Interventions to Address Chronic Disease and HIV: Strategies to Promote Exercise and Nutrition Among HIV-Infected Individuals Authors
Behavioral Aspects of HIV Management (RJ DiClemente and JL Brown, Section Editors)
First Online: 30 August 2012 DOI:
Cite this article as: Botros, D., Somarriba, G., Neri, D. et al. Curr HIV/AIDS Rep (2012) 9: 351. doi:10.1007/s11904-012-0135-7 Abstract
Food insecurity, micronutrient deficits, dyslipidemia, insulin resistance, obesity, cardiovascular disease, and bone disorders complicate the treatment of HIV infection. Nutrition and exercise interventions can be effective in ameliorating these symptoms that are associated with HIV and antiretroviral therapy (ART). In this literature review, we examine the most recent nutrition and exercise interventions for HIV-infected patients. Macronutrient supplementation can be useful in treating malnutrition and wasting. Multivitamin (vitamin B complex, vitamin C, and vitamin E) supplements and vitamin D may improve quality of life and decrease morbidity and mortality. Nutritional counseling and exercise interventions are effective for treating obesity, fat redistribution, and metabolic abnormalities. Physical activity interventions improve body composition, strength, and fitness in HIV-infected individuals. Taken collectively, the evidence suggests that a proactive approach to nutrition and physical activity guidance and interventions can improve outcomes and help abrogate the adverse metabolic, cardiovascular, and psychological consequences of HIV and its treatments.
Keywords HIV Chronic disease and HIV Nutrition Physical activity Interventions Cardiometabolic disease Malnutrition Antiretroviral therapy (ART) Multivitamin supplementation Vitamin D References Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Fitch K, Grinspoon S. Nutritional and metabolic correlates of cardiovascular and bone disease in HIV-infected patients. Am J Clin Nutr. 2011;94(6):1721S–8S.
Palella Jr FJ, Phair JP. Cardiovascular disease in HIV infection. Curr Opin HIV AIDS. 2011;6(4):266–71.
Tseng ZH, Secemsky EA, Dowdy D, Vittinghoff E, Moyers B, Wong JK, et al. Sudden cardiac death in patients with human immunodeficiency virus infection. J Am Coll Cardiol. 2012;59(21):1891–6.
Arbeitman LOBR, Somarriba G, Ludwig D, Messiah S, Neri D, Scott G, Miller T, editors. Prevalence of Obesity in HIV-Infected Children in a Miami Cohort. Boston: Pediatric Academic Societies; 2012 (abstract #450452).
Fields-Gardner C, Campa A, American Dietetics A. Position of the American dietetic association: nutrition intervention and human immunodeficiency virus infection. J Am Diet Assoc. 2010;110(7):1105–19.
Chandra RK. Nutrition, immunity and infection: from basic knowledge of dietary manipulation of immune responses to practical application of ameliorating suffering and improving survival. Proc Natl Acad Sci U S A. 1996;93(25):14304–7.
Hughes S, Kelly P. Interactions of malnutrition and immune impairment, with specific reference to immunity against parasites. Parasite Immunol. 2006;28(11):577–88.
Chandrasekhar A, Gupta A. Nutrition and disease progression pre-highly active antiretroviral therapy (HAART) and post-HAART: can good nutrition delay time to HAART and affect response to HAART? Am J Clin Nutr. 2011;94(6):1703S–15S.
Raiten DJ. Nutrition and pharmacology: general principles and implications for HIV. Am J Clin Nutr. 2011;94(6):1697S–702S.
Raiten DJ, Mulligan K, Papathakis P, Wanke C. Executive summary--nutritional care of HIV-infected adolescents and adults, including pregnant and lactating women: what do we know, what can we do, and where do we go from here? Am J Clin Nutr vol 6. United States 2011. p. 1667S-76S.
Ivers LC, Cullen KA. Food insecurity: special considerations for women. Am J Clin Nutr. 2011;94(6):1740S–4S.
Kosmiski L. Energy expenditure in HIV infection. Am J Clin Nutr. 2011;94(6):1677S–82S.
