblast mitochondrial homeostasis in SIV-infected macaques. Moreover, our findings suggest that adrenergic agonists can potentially ameliorate mitochondrial dysfunction. Future studies will elucidate whether physical exercise in HIV patients with alcohol use disorder can improve mitochondrial health.
Collapse
Affiliation(s)
- Anthony A. Duplanty
- Department of PhysiologyComprehensive Alcohol Research Center, Alcohol and Drug Abuse Center of ExcellenceLouisiana State University Health Sciences CenterNew OrleansLouisiana
| | - Robert W. Siggins
- Department of PhysiologyComprehensive Alcohol Research Center, Alcohol and Drug Abuse Center of ExcellenceLouisiana State University Health Sciences CenterNew OrleansLouisiana
| | - Timothy Allerton
- Department of PhysiologyComprehensive Alcohol Research Center, Alcohol and Drug Abuse Center of ExcellenceLouisiana State University Health Sciences CenterNew OrleansLouisiana
| | - Liz Simon
- Department of PhysiologyComprehensive Alcohol Research Center, Alcohol and Drug Abuse Center of ExcellenceLouisiana State University Health Sciences CenterNew OrleansLouisiana
| | - Patricia E. Molina
- Department of PhysiologyComprehensive Alcohol Research Center, Alcohol and Drug Abuse Center of ExcellenceLouisiana State University Health Sciences CenterNew OrleansLouisiana
| |
Collapse
|
21
|
Mhariwa PC, Myezwa H, Galantino ML, Maleka D. The relationship between lower limb muscle strength and lower extremity function in HIV disease. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2017; 73:360. [PMID: 30135905 PMCID: PMC6093131 DOI: 10.4102/sajp.v73i1.360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 07/11/2017] [Indexed: 11/01/2022] Open
Abstract
Background Human immunodeficiency virus (HIV) negatively impacts muscle strength and function. This study aimed to establish the relationship between lower limb muscle strength and lower extremity function in HIV disease. Method A cross-sectional study was undertaken with a sample of 113 HIV-positive participants. Lower limb muscle strength and self-reported function were established using dynamometry and the Lower Extremity Functional Scale (LEFS), respectively. Muscle strength and functional status were established in a subset of 30 HIV-negative participants to determine normative values. Results Muscle strength for participants with HIV ranged from an ankle dorsiflexion mean of 9.33 kg/m2 to 15.79 kg/m2 in hip extensors. In the HIV-negative group, ankle dorsiflexors recorded 11.17 kg/m2, whereas hip extensors were the strongest, generating 17.68 kg/m2. In the HIV-positive group, linear regression showed a positive relationship between lower limb muscle strength and lower extremity function (r = 0.71, p = 0.00). Fifty per cent of the changes in lower extremity function were attributable to lower limb muscle strength. A simple linear regression model showed that lower limb ankle plantar flexors contributed the most to lower extremity function in this cohort, contrary to the literature which states that hip and trunk muscles are the most active in lower limb functional activities. Conclusion Lower extremity strength impacts perceived function in individuals stabilised on antiretroviral therapy for HIV disease. These findings demonstrate that ankle plantar flexors produce more force over hip flexors. Careful attention should be paid to the implications for strength training in this population.
Collapse
Affiliation(s)
- Peter C Mhariwa
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Hellen Myezwa
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Mary L Galantino
- Stockton University Physical Therapy Program, Galloway, New Jersey, United States.,School of Medicine - CCEB, University of Pennsylvania, United States
| | - Douglas Maleka
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| |
Collapse
|
22
|
Simon L, Ford SM, Song K, Berner P, Vande Stouwe C, Nelson S, Bagby GJ, Molina PE. Decreased myoblast differentiation in chronic binge alcohol-administered simian immunodeficiency virus-infected male macaques: role of decreased miR-206. Am J Physiol Regul Integr Comp Physiol 2017; 313:R240-R250. [PMID: 28637658 PMCID: PMC5625276 DOI: 10.1152/ajpregu.00146.2017] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 06/07/2017] [Accepted: 06/21/2017] [Indexed: 01/05/2023]
Abstract
Skeletal muscle stem cells play a critical role in regeneration of myofibers. We previously demonstrated that chronic binge alcohol (CBA) markedly attenuates myoblast differentiation potential and myogenic gene expression. Muscle-specific microRNAs (miRs) are implicated in regulation of myogenic genes. The aim of this study was to determine whether myoblasts isolated from asymptomatic CBA-administered simian immunodeficiency virus (SIV)-infected macaques treated with antiretroviral therapy (ART) showed similar impairments and, if so, to elucidate potential underlying mechanisms. Myoblasts were isolated from muscle at 11 mo after SIV infection from CBA/SIV macaques and from time-matched sucrose (SUC)-treated SIV-infected (SUC/SIV) animals and age-matched controls. Myoblast differentiation and myogenic gene expression were significantly decreased in myoblasts from SUC/SIV and CBA/SIV animals compared with controls. SIV and CBA decreased muscle-specific miR-206 in plasma and muscle and SIV decreased miR-206 expression in myoblasts, with no statistically significant changes in other muscle-specific miRs. These findings were associated with a significant increase in histone deacetylase 4 (HDAC4) and decrease in myogenic enhancer factor 2C (MEF2C) expression in CBA/SIV muscle. Transfection with miR-206 inhibitor decreased myotube differentiation, increased expression of HDAC4, and decreased MEF2C, suggesting a critical role of miR-206 in myogenesis. Moreover, HDAC4 was confirmed to be a direct miR-206 target. These results support a mechanistic role for decreased miR-206 in suppression of myoblast differentiation resulting from chronic alcohol and SIV infection. The parallel changes in skeletal muscle and circulating levels of miR-206 warrant studies to establish the possible use of plasma miR-206 as an indicator of impaired muscle function.
Collapse
Affiliation(s)
- L Simon
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, Louisiana;
- Comprehensive Alcohol Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana; and
| | - S M Ford
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - K Song
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - P Berner
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - C Vande Stouwe
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - S Nelson
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, Louisiana
- Comprehensive Alcohol Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana; and
- School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - G J Bagby
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, Louisiana
- Comprehensive Alcohol Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana; and
- School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - P E Molina
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, Louisiana
- Comprehensive Alcohol Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana; and
| |
Collapse
|
23
|
Berner K, Morris L, Baumeister J, Louw Q. Objective impairments of gait and balance in adults living with HIV-1 infection: a systematic review and meta-analysis of observational studies. BMC Musculoskelet Disord 2017; 18:325. [PMID: 28764704 PMCID: PMC5540197 DOI: 10.1186/s12891-017-1682-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 07/17/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Gait and balance deficits are reported in adults with HIV infection and are associated with reduced quality of life. Current research suggests an increased fall-incidence in this population, with fall rates among middle-aged adults with HIV approximating that in seronegative elderly populations. Gait and postural balance rely on a complex interaction of the motor system, sensory control, and cognitive function. However, due to disease progression and complications related to ongoing inflammation, these systems may be compromised in people with HIV. Consequently, locomotor impairments may result that can contribute to higher-than-expected fall rates. The aim of this review was to synthesize the evidence regarding objective gait and balance impairments in adults with HIV, and to emphasize those which could contribute to increased fall risk. METHODS This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. An electronic search of published observational studies was conducted in March 2016. Methodological quality was assessed using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Narrative synthesis of gait and balance outcomes was performed, and meta-analyses where possible. RESULTS Seventeen studies were included, with fair to low methodological quality. All studies used clinical tests for gait-assessment. Gait outcomes assessed were speed, initiation-time and cadence. No studies assessed kinetics or kinematics. Balance was assessed using both instrumented and clinical tests. Outcomes were mainly related to center of pressure, postural reflex latencies, and timed clinical tests. There is some agreement that adults with HIV walk slower and have increased center of pressure excursions and -long loop postural reflex latencies, particularly under challenging conditions. CONCLUSIONS Gait and balance impairments exist in people with HIV, resembling fall-associated parameters in the elderly. Impairments are more pronounced during challenging conditions, might be associated with disease severity, are not influenced by antiretroviral therapy, and might not be associated with peripheral neuropathy. Results should be interpreted cautiously due to overall poor methodological quality and heterogeneity. Locomotor impairments in adults with HIV are currently insufficiently quantified. Future research involving more methodological uniformity is warranted to better understand such impairments and to inform clinical decision-making, including fall-prevention strategies, in this population.