Musoke PM, Fergusson P. Severe malnutrition and metabolic complications of HIV-infected children in the antiretroviral era: clinical care and management in resource-limited settings. Am J Clin Nutr. 2011;94(6):1716S–20S.
Weiser SD, Young SL, Cohen CR, Kushel MB, Tsai AC, Tien PC, et al. Conceptual framework for understanding the bidirectional links between food insecurity and HIV/AIDS. Am J Clin Nutr. 2011;94(6):1729S–39S.
Larson NI, Story MT. Food insecurity and weight status among U.S. children and families: a review of the literature. Am J Prev Med. 2011;40(2):166–73.
Bahwere P, Deconinck H, Banda T, Mtimuni A, Collins S. Impact of household food insecurity on the nutritional status and the response to therapeutic feeding of people living with human immunodeficiency virus. Patient Prefer Adherence. 2011;5:619–27.
Yager JE, Kadiyala S, Weiser SD. HIV/AIDS, food supplementation and livelihood programs in Uganda: a way forward? PLoS One. 2011;6(10):e26117.
Ahoua L, Umutoni C, Huerga H, Minetti A, Szumilin E, Balkan S, et al. Nutrition outcomes of HIV-infected malnourished adults treated with ready-to-use therapeutic food in sub-Saharan Africa: a longitudinal study. J Int AIDS Soc. 2011;14:2.
Kundu CK, Samanta M, Sarkar M, Bhattacharyya S, Chatterjee S. Food supplementation as an incentive to improve pre-antiretroviral therapy clinic adherence in HIV-positive children–experience from eastern India. J Trop Pediatr. 2012;58(1):31–7.
• Kayira D, Bentley ME, Wiener J, Mkhomawanthu C, King CC, Chitsulo P, et al. A lipid-based nutrient supplement mitigates weight loss among HIV-infected women in a factorial randomized trial to prevent mother-to-child transmission during exclusive breastfeeding. Am J Clin Nutr. 2012;95(3):759–65.
This study reports that a lipid-based supplement diminishes weight loss in HIV-infected pregnant women living in a resource-limited setting. Optimization of maternal nutrition may ultimately impact pregnancy and infant outcomes
Kindra G, Coutsoudis A, Esposito F. Effect of nutritional supplementation of breastfeeding HIV positive mothers on maternal and child health: findings from a randomized controlled clinical trial. BMC Public Health. 2011;11:946.
Hummelen R, Vos AP, van't Land B, van Norren K, Reid G. Altered host-microbe interaction in HIV: a target for intervention with pro- and prebiotics. Int Rev Immunol. 2010;29(5):485–513.
Hummelen R, Hemsworth J, Changalucha J, Butamanya NL, Hekmat S, Habbema JD, et al. Effect of micronutrient and probiotic fortified yogurt on immune-function of anti-retroviral therapy naive HIV patients. Nutrients. 2011;3(10):897–909.
Hummelen R, Changalucha J, Butamanya NL, Koyama TE, Cook A, Habbema JD, et al. Effect of 25 weeks probiotic supplementation on immune function of HIV patients. Gut Microbes. 2011;2(2):80–5.
Irvine SL, Hummelen R, Hekmat S. Probiotic yogurt consumption may improve gastrointestinal symptoms, productivity, and nutritional intake of people living with human immunodeficiency virus in Mwanza, Tanzania. Nutr Res. 2011;31(12):875–81.
Siegfried N, Irlam JH, Visser ME, Rollins NN. Micronutrient supplementation in pregnant women with HIV infection. Cochrane Database Syst Rev. 2012;3:CD009755.
WHO. Nutrient Requirements for People Living with HIV/AIDS: Report of a technical consultation. 2003.
Forrester JE, Sztam KA. Micronutrients in HIV/AIDS: is there evidence to change the WHO 2003 recommendations? Am J Clin Nutr. 2011;94(6):1683S–9S.
Fawzi WW, Msamanga GI, Spiegelman D, Wei R, Kapiga S, Villamor E, et al. A randomized trial of multivitamin supplements and HIV disease progression and mortality. N Engl J Med. 2004;351(1):23–32.