Collapse
Affiliation(s)
- Karina Berner
- Division of Physiotherapy/Central Analytical Facilities (CAF) 3D Human Biomechanics Unit, Department of Rehabilitation & Health Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000 South Africa
| | - Linzette Morris
- Division of Physiotherapy/Central Analytical Facilities (CAF) 3D Human Biomechanics Unit, Department of Rehabilitation & Health Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000 South Africa
| | - Jochen Baumeister
- Exercise & Neuroscience Unit, Institute of Health, Nutrition and Sports Sciences, Europa-Universität Flensburg, Auf dem Campus 1, 24943 Flensburg, Germany
| | - Quinette Louw
- Division of Physiotherapy/Central Analytical Facilities (CAF) 3D Human Biomechanics Unit, Department of Rehabilitation & Health Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000 South Africa
| |
Collapse
|
24
|
Erlandson KM, Plankey MW, Springer G, Cohen HS, Cox C, Hoffman HJ, Yin MT, Brown TT. Fall frequency and associated factors among men and women with or at risk for HIV infection. HIV Med 2017; 17:740-748. [PMID: 27028463 DOI: 10.1111/hiv.12378] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Falls and fall-related injuries are a major public health concern. HIV-infected adults have been shown to have a high incidence of falls. Identification of major risk factors for falls that are unique to HIV infection or similar to those in the general population will inform development of future interventions for fall prevention. METHODS HIV-infected and uninfected men and women participating in the Hearing and Balance Substudy of the Multicenter AIDS Cohort Study and Women's Interagency HIV Study were asked about balance symptoms and falls during the prior 12 months. Falls were categorized as 0, 1, or ≥ 2; proportional odds logistic regression models were used to investigate relationships between falls and demographic and clinical variables and multivariable models were created. RESULTS Twenty-four per cent of 303 HIV-infected participants reported at least one fall compared with 18% of 233 HIV-uninfected participants (P = 0.27). HIV-infected participants were demographically different from HIV-uninfected participants, and were more likely to report clinical imbalance symptoms (P ≤ 0.035). In univariate analyses, more falls were associated with hepatitis C, female sex, obesity, smoking, and clinical imbalance symptoms, but not age, HIV serostatus or other comorbidities. In multivariable analyses, female sex and imbalance symptoms were independently associated with more falls. Among HIV-infected participants, smoking, a higher number of medications, and imbalance symptoms remained independent fall predictors, while current protease inhibitor use was protective. CONCLUSIONS Similar rates of falls among HIV-infected and uninfected participants were largely explained by a high prevalence of imbalance symptoms. Routine assessment of falls and dizziness/imbalance symptoms should be considered, with interventions targeted at reducing symptomatology.
Collapse
Affiliation(s)
- K M Erlandson
- Department of Medicine, Divisions of Infectious Diseases and Geriatric Medicine, University of Colorado, Aurora, CO, USA.
| | - M W Plankey
- Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC, USA
| | - G Springer
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - H S Cohen
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
| | - C Cox
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - H J Hoffman
- Epidemiology and Statistics Program, National Institute on Deafness and Other Communication Disorders (NIDCD), National Institutes of Health (NIH), Bethesda, MD, USA
| | - M T Yin
- Department of Medicine, Division of Infectious Diseases, Columbia University Medical Center, New York, NY, USA
| | - T T Brown
- Department of Medicine, Division of Endocrinology, Diabetes & Metabolism, Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
25
|
Oliveira VHF, Wiechmann SL, Narciso AMS, Deminice R. Knee extension and flexion strength asymmetry in Human Immunodeficiency Virus positive subjects: a cross-sectional study. Braz J Phys Ther 2017; 21:434-439. [PMID: 28720481 PMCID: PMC5693428 DOI: 10.1016/j.bjpt.2017.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Revised: 11/02/2016] [Accepted: 02/06/2017] [Indexed: 11/26/2022] Open
Abstract
HIV-positive subjects present higher strength indices for the dominant versus the non-dominant leg. Strength asymmetry between limbs was observed in up to 58% of subjects. Lower-limb strength asymmetry is associated with impaired balance and gait.
Background Human Immunodeficiency Virus positive subjects present impairment in muscle function, neural activation, balance, and gait. In other populations, all of these factors have been associated with muscle strength asymmetry. Objective To investigate the existence of muscle strength asymmetry between dominant and non-dominant lower limbs and to determine the hamstrings-to-quadriceps strength ratio in Human Immunodeficiency Virus positive subjects. Methods In this cross-sectional study, 48 subjects were included (22 men and 26 women; mean age 44.6 years), all of them under highly active antiretroviral therapy. They performed isokinetic strength efforts at speeds of 60°/s and 180°/s for knee extension and flexion in concentric-concentric mode. Results Peak torque was higher (p < 0.01) at 60°/s for quadriceps (193, SD = 57 vs. 173, SD = 55% body mass) and hamstrings (97, SD = 36 vs. 90, SD = 37% body mass) in dominant compared to non-dominant. Similarly, peak torque was higher at 180°/s (quadriceps 128, SD = 44 vs. 112, SD = 42; hamstrings 64, SD = 24 vs. 57, SD = 26% body mass) in dominant. Average power was also higher for all muscle groups and speeds, comparing dominant with non-dominant. The hamstrings-to-quadriceps ratio at 60°/s was 0.50 for dominant and 0.52 for non-dominant, and at 180°/s, it was 0.51 for both limbs, with no significant difference between them. The percentage of subjects with strength asymmetry ranged from 46 to 58%, depending upon muscle group and speed analyzed. Conclusion Human Immunodeficiency Virus positive subjects present muscle strength asymmetry between lower limbs, assessed through isokinetic dynamometry.
Collapse
Affiliation(s)
- Vitor H F Oliveira
- Universidade Estadual de Londrina (UEL), Departamento de Educação Física, Londrina, PR, Brazil
| | - Susana L Wiechmann
- Universidade Estadual de Londrina (UEL), Centro de Ciências da Saúde, Hospital das Clínicas, Londrina, PR, Brazil
| | - Argéria M S Narciso
- Universidade Estadual de Londrina (UEL), Centro de Ciências da Saúde, Hospital das Clínicas, Londrina, PR, Brazil
| | - Rafael Deminice
- Universidade Estadual de Londrina (UEL), Departamento de Educação Física, Londrina, PR, Brazil.
| |
Collapse
|
26
|
Khoury AL, Morey MC, Wong TC, McNeil DL, Humphries B, Frankey K, Pieper CF, Hicks CB, Huffman K, McKellar MS. Diminished physical function in older HIV-infected adults in the Southeastern U.S. despite successful antiretroviral therapy. PLoS One 2017; 12:e0179874. [PMID: 28662079 PMCID: PMC5491055 DOI: 10.1371/journal.pone.0179874] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 04/26/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND As antiretroviral therapy efficacy improves, HIV is gradually being recognized more as a chronic disease within the aging HIV-infected population. While these individuals are surviving into old age, they may, however, be experiencing "accelerated aging" with greater declines in physical function than that observed among comparably matched individuals free of HIV. This decline is not well understood and it remains unclear if physical decline correlates with the degree of immunosuppression based on CD4 lymphocyte nadir. METHODS In a cross-sectional study of accelerated aging in the older HIV-infected population on antiretroviral therapy (ART), physical performance evaluations were completed on a cohort of 107 HIV-infected subjects, age 50 years or older (with no HIV-1 RNA >200 copies/mL in the prior 12 months), and compared to reference ranges for age- and gender-matched HIV-uninfected persons. Physical performance testing consisted of four validated assessments: the 2.4-meter walk, 30-second chair stand, grip strength and 6-minute walk test. RESULTS When compared to age- and gender-matched HIV-uninfected reference controls, older HIV-infected persons had diminished physical function. No correlation was found between physical function and degree of immunosuppression as determined by pre-ART CD4 nadir. CONCLUSIONS Despite improved survival, HIV-infected adults on suppressive ART have diminished physical function compared to HIV-uninfected persons. The degree of HIV-associated immunosuppression does not correlate with the observed degree of physical function decline in older HIV-infected persons, suggesting the decline is mediated by other mechanisms.
Collapse
Affiliation(s)
- Audrey L. Khoury
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States of America
| | - Miriam C. Morey
- Claude D Pepper Older Americans Independence Center, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Geriatric Research, Education and Clinical Center, Veterans Affairs Medical Center, Durham, North Carolina, United States of America
| | - Tammy C. Wong
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States of America
| | - Donna Lynn McNeil
- Office of Research Support, Duke Cancer Institute, Durham, North Carolina, United States of America
| | - Barlett Humphries
- Center for Applied Genomics and Precision Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Katherine Frankey
- Center for Applied Genomics and Precision Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Carl F. Pieper
- Claude D Pepper Older Americans Independence Center, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Department of Biostatistics and Bioinformatics, Durham, North Carolina, United States of America
| | - Charles B. Hicks
- Division of Infectious Diseases, University of California San Diego School of Medicine, San Diego, California, United States of America
| | - Kim Huffman
- Claude D Pepper Older Americans Independence Center, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Mehri S. McKellar
- Claude D Pepper Older Americans Independence Center, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Division of Infectious Disease, Duke University Medical Center, Durham, North Carolina, United States of America
| |
Collapse
|
27
|
Abstract
: HIV infection, in many circumstances, can now be managed as a chronic disease due to the marked increase in life expectancy since the introduction of combination antiretroviral therapy (ART). As the patients who first had access to combination ART age into their 50s and 60s, the effects of chronic HIV infection on health have become an important research focus in HIV infection. People living with HIV appear to exhibit an earlier occurrence of some aging-related conditions compared to people without HIV, in part due to higher rates of comorbidities, high-risk behaviors (e.g. smoking, substance use), chronic immune activation, inflammation, and ART-specific factors. Some studies have even suggested an earlier-than-expected appearance of the 'geriatric syndromes,' which are complex medical syndromes of older adults that are associated with morbidity and mortality. The geriatric syndromes include a wide variety of disease processes ranging from incontinence and dementia to impairments in physical function. This review will focus on one geriatric syndrome, sarcopenia, in older HIV-infected populations, and its relation to other aging syndromes, including frailty and falls. The contribution of HIV itself, ART exposure, and specific comorbidities, and the importance of early recognition and prevention of these aging syndromes will be highlighted.
Collapse
Affiliation(s)
- Kellie L Hawkins
- aUniversity of Colorado, Aurora, Colorado bJohns Hopkins School of Medicine cJohns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | | |
Collapse
|
28
|
Bernard C, Dabis F, de Rekeneire N. Physical function, grip strength and frailty in people living with HIV in sub-Saharan Africa: systematic review. Trop Med Int Health 2017; 22:516-525. [PMID: 28170120 DOI: 10.1111/tmi.12852] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To present the current knowledge on physical function, grip strength and frailty in HIV-infected patients living in sub-Saharan Africa, where the phenomenon is largely underestimated. METHODS A systematic search was conducted on MEDLINE, Scopus and African Index Medicus. We reviewed articles on sub-Saharan African people living with HIV (PLHIV) >18 years old, published until November 2016. RESULTS Of 537 articles, 12 were conducted in six African countries and included in this review. Five articles reported information on functional limitation and one on disability. Two of these five articles reported functional limitation (low gait speed) in PLHIV. Disability was observed in 27% and 3% of PLHIV living in rural and urban places, respectively. Two of three studies reporting grip strength reported lower grip strength (nearly 4 kg) in PLHIV in comparison with uninfected patients. One study reported that PLHIV were more likely to be frail than HIV-uninfected individuals (19.4% vs. 13.3%), whereas another reported no statistical difference. CONCLUSION Decline in physical function, grip strength and frailty are now part of the burden of PLHIV living in SSA countries, but current data are insufficient to characterise the real public health dimension of these impairments. Further studies are needed to depict this major public health challenge. As this is likely to contribute to a significant burden on the African healthcare systems and human resources in the near future, a holistic care approach should be developed to inform guidelines.
Collapse
Affiliation(s)
- Charlotte Bernard
- INSERM, Centre INSERM U1219, Bordeaux Population Health, Bordeaux, France.,School of Public Health (ISPED), University of Bordeaux, Bordeaux, France
| | - François Dabis
- INSERM, Centre INSERM U1219, Bordeaux Population Health, Bordeaux, France.,School of Public Health (ISPED), University of Bordeaux, Bordeaux, France
| | - Nathalie de Rekeneire
- INSERM, Centre INSERM U1219, Bordeaux Population Health, Bordeaux, France.,School of Public Health (ISPED), University of Bordeaux, Bordeaux, France
| |
Collapse
|
29
|
De A, Xu X, White J, Sunil TS, Okulicz JF. Physical fitness characteristics of active duty US Air Force members with HIV infection. Medicine (Baltimore) 2016; 95:e5227. [PMID: 27858872 PMCID: PMC5591120 DOI: 10.1097/md.0000000000005227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Human immunodeficiency virus (HIV) infection is associated with reduced muscle mass and adverse metabolic effects. We evaluated the impact of HIV infection on longitudinal exercise performance in US Air Force (USAF) members with HIV infection.USAF members perform standardized fitness assessments every 6 to 12 months with a composite score comprised of abdominal circumference, push-ups, sit-ups, and 1.5-mile run. Fitness tests between 2004 and 2014 for male USAF members with HIV infection (n = 172) were compared with male HIV-negative controls (∼10 per case; n = 1636) matched by age and rank category at service entry.Fitness tests for cases (n = 1821) were divided into 2 groups, before (pre-HIV) and after (post-HIV) diagnosis, and compared with control fitness assessments (n = 30,443) by paired t tests. Random-effects regression analyses were also performed to compare fitness components.Mean composite scores for cases were higher post-HIV (87.06 ± 9.10) compared with pre-HIV (84.92 ± 8.36; P = 0.004) and did not differ from respective controls. Compared with pre-HIV, mean push-up (51.50 ± 9.67 vs 50.35 ± 11.18; P = 0.018) and sit-up (51.66 ± 7.81 vs 50.57 ± 9.19; P < 0.001) counts improved post-HIV, whereas run times were similar (11:53 ± 1:42 vs 11:51 ± 2:05; P = 0.056). Regression analyses demonstrated that cases had significantly lower predicted abdominal circumference and push-up counts over time compared with controls, regardless of pre-HIV or post-HIV status (P < 0.05 for all).Although functional limitations may occur in the setting of HIV infection, vigorous exercise performance can be both preserved and improved in HIV-infected individuals at a level comparable with HIV-uninfected persons.
Collapse
Affiliation(s)
- Asha De
- Internal Medicine Residency, San Antonio Military Medical Center, Fort Sam Houston University of Texas San Antonio, Department of Sociology, San Antonio Infectious Disease Service, San Antonio Military Medical Center, Fort Sam Houston, Texas, USA
| | | | | | | | | |
Collapse
|
30
|
Sharma A, Hoover DR, Shi Q, Holman S, Plankey MW, Wheeler AL, Weber K, Floris-Moore M, Bolivar HH, Vance DE, Mack WJ, Golub ET, Holstad MM, Yin MT. Falls among middle-aged women in the Women's Interagency HIV Study. Antivir Ther 2016; 21:697-706. [PMID: 27427794 PMCID: PMC5243157 DOI: 10.3851/imp3070] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND To determine the frequency and risk factors for falls among middle-aged HIV+ and HIV- women in the Women's Interagency HIV Study (WIHS). METHODS We quantified self-report of any and multiple (≥2) falls in the prior 6 months among 1,412 HIV+ and 650 HIV- women with mean age 48 years. Logistic regression was used to evaluate associations of demographics, behavioural factors, comorbid conditions and medications with odds of any fall (versus none) and multiple falls (versus ≤1 fall). RESULTS At least one fall was reported in 263 HIV+ (19%) versus 119 HIV- (18%) women, and ≥2 falls reported in 133 HIV+ (9%) versus 65 HIV- (10%) women. HIV infection was not associated with falls in multivariate analyses. Factors independently associated with any fall included age (adjusted odds ratio [aOR] 1.71, 95% CI 1.17, 2.49 age 50-59 versus <39 years; aOR 2.26, 95% CI 1.38, 3.71 age ≥60 versus <39), current marijuana use (aOR 2.19, 95% CI 1.53, 3.13) depressive symptoms (aOR 1.57, 95% CI 1.21, 2.05 for Center for Epidemiology Studies Depression score ≥16), subjective cognitive complaints (aOR 2.19, 95% CI 1.56, 3.08), neuropathy (aOR 1.59, 95% CI 1.19, 2.13), obesity (aOR 1.39, 95% CI 1.08, 1.80), number of central nervous system active agents (aOR 2.98, 95% CI 1.90, 4.68 for ≥3 agents versus 0) and WIHS site. Factors associated with ≥2 falls included age, marijuana use, number of central nervous system active agents, subjective cognitive complaints, depressive symptoms, neuropathy and study site. CONCLUSIONS Falls were associated with factors affecting cognition, but not HIV status in this large cohort of women. Longitudinal studies are needed to determine the incidence and consequences of falls by HIV status as women age.
Collapse
Affiliation(s)
- Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Donald R Hoover
- Department of Statistics and Biostatistics, Rutgers University, Piscataway, NJ, USA
| | - Qiuhu Shi
- Department of Epidemiology and Community Health, New York Medical College, Valhalla, NY, USA
| | - Susan Holman
- Department of Medicine, State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - Michael W Plankey
- Department of Medicine, Georgetown University Medical Center, Washington, DC, USA
| | - Amber L Wheeler
- Department of Medicine, San Francisco VA Medical Center, San Francisco, CA, USA
| | - Kathleen Weber
- Department of Medicine, John H Stroger Jr Hospital of Cook County, Chicago, IL, USA
| | - Michelle Floris-Moore
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Hector H Bolivar
- Department of Medicine, University of Miami Health System, Miami, FL, USA
| | - David E Vance
- School of Nursing, the University of Alabama at Birmingham, Birmingham, AL, USA
| | - Wendy J Mack
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Elizabeth T Golub
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Michael T Yin
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| |
Collapse
|
31
|
Abstract
PURPOSE OF REVIEW The interaction between fall and fracture risk factors is an area of increasing clinical relevance, but little information is known about the age-specific issues in bone health unique to HIV-infected adults. The present review will focus on what is known about falls and fall risk factors among HIV-infected adults, and then review the association between decreased muscle, increased adiposity, and frailty with both low bone mineral density (BMD) and falls. RECENT FINDINGS The rate of falls among middle-aged HIV-infected adults is similar to that of HIV-uninfected adults 65 years and older. Many of the clinical factors that contribute to low BMD overlap with risk factors for falls, resulting in a high risk of a serious fall among older adults with the greatest risk for a fracture. Low muscle mass, increased adiposity and metabolic syndrome, physical function impairment and frailty, common among older HIV-infected adults, contribute to an increased risk for low BMD and falls, and subsequently, may increase the risk of fracture among HIV-infected older adults. SUMMARY Interventions with dual benefit on reducing fall risk and improving BMD are likely to have the greatest impact on fracture prevention in the older, HIV-infected adult.