Fawzi WW, Msamanga GI, Kupka R, Spiegelman D, Villamor E, Mugusi F, et al. Multivitamin supplementation improves hematologic status in HIV-infected women and their children in Tanzania. Am J Clin Nutr. 2007;85(5):1335–43.
• Kawai K, Kupka R, Mugusi F, Aboud S, Okuma J, Villamor E, et al. A randomized trial to determine the optimal dosage of multivitamin supplements to reduce adverse pregnancy outcomes among HIV-infected women in Tanzania. Am J Clin Nutr. 2010;91(2):391–7.
This randomized trial found no difference in the effects of single compared with multiple RDA multivitamin supplements on the risks of adverse pregnancy outcomes among HIV-infected pregnant women. Micronutrient deficiencies and nutrient-nutrient interactions are of great concern to this population of HIV-infected women and their offspring
Ndeezi G, Tylleskar T, Ndugwa CM, Tumwine JK. Effect of multiple micronutrient supplementation on survival of HIV-infected children in Uganda: a randomized, controlled trial. J Int AIDS Soc. 2010;13:18.
Irlam JH, Visser MM, Rollins NN, Siegfried N. Micronutrient supplementation in children and adults with HIV infection. Cochrane Database Syst Rev. 2010(12):CD003650.
Semba RD, Miotti PG, Chiphangwi JD, Saah AJ, Canner JK, Dallabetta GA, et al. Maternal vitamin A deficiency and mother-to-child transmission of HIV-1. Lancet. 1994;343(8913):1593–7.
Azais-Braesco V, Pascal G. Vitamin A in pregnancy: requirements and safety limits. Am J Clin Nutr. 2000;71(5 Suppl):1325S–33S.
Wiysonge CS, Shey M, Kongnyuy EJ, Sterne JA, Brocklehurst P. Vitamin A supplementation for reducing the risk of mother-to-child transmission of HIV infection. Cochrane Database Syst Rev. 2011(1):CD003648.
Bonjoch A, Figueras M, Estany C, Perez-Alvarez N, Rosales J, del Rio L, et al. High prevalence of and progression to low bone mineral density in HIV-infected patients: a longitudinal cohort study. AIDS. 2010;24(18):2827–33.
Ofotokun I, McIntosh E, Weitzmann MN. HIV: inflammation and bone. Curr HIV/AIDS Rep. 2012;9(1):16–25.
Lagishetty V, Liu NQ, Hewison M. Vitamin D metabolism and innate immunity. Mol Cell Endocrinol. 2011;347(1–2):97–105.
Gagnon C, Lu ZX, Magliano DJ, Dunstan DW, Shaw JE, Zimmet PZ, et al. Low serum 25-hydroxyvitamin D is associated with increased risk of the development of the metabolic syndrome at five years: results from a national, population-based prospective study (the Australian diabetes, obesity and lifestyle study: AusDiab). J Clin Endocrinol Metab. 2012;97(6):1953–61.
Muscogiuri G, Sorice GP, Ajjan R, Mezza T, Pilz S, Prioletta A, et al. Can vitamin D deficiency cause diabetes and cardiovascular diseases? Present evidence and future perspectives. Nutr Metab Cardiovasc Dis. 2012;22(2):81–7.
Adeyemi OM, Agniel D, French AL, Tien PC, Weber K, Glesby MJ, et al. Vitamin D deficiency in HIV-infected and HIV-uninfected women in the United States. J Acquir Immune Defic Syndr. 2011;57(3):197–204.
Rutstein R, Downes A, Zemel B, Schall J, Stallings V. Vitamin D status in children and young adults with perinatally acquired HIV infection. Clin Nutr. 2011;30(5):624–8.
•• Viard JP, Souberbielle JC, Kirk O, Reekie J, Knysz B, Losso M, et al. Vitamin D and clinical disease progression in HIV infection: results from the EuroSIDA study. AIDS. 2011;25(10):1305–15.
This study shows evidence that vitamin D deficiency is an important cofactor in HIV disease progression and this is of importance as vitamin D deficiency is frequent and also associated with morbidity and mortality in this population
Mehta S, Mugusi FM, Spiegelman D, Villamor E, Finkelstein JL, Hertzmark E, et al. Vitamin D status and its association with morbidity including wasting and opportunistic illnesses in HIV-infected women in Tanzania. AIDS Patient Care STDS. 2011;25(10):579–85.