Collapse
Affiliation(s)
- Kristine M Erlandson
- aUniversity of Colorado, Aurora, Colorado, USA bUniversity of Modena and Reggio Emilia, Modena, Italy cMcGill University, Montreal, Quebec, Canada
| | | | | |
Collapse
|
32
|
Vartak-Sharma N, Nooka S, Ghorpade A. Astrocyte elevated gene-1 (AEG-1) and the A(E)Ging HIV/AIDS-HAND. Prog Neurobiol 2016; 157:133-157. [PMID: 27090750 DOI: 10.1016/j.pneurobio.2016.03.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 03/11/2016] [Accepted: 03/19/2016] [Indexed: 12/23/2022]
Abstract
Recent attempts to analyze human immunodeficiency virus (HIV)-1-induced gene expression changes in astrocytes uncovered a multifunctional oncogene, astrocyte elevated gene-1 (AEG-1). Our previous studies revealed that AEG-1 regulates reactive astrocytes proliferation, migration and inflammation, hallmarks of aging and CNS injury. Moreover, the involvement of AEG-1 in neurodegenerative disorders, such as Huntington's disease and migraine, and its induction in the aged brain suggest a plausible role in regulating overall CNS homeostasis and aging. Therefore, it is important to investigate AEG-1 specifically in aging-associated cognitive decline. In this study, we decipher the common mechanistic links in cancer, aging and HIV-1-associated neurocognitive disorders that likely contribute to AEG-1-based regulation of astrocyte responses and function. Despite AEG-1 incorporation into HIV-1 virions and its induction by HIV-1, tumor necrosis factor-α and interleukin-1β, the specific role(s) of AEG-1 in astrocyte-driven HIV-1 neuropathogenesis are incompletely defined. We propose that AEG-1 plays a central role in a multitude of cellular stress responses involving mitochondria, endoplasmic reticulum and the nucleolus. It is thus important to further investigate AEG-1-based cellular and molecular regulation in order to successfully develop better therapeutic approaches that target AEG-1 to combat cancer, HIV-1 and aging.
Collapse
Affiliation(s)
- Neha Vartak-Sharma
- Department of Cell Biology and Immunology, University of North Texas Health Science Center, Fort Worth, TX, 76107-2699, USA; Institute for Integrated Cell-Material Sciences, Kyoto University, Japan; Institute for Stem Cell Research and Regenerative Medicine, National Center for Biological Sciences, Tata Institute of Fundamental Research, Bangalore, India
| | - Shruthi Nooka
- Department of Cell Biology and Immunology, University of North Texas Health Science Center, Fort Worth, TX, 76107-2699, USA
| | - Anuja Ghorpade
- Department of Cell Biology and Immunology, University of North Texas Health Science Center, Fort Worth, TX, 76107-2699, USA.
| |
Collapse
|
33
|
Ávila-Funes JA, Belaunzarán-Zamudio PF, Tamez-Rivera O, Crabtree-Ramírez B, Navarrete-Reyes AP, Cuellar-Rodríguez J, Sierra-Madero J, Amieva H. Correlates of Prevalent Disability Among HIV-Infected Elderly Patients. AIDS Res Hum Retroviruses 2016; 32:155-62. [PMID: 26559405 DOI: 10.1089/aid.2015.0171] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The growing elderly population of HIV-infected patients is leading to a significant epidemiological transition and HIV infection has been proposed as a premature and accelerated aging model rending the individual more susceptible to premature disability. However, the determinants of disability among this emergent population are still lacking. Therefore, the aim of this study is to determine the correlates of prevalent disability in adults ≥50 years with HIV infection. A cross-sectional study of 184 HIV-infected adults receiving ambulatory care in an HIV clinic of a tertiary care, university-affiliated hospital in Mexico City was conducted. Disability for instrumental (IADL) and basic activities of daily living (ADL) was established. Sociodemographic factors, clinical variables, current CD4(+) cell count, and HIV viral load (VL) were tested as potential determinants of disability. Multivariate logistic regression analyses were used to identify the correlates of both types of disability. The mean age was 59.3 years. All participants were receiving highly active antiretroviral therapy. Of participants 17.9% had disability for IADL and 26.1% for ADL. Multivariate logistic regression analyses indicated that being older; having a lower CD4(+) cell count, and having a detectable HIV VL were independently associated with both types of disability. In addition, educational level was also independently associated with ADL disability. Age, educational level, low CD4(+) cell count, and detectable HIV VL were independently associated with disability. Whether effective and timely antiretroviral therapy will reduce the risk of disability in HIV-infected elderly patients needs to be evaluated.
Collapse
Affiliation(s)
- José Alberto Ávila-Funes
- Departmento of Geriatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Centre de Recherche Inserm, U897, Bordeaux, France and University Victor Segalen Bordeaux 2, Bordeaux, France
| | - Pablo Francisco Belaunzarán-Zamudio
- Departmento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- División de Investigación de la Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Oscar Tamez-Rivera
- Departmento of Geriatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Brenda Crabtree-Ramírez
- Departmento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Ana Patricia Navarrete-Reyes
- Departmento of Geriatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Jennifer Cuellar-Rodríguez
- Departmento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Juan Sierra-Madero
- Departmento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Hélène Amieva
- Centre de Recherche Inserm, U897, Bordeaux, France and University Victor Segalen Bordeaux 2, Bordeaux, France
| |
Collapse
|
34
|
Simon L, Hollenbach AD, Zabaleta J, Molina PE. Chronic binge alcohol administration dysregulates global regulatory gene networks associated with skeletal muscle wasting in simian immunodeficiency virus-infected macaques. BMC Genomics 2015; 16:1097. [PMID: 26699868 PMCID: PMC4690320 DOI: 10.1186/s12864-015-2329-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 12/15/2015] [Indexed: 12/24/2022] Open
Abstract
Background There are more than 1 million persons living with HIV/AIDS (PLWHA) in the United States and approximately 40 % of them have a history of alcohol use disorders (AUD). Chronic heavy alcohol consumption and HIV/AIDS both result in reduced lean body mass and muscle dysfunction, increasing the incidence of comorbid conditions. Previous studies from our laboratory using rhesus macaques infected with Simian Immunodeficiency Virus (SIV) demonstrated that chronic binge alcohol (CBA) administration in the absence of antiretroviral therapy exacerbates skeletal muscle (SKM) wasting at end-stage SIV disease. The aim of this study was to characterize how CBA alters global gene regulatory networks that lead to SKM wasting at end-stage disease. Administration of intragastric alcohol or sucrose to male rhesus macaques began 3 months prior to SIV infection and continued throughout the duration of study. High-output array analysis was used to determine CBA-dependent changes in mRNA expression, miRNA expression, and promoter methylation status of SKM at end-stage disease (~10 months post-SIV) from healthy control (control), sucrose-administered, SIV-infected (SUC/SIV), and CBA-administered/SIV-infected (CBA/SIV) macaques. Results In addition to previously reported effects on the extracellular matrix and the promotion of a pro-inflammatory environment, we found that CBA adversely affects gene regulatory networks that involve “universal” cellular functions, protein homeostasis, calcium and ion homeostasis, neuronal growth and signaling, and satellite cell growth and survival. Conclusions The results from this study provide an overview of the impact of CBA on gene regulatory networks involved in biological functions, including transcriptional and epigenetic processes, illustrating the genetic and molecular mechanisms associated with CBA-dependent SKM wasting at end-stage SIV infection. Electronic supplementary material The online version of this article (doi:10.1186/s12864-015-2329-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Liz Simon
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, LA, 70112, USA. .,LSUHSC-NO Comprehensive Alcohol-HIV/AIDS Research Center (CARC), 1901 Perdido Street, New Orleans, LA, 70112, USA.
| | | | - Jovanny Zabaleta
- Department of Pediatrics, Stanley S. Scott Cancer Center, 1700 Tulane Ave., Suite 909, New Orleans, USA.
| | - Patricia E Molina
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, LA, 70112, USA. .,LSUHSC-NO Comprehensive Alcohol-HIV/AIDS Research Center (CARC), 1901 Perdido Street, New Orleans, LA, 70112, USA.