Ross AC, Judd S, Kumari M, Hileman C, Storer N, Labbato D, et al. Vitamin D is linked to carotid intima-media thickness and immune reconstitution in HIV-positive individuals. Antivir Ther. 2011;16(4):555–63.
Shikuma CM, Seto T, Liang CY, Bennett K, Degruttola V, Gerschenson M, et al. Vitamin D levels and markers of arterial dysfunction in HIV. AIDS Res Hum Retroviruses. 2012;28(8):793–7.
Sroussi HY, Burke-Miller J, French AL, Adeyemi OM, Weber KM, Lu Y, et al. Association among Vitamin D, Oral Candidiasis, and Calprotectinemia in HIV. J Dent Res. 2012;91(7):666–70.
Crutchley RD, Gathe Jr J, Mayberry C, Trieu A, Abughosh S, Garey KW. Risk factors for vitamin D deficiency in HIV-infected patients in the south central United States. AIDS Res Hum Retroviruses. 2012;28(5):454–9.
O'Brien KO, Donangelo CM, Ritchie LD, Gildengorin G, Abrams S, King JC. Serum 1,25-dihydroxyvitamin D and calcium intake affect rates of bone calcium deposition during pregnancy and the early postpartum period. Am J Clin Nutr. 2012;96(1):64–72.
Kim JH, Gandhi V, Psevdos Jr G, Espinoza F, Park J, Sharp V. Evaluation of vitamin D levels among HIV-infected patients in New York City. AIDS Res Hum Retroviruses. 2012;28(3):235–41.
Lai H, Detrick B, Fishman EK, Gerstenblith G, Brinker JA, Hollis BW, et al. Vitamin D deficiency is associated with the development of subclinical coronary artery disease in African Americans with HIV infection: a preliminary study. J Investig Med. 2012;60(5):801–7.
Lai H, Gerstenblith G, Fishman EK, Brinker J, Kickler T, Tong W, et al. Vitamin D deficiency is associated with silent coronary artery disease in cardiovascularly asymptomatic African Americans with HIV infection. Clin Infect Dis. 2012;54(12):1747–55.
Forrest KY, Stuhldreher WL. Prevalence and correlates of vitamin D deficiency in US adults. Nutr Res. 2011;31(1):48–54.
Yetley EA. Assessing the vitamin D status of the US population. Am J Clin Nutr. 2008;88(2):558S–64S.
Childs K, Welz T, Samarawickrama A, Post FA. Effects of vitamin D deficiency and combination antiretroviral therapy on bone in HIV-positive patients. AIDS. 2012;26(3):253–62.
• Havens PL, Stephensen CB, Hazra R, Flynn PM, Wilson CM, Rutledge B, et al. Vitamin D3 decreases parathyroid hormone in HIV-infected youth being treated with tenofovir: a randomized, placebo-controlled trial. Clin Infect Dis. 2012;54(7):1013–25.
This study of over 200 young adults randomized to receive vitamin D or not showed decreases in PTH levels of those one tenofovir, regardless of vitamin D levels at baseline. This suggests that vitamin D supplementation may offset the effect of tenofovir on calcium balance and bone metabolism
Longenecker CT, Hileman CO, Carman TL, Ross AC, Seydafkan S, Brown TT, et al. Vitamin D supplementation and endothelial function in vitamin D deficient HIV-infected patients: a randomized placebo-controlled trial. Antivir Ther. 2012;17(4):613–21.
• Kakalia S, Sochett EB, Stephens D, Assor E, Read SE, Bitnun A. Vitamin D supplementation and CD4 count in children infected with human immunodeficiency virus. J Pediatr. 2011;159(6):951–7.
This randomized clinical trial concluded that supplementation with 1600 IU of vitamin D per day does not impact CD4 count and suggested that doses above current recommendations may be more appropriate.