| |
Collapse
|
35
|
Dufouil C, Richert L, Thiébaut R, Bruyand M, Amieva H, Dauchy FA, Dartigues JF, Neau D, Morlat P, Dehail P, Dabis F, Bonnet F, Chêne G. Diabetes and cognitive decline in a French cohort of patients infected with HIV-1. Neurology 2015; 85:1065-73. [PMID: 26156515 DOI: 10.1212/wnl.0000000000001815] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 05/21/2015] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE We investigated the relationship of diabetes and prediabetes with cognitive performances, assessed through raw test and z scores and according to neurocognitive impairment (NCI) classification in a cohort of individuals infected with HIV. METHODS The ANRS CO3 Aquitaine cohort is a prospective hospital-based cohort of HIV-1-infected patients under routine clinical management in 6 public hospitals in southwestern France. Between 2007 and 2009, an ancillary study consisted of a neuropsychological battery of 10 tests at baseline and 2-year follow-up. The severity of NCI (normal, asymptomatic, mild, HIV dementia) was assessed according to international guidelines. RESULTS At baseline (400 patients, 33 with prediabetes, 39 with diabetes), in cross-sectional multivariable analyses, patients with diabetes performed significantly worse on 9 neuropsychological tests that assessed memory, executive functions, attention, psychomotor speed, language, and manual dexterity. Participants with prediabetes had worse performances compared with those who had normal glycemia in 5 tests. The longitudinal analysis of the association between glycemia status at baseline and change in cognitive performances over 2-year follow-up (n = 283) suggested that patients with diabetes also showed a slightly higher decline on 5 of the 10 tests, those involving executive functions and memory functioning. Glycemia status at baseline was not significantly associated with NCI severity in cross-sectional (p = 0.44) and longitudinal (p = 0.64) analyses. CONCLUSIONS In this hospital-based cohort of people living with HIV, diabetes, but not the other cardiovascular risk factors, is associated with worse cognitive performances in several cognitive domains and with larger decline in fewer domains over the short term.
Collapse
Affiliation(s)
- Carole Dufouil
- From INSERM (C.D., L.R., R.T., M.B., H.A., J.-F.D., P.M., P.D., F.D., F.B., G.C.), Centre INSERM U897 and CIC-1401, Bordeaux School of Public Health; University of Bordeaux (C.D., L.R., R.T., M.B., H.A., J.-F.D., P.M., P.D., F.D., F.B., G.C.); and Public Health Department (C.D., L.R., R.T., M.B., F.D., G.C.), Internal Medicine and Infectious Disease Department (F.-A.D., P.M., P.D., F.B.), Neurology Department (J.-F.D.), and Infectious and Tropical Diseases Federation (D.N.), Bordeaux Hospital, France.
| | - Laura Richert
- From INSERM (C.D., L.R., R.T., M.B., H.A., J.-F.D., P.M., P.D., F.D., F.B., G.C.), Centre INSERM U897 and CIC-1401, Bordeaux School of Public Health; University of Bordeaux (C.D., L.R., R.T., M.B., H.A., J.-F.D., P.M., P.D., F.D., F.B., G.C.); and Public Health Department (C.D., L.R., R.T., M.B., F.D., G.C.), Internal Medicine and Infectious Disease Department (F.-A.D., P.M., P.D., F.B.), Neurology Department (J.-F.D.), and Infectious and Tropical Diseases Federation (D.N.), Bordeaux Hospital, France
| | - Rodolphe Thiébaut
- From INSERM (C.D., L.R., R.T., M.B., H.A., J.-F.D., P.M., P.D., F.D., F.B., G.C.), Centre INSERM U897 and CIC-1401, Bordeaux School of Public Health; University of Bordeaux (C.D., L.R., R.T., M.B., H.A., J.-F.D., P.M., P.D., F.D., F.B., G.C.); and Public Health Department (C.D., L.R., R.T., M.B., F.D., G.C.), Internal Medicine and Infectious Disease Department (F.-A.D., P.M., P.D., F.B.), Neurology Department (J.-F.D.), and Infectious and Tropical Diseases Federation (D.N.), Bordeaux Hospital, France
| | - Mathias Bruyand
- From INSERM (C.D., L.R., R.T., M.B., H.A., J.-F.D., P.M., P.D., F.D., F.B., G.C.), Centre INSERM U897 and CIC-1401, Bordeaux School of Public Health; University of Bordeaux (C.D., L.R., R.T., M.B., H.A., J.-F.D., P.M., P.D., F.D., F.B., G.C.); and Public Health Department (C.D., L.R., R.T., M.B., F.D., G.C.), Internal Medicine and Infectious Disease Department (F.-A.D., P.M., P.D., F.B.), Neurology Department (J.-F.D.), and Infectious and Tropical Diseases Federation (D.N.), Bordeaux Hospital, France
| | - Hélène Amieva
- From INSERM (C.D., L.R., R.T., M.B., H.A., J.-F.D., P.M., P.D., F.D., F.B., G.C.), Centre INSERM U897 and CIC-1401, Bordeaux School of Public Health; University of Bordeaux (C.D., L.R., R.T., M.B., H.A., J.-F.D., P.M., P.D., F.D., F.B., G.C.); and Public Health Department (C.D., L.R., R.T., M.B., F.D., G.C.), Internal Medicine and Infectious Disease Department (F.-A.D., P.M., P.D., F.B.), Neurology Department (J.-F.D.), and Infectious and Tropical Diseases Federation (D.N.), Bordeaux Hospital, France
| | - Frédéric-Antoine Dauchy
- From INSERM (C.D., L.R., R.T., M.B., H.A., J.-F.D., P.M., P.D., F.D., F.B., G.C.), Centre INSERM U897 and CIC-1401, Bordeaux School of Public Health; University of Bordeaux (C.D., L.R., R.T., M.B., H.A., J.-F.D., P.M., P.D., F.D., F.B., G.C.); and Public Health Department (C.D., L.R., R.T., M.B., F.D., G.C.), Internal Medicine and Infectious Disease Department (F.-A.D., P.M., P.D., F.B.), Neurology Department (J.-F.D.), and Infectious and Tropical Diseases Federation (D.N.), Bordeaux Hospital, France
| | - Jean-François Dartigues
- From INSERM (C.D., L.R., R.T., M.B., H.A., J.-F.D., P.M., P.D., F.D., F.B., G.C.), Centre INSERM U897 and CIC-1401, Bordeaux School of Public Health; University of Bordeaux (C.D., L.R., R.T., M.B., H.A., J.-F.D., P.M., P.D., F.D., F.B., G.C.); and Public Health Department (C.D., L.R., R.T., M.B., F.D., G.C.), Internal Medicine and Infectious Disease Department (F.-A.D., P.M., P.D., F.B.), Neurology Department (J.-F.D.), and Infectious and Tropical Diseases Federation (D.N.), Bordeaux Hospital, France
| | - Didier Neau
- From INSERM (C.D., L.R., R.T., M.B., H.A., J.-F.D., P.M., P.D., F.D., F.B., G.C.), Centre INSERM U897 and CIC-1401, Bordeaux School of Public Health; University of Bordeaux (C.D., L.R., R.T., M.B., H.A., J.-F.D., P.M., P.D., F.D., F.B., G.C.); and Public Health Department (C.D., L.R., R.T., M.B., F.D., G.C.), Internal Medicine and Infectious Disease Department (F.-A.D., P.M., P.D., F.B.), Neurology Department (J.-F.D.), and Infectious and Tropical Diseases Federation (D.N.), Bordeaux Hospital, France
| | - Philippe Morlat
- From INSERM (C.D., L.R., R.T., M.B., H.A., J.-F.D., P.M., P.D., F.D., F.B., G.C.), Centre INSERM U897 and CIC-1401, Bordeaux School of Public Health; University of Bordeaux (C.D., L.R., R.T., M.B., H.A., J.-F.D., P.M., P.D., F.D., F.B., G.C.); and Public Health Department (C.D., L.R., R.T., M.B., F.D., G.C.), Internal Medicine and Infectious Disease Department (F.-A.D., P.M., P.D., F.B.), Neurology Department (J.-F.D.), and Infectious and Tropical Diseases Federation (D.N.), Bordeaux Hospital, France
| | - Patrick Dehail
- From INSERM (C.D., L.R., R.T., M.B., H.A., J.-F.D., P.M., P.D., F.D., F.B., G.C.), Centre INSERM U897 and CIC-1401, Bordeaux School of Public Health; University of Bordeaux (C.D., L.R., R.T., M.B., H.A., J.-F.D., P.M., P.D., F.D., F.B., G.C.); and Public Health Department (C.D., L.R., R.T., M.B., F.D., G.C.), Internal Medicine and Infectious Disease Department (F.-A.D., P.M., P.D., F.B.), Neurology Department (J.-F.D.), and Infectious and Tropical Diseases Federation (D.N.), Bordeaux Hospital, France
| | - François Dabis
- From INSERM (C.D., L.R., R.T., M.B., H.A., J.-F.D., P.M., P.D., F.D., F.B., G.C.), Centre INSERM U897 and CIC-1401, Bordeaux School of Public Health; University of Bordeaux (C.D., L.R., R.T., M.B., H.A., J.-F.D., P.M., P.D., F.D., F.B., G.C.); and Public Health Department (C.D., L.R., R.T., M.B., F.D., G.C.), Internal Medicine and Infectious Disease Department (F.-A.D., P.M., P.D., F.B.), Neurology Department (J.-F.D.), and Infectious and Tropical Diseases Federation (D.N.), Bordeaux Hospital, France
| | - Fabrice Bonnet
- From INSERM (C.D., L.R., R.T., M.B., H.A., J.-F.D., P.M., P.D., F.D., F.B., G.C.), Centre INSERM U897 and CIC-1401, Bordeaux School of Public Health; University of Bordeaux (C.D., L.R., R.T., M.B., H.A., J.-F.D., P.M., P.D., F.D., F.B., G.C.); and Public Health Department (C.D., L.R., R.T., M.B., F.D., G.C.), Internal Medicine and Infectious Disease Department (F.-A.D., P.M., P.D., F.B.), Neurology Department (J.-F.D.), and Infectious and Tropical Diseases Federation (D.N.), Bordeaux Hospital, France
| | - Geneviève Chêne
- From INSERM (C.D., L.R., R.T., M.B., H.A., J.-F.D., P.M., P.D., F.D., F.B., G.C.), Centre INSERM U897 and CIC-1401, Bordeaux School of Public Health; University of Bordeaux (C.D., L.R., R.T., M.B., H.A., J.-F.D., P.M., P.D., F.D., F.B., G.C.); and Public Health Department (C.D., L.R., R.T., M.B., F.D., G.C.), Internal Medicine and Infectious Disease Department (F.-A.D., P.M., P.D., F.B.), Neurology Department (J.-F.D.), and Infectious and Tropical Diseases Federation (D.N.), Bordeaux Hospital, France
| | | |
Collapse
|
36
|
Erlandson KM, Schrack JA, Jankowski CM, Brown TT, Campbell TB. Functional impairment, disability, and frailty in adults aging with HIV-infection. Curr HIV/AIDS Rep 2015; 11:279-90. [PMID: 24966138 DOI: 10.1007/s11904-014-0215-y] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The integration of antiretroviral therapy (i.e., ART) into HIV care has dramatically extended the life expectancy of those living with HIV. However, in comparison to similar HIV-uninfected populations, HIV-infected persons experience an excess of morbidity and mortality with an early onset of aging complications including neurocognitive decline, osteoporosis, impaired physical function, frailty, and falls. Recent consensus guidelines encourage clinicians and researchers to consider functional impairment of HIV-infected adults as a measure to understand the impact of aging across a range of abilities. Despite the importance of assessing function in persons aging with HIV infection, a lack of consistent terminology and standardization of assessment tools has limited the application of functional assessments in clinical or research settings. Herein, we distinguish between different approaches used to assess function, describe what is known about function in the aging HIV population, and consider directions for future research.