• Arpadi SM, McMahon DJ, Abrams EJ, Bamji M, Purswani M, Engelson ES, et al. Effect of supplementation with cholecalciferol and calcium on 2-y bone mass accrual in HIV-infected children and adolescents: a randomized clinical trial. Am J Clin Nutr. 2012;95(3):678–85.
This randomized clinical trial concluded that 1g of calcium per day and 100,000 IU oral cholecalciferol every 2 months improves vitamin D serum levels but does not affect bone mass accrual in HIV-infected children and adolescents
Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96(7):1911–30.
Nunnari G, Coco C, Pinzone MR, Pavone P, Berretta M, Di Rosa M, et al. The role of micronutrients in the diet of HIV-1-infected individuals. Front Biosci (Elite Ed). 2012;4:2442–56.
Baum MK, Lai S, Sales S, Page JB, Campa A. Randomized, controlled clinical trial of zinc supplementation to prevent immunological failure in HIV-infected adults. Clin Infect Dis. 2010;50(12):1653–60.
Zeng L, Zhang L. Efficacy and safety of zinc supplementation for adults, children and pregnant women with HIV infection: systematic review. Trop Med Int Health. 2011. doi:
Kamwesiga J, Mutabazi V, Kayumba J, Tayari JC, Smyth R, Fay H, et al. Effect of selenium supplementation on CD4 T-cell recovery, viral suppression, morbidity and quality of life of HIV-infected patients in Rwanda: study protocol for a randomized controlled trial. Trials. 2011;12:192.
Stone CA, Kawai K, Kupka R, Fawzi WW. Role of selenium in HIV infection. Nutr Rev. 2010;68(11):671–81.
Borges-Santos MD, Moreto F, Pereira PC, Ming-Yu Y, Burini RC. Plasma glutathione of HIV(+) patients responded positively and differently to dietary supplementation with cysteine or glutamine. Nutrition. 2012;28(7–8):753–6.
Geffner ME, Patel K, Miller TL, Hazra R, Silio M, Van Dyke RB, et al. Factors associated with insulin resistance among children and adolescents perinatally infected with HIV-1 in the pediatric HIV/AIDS cohort study. Horm Res Paediatr. 2011;76(6):386–91.
Silva EF, Lewi DS, Vedovato GM, Garcia VR, Tenore SB, Bassichetto KC. Nutritional and clinical status, and dietary patterns of people living with HIV/AIDS in ambulatory care in Sao Paulo, Brazil. Rev Bras Epidemiol. 2010;13(4):677–88.
Souza DT, Rondo PH, Reis LC. The nutritional status of children and adolescents with HIV/AIDS on antiretroviral therapy. J Trop Pediatr. 2011;57(1):65–8.
•• Miller TI, Borkowsky W, DiMeglio LA, Dooley L, Geffner ME, Hazra R, et al. Metabolic abnormalities and viral replication are associated with biomarkers of vascular dysfunction in HIV-infected children. HIV Med. 2012;13(5):264–75.
This multi-centered study presents the anthropometric, metabolic, inflammatory and endothelial dysfunction abnormalities in children and adolescents with HIV
Bonfanti P, De Socio GV, Ricci E, Antinori A, Martinelli C, Vichi F, et al. The feature of metabolic syndrome in HIV naive patients is not the same of those treated: Results from a prospective study. Biomed Pharmacother. 2012;66(5):348–53.
Stanley TL, Grinspoon SK. Body composition and metabolic changes in HIV-infected patients. J Infect Dis. 2012;205 Suppl 3:S383–90.
Miller TL, Somarriba G, Orav EJ, Mendez AJ, Neri D, Schaefer N, et al. Biomarkers of vascular dysfunction in children infected with human immunodeficiency virus-1. J Acquir Immune Defic Syndr. 2010;55(2):182–8.
Baker JV, Duprez D. Biomarkers and HIV-associated cardiovascular disease. Curr Opin HIV AIDS. 2010;5(6):511–6.
Worm SW, Hsue P. Role of biomarkers in predicting CVD risk in the setting of HIV infection? Curr Opin HIV AIDS. 2010;5(6):467–72.
Sztam KA, Jiang H, Jurgrau A, Deckelbaum RJ, Foca MD. Early increases in concentrations of total, LDL, and HDL cholesterol in HIV-infected children following new exposure to antiretroviral therapy. J Pediatr Gastroenterol Nutr. 2011;52(4):495–8.
Rhoads MP, Lanigan J, Smith CJ, Lyall EG. Effect of specific ART drugs on lipid changes and the need for lipid management in children with HIV. J Acquir Immune Defic Syndr. 2011;57(5):404–12.
Jacobson DL, Williams P, Tassiopoulos K, Melvin A, Hazra R, Farley J. Clinical management and follow-up of hypercholesterolemia among perinatally HIV-infected children enrolled in the PACTG 219C study. J Acquir Immune Defic Syndr. 2011;57(5):413–20.
Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. Available at
. Accessed 28 June 2012.
• Lazzaretti RK, Kuhmmer R, Sprinz E, Polanczyk CA, Ribeiro JP. Dietary intervention prevents dyslipidemia associated with highly active antiretroviral therapy in human immunodeficiency virus type 1-infected individuals: a randomized trial. J Am Coll Cardiol. 2012;59(11):979–88.
This randomized trial of nutritional education through NCEP guidelines showed caloric intake from fat was decreased and resulted in lower levels of triglycerides and a lower percent of patients with dyslipidemia at 1 year post intervention. This is an encouraging study that shows close nutritional monitoring and guidance can be effective in decreased CVD risk among HIV-infected adults
Almeida LB, Segurado AC, Duran AC, Jaime PC. Impact of a nutritional counseling program on prevention of HAART-related metabolic and morphologic abnormalities. AIDS Care. 2011;23(6):755–63.
• Balasubramanyam A, Coraza I, Smith EO, Scott LW, Patel P, Iyer D, et al. Combination of niacin and fenofibrate with lifestyle changes improves dyslipidemia and hypoadiponectinemia in HIV patients on antiretroviral therapy: results of "heart positive," a randomized, controlled trial. J Clin Endocrinol Metab. 2011;96(7):2236–47.
This study of over 200 HIV-infected adults shows that the addition of dietary counseling can improve metabolic outcomes in adults who are on other pharmacologic interventions. This suggests a role of dietary counseling even in those HIV-infected patients who require medications to treat their dyslipidemia
Panagiotakos DB, Pitsavos C, Arvaniti F, Stefanadis C. Adherence to the Mediterranean food pattern predicts the prevalence of hypertension, hypercholesterolemia, diabetes and obesity, among healthy adults; the accuracy of the MedDietScore. Prev Med. 2007;44(4):335–40.
Tsiodras S, Poulia KA, Yannakoulia M, Chimienti SN, Wadhwa S, Karchmer AW, et al. Adherence to Mediterranean diet is favorably associated with metabolic parameters in HIV-positive patients with the highly active antiretroviral therapy-induced metabolic syndrome and lipodystrophy. Metabolism. 2009;58(6):854–9.
Oliveira JM, Rondo PH. Omega-3 fatty acids and hypertriglyceridemia in HIV-infected subjects on antiretroviral therapy: systematic review and meta-analysis. HIV Clin Trials. 2011;12(5):268–74.
Peters BS, Wierzbicki AS, Moyle G, Nair D, Brockmeyer N. The effect of a 12-week course of omega-3 polyunsaturated fatty acids on lipid parameters in hypertriglyceridemic adult HIV-infected patients undergoing HAART: a randomized, placebo-controlled pilot trial. Clin Ther. 2012;34(1):67–76.
Aghdassi E, Arendt BM, Salit IE, Mohammed SS, Jalali P, Bondar H, et al. In patients with HIV-infection, chromium supplementation improves insulin resistance and other metabolic abnormalities: a randomized, double-blind, placebo controlled trial. Curr HIV Res. 2010;8(2):113–20.
McComsey GA, O'Riordan M, Choi J, Libutti D, Rowe D, Storer N, et al. Mitochondrial function, inflammation, fat and bone in HIV lipoatrophy: randomized study of uridine supplementation or switch to tenofovir. Antivir Ther. 2012;17(2):347–53.