Collapse
Affiliation(s)
- Kristine M Erlandson
- Department of Medicine, Divisions of Infectious Diseases, University of Colorado, 12700 E. 19th Avenue, Mail Stop B168, Aurora, CO, 80045, USA,
| | | | | | | | | |
Collapse
|
37
|
Greene M, Covinsky K, Astemborski J, Piggott DA, Brown T, Leng S, Galai N, Mehta SH, Guralnik J, Patel KV, Kirk GD. The relationship of physical performance with HIV disease and mortality. AIDS 2014; 28:2711-9. [PMID: 25493597 PMCID: PMC4380225 DOI: 10.1097/qad.0000000000000507] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To evaluate whether HIV infection was associated with reduced physical performance, and to examine if reduced physical performance predicted mortality in our aging cohort of HIV-infected and HIV-uninfected persons. DESIGN Prospective, observational cohort of current and former injection drug users in the AIDS Linked to the IntraVenous Experience study in Baltimore, Maryland, USA. METHODS The Short Physical Performance Battery (SPPB) was used as an objective measure of physical performance and measured semiannually along with behavioral and demographic data. Correlates of reduced physical performance (SPPB score ≤10) were identified and the relationship between reduced physical performance, HIV infection and mortality was analyzed by Cox regression. RESULTS Among 12 270 person-visits contributed by 1627 participants, the median age was 51, 30.3% were HIV-infected and 32.6% had an SPPB score 10 or less. In multivariable models, HIV infection was independently associated with 30% increased odds of reduced physical performance [odds ratio 1.30; 95% confidence interval (CI):1.12-1.52]. Reduced physical performance predicted mortality in a dose-response manner and within all HIV disease strata. Whereas reduced physical performance alone (hazard ratio 2.52, 95% CI: 1.59-4.00) and HIV infection alone (hazard ratio 2.78, 95% CI: 1.70-4.54) increased mortality, HIV-infected participants with reduced physical performance had a six-fold increased mortality risk (hazard ratio 6.03, 95% CI: 3.80-10.0) compared with HIV-uninfected participants with higher physical performance. CONCLUSION HIV infection was independently associated with reduced physical performance. HIV and reduced physical performance have independent and joint effects on mortality. Physical performance measurement may be an important research and clinical tool to predict adverse outcomes among aging HIV-infected persons.
Collapse
Affiliation(s)
- Meredith Greene
- Division of Geriatrics, Department of Medicine, University of California San Francisco
- San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Kenneth Covinsky
- Division of Geriatrics, Department of Medicine, University of California San Francisco
- San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Jacquie Astemborski
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Damani A. Piggott
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Todd Brown
- Division of Endocrinology and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sean Leng
- Division of Geriatrics and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Statistics, University of Haifa, Mt Carmel, Israel
| | - Shruti H. Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jack Guralnik
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Kushang V. Patel
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
| | - Gregory D. Kirk
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
38
|
Erlandson KM, Allshouse AA, Jankowski CM, Mawhinney S, Kohrt WM, Campbell TB. Relationship of physical function and quality of life among persons aging with HIV infection. AIDS 2014; 28:1939-43. [PMID: 24992000 DOI: 10.1097/qad.0000000000000384] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Physical function impairments are seen among aging, HIV-infected persons on effective antiretroviral therapy (ART). The impact of physical function impairments on health-related quality of life (QoL) during ART is unknown. DESIGN This was a cross-sectional study including 359 HIV-infected patients, aged 45-65 years, on ART for more than 6 months. METHODS Patients completed the SF-36 QoL questionnaire, 400-m walk, 5-time chair rise, and grip strength. HIV-associated mortality risk was calculated using the Veterans Aging Cohort Study (VACS) Index. Physical function, physical activity (> 500 versus ≤ 500 kcal/week), and VACS scores were used to estimate QoL in multivariable linear regression. RESULTS For every 1 m/s increase in gait speed, we saw an estimated 11.8 [95% confidence interval (CI) 8.4, 15.2] point increase in the physical function scale with smaller differences across all subscales. For every 1 rise/s faster chair rise pace, we saw an estimated 16.0 (95% CI 9.1, 22.9) point increase in the physical function scale with smaller differences across all subscales. SF-36 scores were between 2.8 and 5.7 points higher among more physically active compared to less active patients. A 1 kg increase in grip strength was associated with a 0.2 (95% CI 0.01, 0.3) higher mental health score, but there were no differences in other subscales. VACS scores did not improve the model. CONCLUSIONS Faster gait speed and chair rise time, and greater physical activity were associated with greater QoL, independent of HIV-related mortality risk. Targeted exercise programs to increase physical activity and improve speed and power should be evaluated as interventions to improve QoL during ART.
Collapse
|
39
|
Association of chronic cough and pulmonary function with 6-minute walk test performance in HIV infection. J Acquir Immune Defic Syndr 2014; 65:557-63. [PMID: 24346638 DOI: 10.1097/qai.0000000000000086] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Chronic lung disease has been associated with greater impairment in self-reported physical function in HIV-infected patients. We sought to study this association using objective measures of physical function and pulmonary function. DESIGN Baseline data from the Examinations of HIV Associated Lung Emphysema study, a multicenter observational cohort of HIV-infected and uninfected veterans. METHODS We assessed the association between clinical, laboratory, and pulmonary function measures with 6-minute walk test (6-MWT). Multivariable linear regression models were generated to identify factors associated with 6-MWT performance. RESULTS Three hundred forty participants completed 6-MWT (mean age 55 years), with 68% blacks, 94% men, and 62% current smokers. Overall, 180 (53%) were HIV-infected and 63 (19%) had spirometry-defined chronic obstructive pulmonary disease. In a multivariable model, age, current smoking, and obesity (body mass index > 30) were independently associated with lower 6-MWT performance, but HIV infection was not; there was a significant interaction between HIV and chronic cough, such that distance walked among HIV-infected participants with chronic cough was 51.76 m less (P = 0.04) compared with those without cough or HIV. Among HIV-infected participants, the forced expiratory volume in 1 second (FEV1, percent predicted), to a greater extent than total lung capacity or diffusing capacity, attenuated the association with chronic cough; decreased FEV1 was independently associated with lower 6-MWT performance in those with HIV. CONCLUSIONS Older age, current smoking, and airflow limitation were important determinants of 6-MWT performance in the HIV-infected participants. These findings suggest that potential interventions to improve physical function may include early management of respiratory symptoms and airflow limitation.