Cade WT, Peralta L, Keyser RE. Aerobic capacity in late adolescents infected with HIV and controls. Pediatr Rehabil. 2002;5(3):161–9.
Cade WT, Fantry LE, Nabar SR, Keyser RE. Decreased peak arteriovenous oxygen difference during treadmill exercise testing in individuals infected with the human immunodeficiency virus. Arch Phys Med Rehabil. 2003;84(11):1595–603.
Oursler KK, Sorkin JD, Smith BA, Katzel LI. Reduced aerobic capacity and physical functioning in older HIV-infected men. AIDS Res Hum Retroviruses. 2006;22(11):1113–21.
Somarriba G, Lopez-Mitnik G, Ludwig DA, Neri D, Schaefer N, Lipshultz SE et al. Physical fitness in children infected with the Human Immunodeficiency Virus: associations with highly active antiretroviral therapy. AIDS Res Hum Retroviruses. 2012. doi:
Dudgeon WD, Phillips KD, Carson JA, Brewer RB, Durstine JL, Hand GA. Counteracting muscle wasting in HIV-infected individuals. HIV Med. 2006;7(5):299–310.
Miller TL. A hospital-based exercise program to improve body composition, strength, and abdominal adiposity in 2 HIV-infected children. AIDS Read. 2007;17(9):450–2, 5, 8.
O'Brien K, Nixon S, Tynan AM, Glazier R. Aerobic exercise interventions for adults living with HIV/AIDS. Cochrane Database Syst Rev. 2010(8):CD001796.
Glover EI, Phillips SM. Resistance exercise and appropriate nutrition to counteract muscle wasting and promote muscle hypertrophy. Curr Opin Clin Nutr Metab Care. 2010;13(6):630–4.
Mesquita Soares TC, Galvao De Souza HA, De Medeiros Guerra LM, Pinto E, Pipolo Milan E, Moreira Dantas P, et al. Morphology and biochemical markers of people living with HIV/AIDS undergoing a resistance exercise program: clinical series. J Sports Med Phys Fitness. 2011;51(3):462–6.
• Farinatti PT, Borges JP, Gomes RD, Lima D, Fleck SJ. Effects of a supervised exercise program on the physical fitness and immunological function of HIV-infected patients. J Sports Med Phys Fitness. 2010;50(4):511–8.
This aerobic and resistance training intervention study in adults with HIV concluded that a supervised exercise program was safe, improved muscular and aerobic fitness and has no negative effects on immunological function.
Fillipas S, Cherry CL, Cicuttini F, Smirneos L, Holland AE. The effects of exercise training on metabolic and morphological outcomes for people living with HIV: a systematic review of randomised controlled trials. HIV Clin Trials. 2010;11(5):270–82.
Ogalha C, Luz E, Sampaio E, Souza R, Zarife A, Neto MG, et al. A randomized, clinical trial to evaluate the impact of regular physical activity on the quality of life, body morphology and metabolic parameters of patients with AIDS in Salvador, Brazil. J Acquir Immune Defic Syndr. 2011;57 Suppl 3:S179–85.
•• Yarasheski KE, Cade WT, Overton ET, Mondy KE, Hubert S, Laciny E, et al. Exercise training augments the peripheral insulin-sensitizing effects of pioglitazone in HIV-infected adults with insulin resistance and central adiposity. Am J Physiol Endocrinol Metab. 2011;300(1):E243–51.
This study showed that exercise training augments the insulin response to pioglitazone (as assessed by hyperinsulinemic euglycemic clamp) and exercise training was associated with reduction in total body and limb fat. Exercise may be an important complementary treatment for patients requiring pharmacologic treatments for insulin resistance.
UNAIDS. Global Report: UNAIDS Report on the Global AIDS Epidemic. 2010.
Miller TL, Somarriba G, Kinnamon DD, Weinberg GA, Friedman LB, Scott GB. The effect of a structured exercise program on nutrition and fitness outcomes in human immunodeficiency virus-infected children. AIDS Res Hum Retroviruses. 2010;26(3):313–9.
Mansky KC. Aging, human immunodeficiency virus, and bone health. Clin Interv Aging. 2010;5:285–92.