Collapse
|
40
|
|
41
|
Abstract
OBJECTIVES To assess changes in locomotor function in HIV-infected patients and to evaluate the determinants of variations in lower limb muscle performance. DESIGN Longitudinal study within the ANRS CO3 Aquitaine Cohort. METHODS Standardized locomotor tests, including global functional capacity [6-min walk distance (6MWD)] and lower limb muscle performance tests [five times sit-to-stand (5STS) test], were performed in HIV-infected adults at baseline and 2-year follow-up. Evolution of performances and determinants of 5STS time were studied in linear mixed-effects models. RESULTS At baseline (354 patients, 90% on antiretroviral treatment), median 5STS time was 9.8 s and 6MWD 549 m. Poorer performances were associated with falls, reported by 12% of 178 patients at follow-up. Estimated mean deterioration was +0.24 s/year (P < 10) for 5STS time and -11 m/year (P < 10) for 6MWD. In multivariable analyses, older age was associated with worse baseline 5STS time (+0.47 s/10-year age increase; P = 10), but not with further deterioration. Deterioration was greater in prior injecting drug users compared to others (difference in slope +0.62 s/year; P = 0.04). 5STS time at any time point was worse in patients with history of cerebral AIDS conditions (+2.47 s; P < 10) and diabetes (+0.95 s; P = 0.02) than in others. No significant associations were found for antiretroviral treatment type, viral load or CD4 cell count. CONCLUSION Compared to published data from healthy persons of similar age, baseline 5STS time and 6MWD were poorer in HIV-infected adults and associated with subsequent falls. Test performances deteriorated further over time. Age, diabetes, neurologic complications and injection drug use, rather than virologic factors, contribute to variations in lower limb muscle performance.
Collapse
|
42
|
Richert L, Brault M, Mercié P, Dauchy FA, Bruyand M, Greib C, Dabis F, Bonnet F, Chêne G, Dehail P. Handgrip strength is only weakly correlated with physical function in well-controlled HIV infection: ANRS CO3 Aquitaine Cohort. J Acquir Immune Defic Syndr 2014; 65:e25-7. [PMID: 24419068 DOI: 10.1097/qai.0b013e3182a03db8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Laura Richert
- *INSERM, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux, France †Université de Bordeaux, Bordeaux, France ‡Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France §EA 4136, Université de Bordeaux, Bordeaux, France
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
A comparative study of the five-times-sit-to-stand and timed-up-and-go tests as measures of functional mobility in persons with and without injection-related venous ulcers. Adv Skin Wound Care 2014; 27:82-92; quiz 93-4. [PMID: 24440866 DOI: 10.1097/01.asw.0000442876.94332.26] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To provide information on the Five-Times-Sit-to-Stand (FTSTS) and Timed-Up-and-Go (TUG) tests in persons with injection-related venous ulcers (VU+) and persons without venous ulcers (VU-). TARGET AUDIENCE This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES After participating in this educational activity, the participant should be better able to: ABSTRACT OBJECTIVE To examine functional mobility using Five-Times-Sit-to-Stand (FTSTS) and Timed-Up-and-Go (TUG) tests in persons with injection-related venous ulcers (VU+) and compare these findings to persons without venous ulcers (VU-). DESIGN Cross-sectional, comparative design. SETTING Outpatient clinic.PARTICPANTS: Participants (n = 61) were 31 persons VU+ and 30 persons VU-; 57.4% men; mean age, 54 years; 93% African American. MAIN OUTCOME MEASURES Five-Times-Sit-to-Stand, TUG, physical activity, quality of life, comorbidities, falls, and body mass index. RESULTS Participants VU+ were 36.8% slower on completion of the TUG test (P = .012) and 26.5% slower on completion of the FTSTS test (P = .081). Five-Times-Sit-to-Stand and TUG were strongly correlated with each other, r = 0.93, 0.87, P < .001 for VU- and VU+, respectively. Test-retest reliabilities for the FTSTS and TUG tests were high (intraclass correlation coefficient = 0.89-0.94) for the VU+ and VU-. Within each group, correlations of FTSTS and TUG were similar for each of the variables examined. Across groups, correlations showed that the time to complete FTSTS and TUG increased as a function of comorbidities in the VU+ group; the correlations in the VU- group were not significantly different from zero. CONCLUSIONS The VU+ group exhibited poorer physical performance than the VU- group. The high correlation between FTSTS and TUG and the similarity of correlations with other variables suggest that these physical performance measures may be interchangeable in their ability to predict physical functioning in these clinical groups despite differences in test demands. Clinicians need easy-to-perform reliable clinical tests such as FTSTS and TUG to assess mobility of aging injection users with venous ulcers.
Collapse
|
44
|
Wasserman P, Segal-Maurer S, Rubin DS. High Prevalence of Low Skeletal Muscle Mass Associated with Male Gender in Midlife and Older HIV-Infected Persons Despite CD4 Cell Reconstitution and Viral Suppression. ACTA ACUST UNITED AC 2013; 13:145-52. [DOI: 10.1177/2325957413495919] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Therapeutic goals for HIV-infected patients receiving antiretroviral therapy include minimizing risk of future physical disability. Presarcopenia and sarcopenia precede age-associated physical disability. We investigated their prevalence and the predictive value of patient mid-upper arm circumference (MUAC) for them. Eighty community-dwelling patients ≥45 years old demonstrating durable viral suppression were evaluated. Sarcopenia was defined as low skeletal muscle index (SMI, skeletal muscle kg/height m2) and either low strength or poor performance by handgrip dynamometry and gait speed, respectively. Presarcopenia was defined as low SMI only. MUAC was interpreted according to National Health Statistics percentile. Prevalence of sarcopenia and presarcopenia was 5.0% and 20.0%, respectively. Male gender (odds ratio [OR] 10.72; P < .026), recreational psychoactive substance use (OR 5.13; P < .037), and intravenous drug use transmission category (OR 6.94; P <.0327) were associated with presarcopenia. Higher body mass index (OR 0.80; P < .0007), MUAC (OR 0.83; P < .024), and large skeletal frame (OR 0.09; P < .003) were negatively associated with presarcopenia. Finding that a participant did not have a MUAC <25th percentile on physical examination had a 90.4% negative predictive value for presarcopenia. Although sarcopenia was uncommon, presarcopenia was highly prevalent in midlife and older HIV-infected males. Determination of MUAC percentile may identify those least likely to demonstrate skeletal muscle deficit and improve patient selection for mass and function testing.
Collapse
Affiliation(s)
- Peter Wasserman
- Department of Medicine, Infectious Disease Division, New York Hospital Queens, Flushing, NY, USA
| | - Sorana Segal-Maurer
- Department of Medicine, Infectious Disease Division, New York Hospital Queens, Flushing, NY, USA
| | - David S. Rubin
- Department of Medicine, Infectious Disease Division, New York Hospital Queens, Flushing, NY, USA
| |
Collapse
|
45
|
Oursler KK, Tate JP, Gill TM, Crothers K, Brown TT, Crystal S, Womack J, Leaf DA, Sorkin JD, Justice AC. Association of the veterans aging cohort study index with exercise capacity in HIV-infected adults. AIDS Res Hum Retroviruses 2013; 29:1218-23. [PMID: 23705911 DOI: 10.1089/aid.2012.0388] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Physical disability is a major priority in aging, affecting morbidity, mortality, and quality of life. Despite the large number of adults aging with HIV, our understanding of the physiologic and clinical risk factors for disability is limited. Our goal is to determine whether the Veterans Aging Cohort Study (VACS) Index, based on routine clinical blood tests, could serve as a point of care screening tool to identify HIV-infected adults at high risk for physical disability. HIV-infected adults enrolled in the VACS participated in a cross-sectional exercise study with established measures of strength and endurance. The VACS Index was calculated using recent clinical laboratory values and age; a higher score reflects greater mortality risk. Statistical analyses included correlation and linear regression models adjusted for muscle mass. Fifty-five HIV-infected adults, predominantly African-American men, were included with age mean±SD of 52±7 years. Median (IQR) CD4 cell count was 356 cells/mm(3) (212-527). The VACS Index was inversely correlated with quadriceps strength (r=-0.45, p<0.01), grip strength (r=-0.28, p=0.04), and 6-min walk distance (r=-0.27, p=0.05). A 20-point increase in VACS Index score was associated with a 10% lower leg strength (p<0.01), which remained significant after adjustment for muscle cross-sectional area (p=0.02). The VACS Index explained 31% of the variance in specific leg strength. In this group of middle-aged adults with well-controlled HIV infection the VACS Index was significantly associated with upper and lower extremity strength. The VACS Index may be valuable for identification of patients at high risk for disability due to muscle weakness.
Collapse
Affiliation(s)
- Krisann K. Oursler
- University of Maryland School of Medicine and the Baltimore VA Medical Center Geriatric Research, Education, and Clinical Center, Baltimore, Maryland
| | - Janet P. Tate
- Yale University School of Medicine and Public Health, and VA Connecticut Healthcare System, New Haven, Connecticut
| | - Thomas M. Gill
- Yale School of Medicine, Department of Internal Medicine, New Haven, Connecticut
| | | | - Todd T. Brown
- Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Stephen Crystal
- Center for Health Services Research on Pharmacotherapy, Chronic Disease Management, and Outcomes, Institute for Health, Rutgers University, New Brunswick, New Jersey
| | | | - David A. Leaf
- UCLA School of Medicine and Greater Los Angeles VA Healthcare System, Los Angeles, California
| | - John D. Sorkin
- University of Maryland School of Medicine and the Baltimore VA Medical Center Geriatric Research, Education, and Clinical Center, Baltimore, Maryland
| | - Amy C. Justice
- Yale University School of Medicine and Public Health, and VA Connecticut Healthcare System, New Haven, Connecticut
| |
Collapse
|
46
|
Muscular weakness in individuals with HIV associated with a disorganization of the cortico-spinal tract: a multi-modal MRI investigation. PLoS One 2013; 8:e66810. [PMID: 23874398 PMCID: PMC3708953 DOI: 10.1371/journal.pone.0066810] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 05/12/2013] [Indexed: 12/11/2022] Open
Abstract
Motor impairment is highly prevalent in HIV-infected patients. Here, we assess associations between peripheral muscular deficits as evaluated by the 5 sit-to-stand test (5STS) and structural integrity of the motor system at a central level. Eighty-six HIV-infected patients receiving combination antiretroviral therapy and with no major cerebral events, underwent an MRI scan and the 5STS. Out of 86 participants, forty presented a score greater than two standard deviations above mean normative scores calculated for the 5STS and were therefore considered as motor-impaired. MRI-structural cerebral parameters were compared to the unimpaired participants. Fractional Anisotropy (FA), Axial Diffusivity (AD) and Radial Diffusivity (RD), reflecting microstructural integrity, were extracted from Diffusion-Tensor MRI. Global and regional cerebral volumes or thicknesses were extracted from 3D-T1 morphological MRI. Whereas the two groups did not differ for any HIV variables, voxel-wise analysis revealed that motor-impaired participants present low FA values in various cortico-motor tracts and low AD in left cortico-spinal tract. However, they did not present reduced volumes or thicknesses of the precentral cortices compared to unimpaired participants. The absence of alterations in cortical regions holding motor-neurons might argue against neurodegenerative process as an explanation of White Matter (WM) disorganization.
Collapse
|
47
|
Functional impairment is associated with low bone and muscle mass among persons aging with HIV infection. J Acquir Immune Defic Syndr 2013; 63:209-15. [PMID: 23392468 DOI: 10.1097/qai.0b013e318289bb7e] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Disability and frailty are associated with osteoporosis, obesity, and sarcopenia. HIV-infected persons have early functional impairment, but the association between body composition and functional impairment is unknown. METHODS HIV-1-infected participants on combination antiretroviral therapy with virologic suppression, aged 45-65 years, had standardized physical function measures. In a nested analysis, 30 low- and 48 high-functioning cases and controls were matched by age, gender, and time since HIV diagnosis. Bone mineral density, fat mass, and lean body mass were assessed by dual-energy x-ray absorptiometry. Odds ratios (ORs) with 95% confidence intervals were obtained from conditional logistic regression. RESULTS Mean age was 53 years, mean CD4(+) lymphocytes 598 cells per microliter, and 96% had plasma HIV-1 RNA <50 copies per milliliter. Low- and high-function subjects had similar CD4(+) lymphocyte count and duration and type of antiretroviral therapy. Lower T scores at the hip [OR: 3.8 (1.1 to 12.5)] and lumbar spine [OR: 2.3 (1.1 to 4.5)] and lower lean body mass [OR: 1.1 (1.0 to 1.2)] were associated with significantly greater odds of low function (P ≤ 0.03). Lower insulin-like growth hormone [IGF-1; OR: 5.0 (1.4 to 20.0)] and IGF-1 binding protein-3 [OR: 3.3 (1.7 to 9.9)] increased the odds of low functional status (P ≤ 0.02). Fat mass and lower 25-OH vitamin D did not increase the odds of low functional status (P > 0.05). CONCLUSIONS Functional impairment in HIV-1-infected persons on successful antiretroviral therapy is associated with low muscle mass, low bone mineral density, and low IGF-1 and IGF-1 binding protein-3. These characteristics may be a manifestation of early "somatopause" in middle-aged HIV-infected adults.
Collapse
|
48
|
Ruiz MA, Reske T, Cefalu C, Estrada J. Falls in HIV-infected patients: a geriatric syndrome in a susceptible population. J Int Assoc Provid AIDS Care 2013; 12:266-9. [PMID: 23719236 DOI: 10.1177/2325957413488204] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Falls is a common geriatric syndrome that has not been well characterized in HIV-infected populations. METHODS We retrospectively reviewed our database and identified patients who fell over the last 12 months. RESULTS Thirty-two patients were identified (incidence rate of 16 × 1000 patients per year). Twenty-five percent were female and 75% male. Sixty-seven percent were African American with 33% Caucasians. Average age was 48.19, number of years with HIV infection on average was 9.38 years, mean CD4 count 347.2 cell/mm(3), mean HIV viral load was 31 379 copies/mL. The average number of medications was 8.7 with a mean of 3.48 comorbidities. The mean vitamin D level was 27.20. Sixty-two percent of patients were compliant with antiretroviral therapy. Univariate and multivariate analysis showed that number of medications (< .005 medications; P < .005), more than 3 comorbidities (P < .005), and noncompliance (P < .001) were related to falls in this population. CONCLUSION Falls is a common geriatric syndrome. Associated risk factors in our cohort included number of medications, more than 3 comorbidities, and noncompliance. Larger studies are needed to properly characterize this geriatric syndrome in HIV-infected patients. As HIV-infected populations age, a shift into a more comprehensive geriatrics care including fall risk evaluation may be needed.
Collapse
Affiliation(s)
- Marco Andres Ruiz
- Louisiana State University Health Sciences Center, New Orleans, LA, USA.
| | | | | | | |
Collapse
|
49
|
Mbada CE, Onayemi O, Ogunmoyole Y, Johnson OE, Akosile CO. Health-related quality of life and physical functioning in people living with HIV/AIDS: a case-control design. Health Qual Life Outcomes 2013; 11:106. [PMID: 23802924 PMCID: PMC3698161 DOI: 10.1186/1477-7525-11-106] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Accepted: 06/19/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health-Related Quality of Life (HRQoL) and functional exercise capacity are important area of therapeutic interventions needed to improve the general health of People Living with HIV/AIDS (PLWH). However, the relationship between self-report and Performance-based Measure of Functional Capacity (PMFC) of PLWH is still obscure. This study compared the HRQoL and PMFC between a homogenous sample of clinical stage I PLWH and apparently healthy controls. METHODS This case-control study involved 74 consenting participants (37 PLWH and 37 controls) who completed the self-report SF-12 questionnaire and PMFC assessment using Six Minute Walk Test (6MWT). PMFC was expressed in terms of Six-Minute Walk Distance (6MWD), Six-Minute Walk Work (6MWW) and Maximum oxygen uptake (VO2max). Data were analyzed using descriptive statistics of mean and inferential statistics of independent t-test, ANOVA and Pearson's product moment correlation. Alpha level was set at 0.05. RESULTS There was no significant difference in the SF-12 Physical-health Component Score (PCS) of PLWH and the controls (p=0.782). However, the SF-12 Mental-health Component Score (MCS) of PLWH was higher than that of controls (p=0.040). 6MWD, 6MWW and VO2max were significantly lower for PLWH (p<0.05). Among PLWH, there was no significant gender differences in the PMFC (p>0.05) while PCS was higher among females. There was no significant correlation between PMFC variables and each of PCS and MCS for PLWH and controls (p>0.05) respectively. CONCLUSION Self-report physical health of clinical stage 1 PLWH and controls was comparable, while self-report mental health capacity was higher in PLWH than the controls. PMFC of PLWH was significantly lower compared to healthy controls without gender bias. Overall, self-report and performance-based measure of physical functional capacity of PLWH was not inter-related. Therefore understanding the factors that may influence exercise capacity of PLWH may help to develop effective exercise programmes for PLWH.
Collapse
Affiliation(s)
- Chidozie Emmanuel Mbada
- Department of Medical Rehabilitation, College of Health Sciences, Obafemi Awolowo University, Ile – Ife, Nigeria
| | - Olaniyi Onayemi
- Department of Dermatology and Veneriology, Faculty of Clinical Sciences, College of Health Sciences, Obafemi Awolowo University, Ile – Ife, Nigeria
| | - Yewande Ogunmoyole
- Department of Physiotherapy, Obafemi Awolowo University Teaching Hospitals Complex, Ile – Ife, Nigeria
| | - Olubusola Esther Johnson
- Department of Medical Rehabilitation, College of Health Sciences, Obafemi Awolowo University, Ile – Ife, Nigeria
| | - Christopher O Akosile
- Department of Medical Rehabilitation, College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus, Nnewi, Anambra State, Nigeria
| |
Collapse
|
50
|
Handgrip force offers a measure of physical function in individuals living with HIV/AIDS. J Acquir Immune Defic Syndr 2013; 63:e30-2. [PMID: 23574925 DOI: 10.1097/qai.0b013e31828c42bb] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|