Somarriba G, Neri D, Schaefer N, Miller TL. The effect of aging, nutrition, and exercise during HIV infection. HIV AIDS (Auckl). 2010;2:191–201.
Yahiaoui A, McGough EL, Voss JG. Development of evidence-based exercise recommendations for older HIV-infected patients. J Assoc Nurses AIDS Care. 2012;23(3):204–19.
Souza PM, Jacob-Filho W, Santarem JM, Zomignan AA, Burattini MN. Effect of progressive resistance exercise on strength evolution of elderly patients living with HIV compared to healthy controls. Clinics (Sao Paulo). 2011;66(2):261–6.
Cade WT, Reeds DN, Overton ET, Herrero P, Waggoner AD, Davila-Roman VG, et al. Effects of human immunodeficiency virus and metabolic complications on myocardial nutrient metabolism, blood flow, and oxygen consumption: a cross-sectional analysis. Cardiovasc Diabetol. 2011;10:111.
Ciccolo JT, Jowers EM, Bartholomew JB. The benefits of exercise training for quality of life in HIV/AIDS in the post-HAART era. Sports Med. 2004;34(8):487–99.
Jong E, Oudhoff LA, Epskamp C, Wagener MN, van Duijn M, Fischer S, et al. Predictors and treatment strategies of HIV-related fatigue in the combined antiretroviral therapy era. AIDS. 2010;24(10):1387–405.
Petroczi A, Hawkins K, Jones G, Naughton DP. HIV patient characteristics that affect adherence to exercise programmes: an observational study. Open AIDS J. 2010;4:148–55.
• El-Bassel N, Jemmott 3rd JB, Landis JR, Pequegnat W, Wingood GM, Wyatt GE, et al. Intervention to influence behaviors linked to risk of chronic diseases: a multisite randomized controlled trial with African-American HIV-serodiscordant heterosexual couples. Arch Intern Med. 2011;171(8):728–36.
This study is a multi-centered, multi-disciplinary team approach to improve multiple health behaviors in adults living with HIV. The authors concluded that this approach improved adherence to physical activity, improved healthy diet consumption and increased medical compliance
Rotheram-Borus MJ, Swendeman D, Lee SJ, Li L, Amani B, Nartey M. Interventions for families affected by HIV. Transl Behav Med. 2011;1(2):313–26.
Weiss SM, Tobin JN, Antoni M, Ironson G, Ishii M, Vaughn A, et al. Enhancing the health of women living with HIV: the SMART/EST Women's Project. Int J Womens Health. 2011;3:63–77.
Ardoy DN, Fernandez-Rodriguez JM, Ruiz JR, Chillon P, Espana-Romero V, Castillo MJ, et al. Improving physical fitness in adolescents through a school-based intervention: the EDUFIT study. Rev Esp Cardiol. 2011;64(6):484–91.
Snyder A, Colvin B, Gammack JK. Pedometer use increases daily steps and functional status in older adults. J Am Med Dir Assoc. 2011;12(8):590–4.
Davies CA, Spence JC, Vandelanotte C, Caperchione CM, Mummery WK. Meta-analysis of internet-delivered interventions to increase physical activity levels. Int J Behav Nutr Phys Act. 2012;9(1):52.
Hardy OT, Wiecha J, Kim A, Salas C, Briceno R, Moody K, et al. Effects of a multicomponent wellness intervention on dyslipidemia among overweight adolescents. J Pediatr Endocrinol Metab. 2012;25(1–2):79–82.
Lloyd JJ, Wyatt KM, Creanor S. Behavioural and weight status outcomes from an exploratory trial of the Healthy Lifestyles Programme (HeLP): a novel school-based obesity prevention programme. BMJ Open. 2012;2(3). doi:
Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA, et al. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc. 2007;39(8):1423–34.
Mutimura E, Crowther NJ, Cade TW, Yarasheski KE, Stewart A. Exercise training reduces central adiposity and improves metabolic indices in HAART-treated HIV-positive subjects in Rwanda: a randomized controlled trial. AIDS Res Hum Retroviruses. 2008;24(1):15–23.
© Springer Science+Business Media, LLC 2012