Advertisement

Contemporary Lifestyle Modification Interventions to Improve Metabolic Comorbidities in HIV

  • Kathleen V. FitchEmail author
Complications of HIV and Antiretroviral Therapy (GA McComsey, Section Editor)
  • 27 Downloads
Part of the following topical collections:
  1. Topical Collection on Complications of HIV and Antiretroviral Therapy

Abstract

Purpose of Review

Metabolic comorbidities including diabetes, obesity, dyslipidemia, and hypertension, all of which are traditional cardiovascular disease risk factors that are highly prevalent in people with HIV (PWH). Bone disease including osteopenia, osteoporosis, and fragility fractures is also prevalent in PWH. These comorbidities may be prevented and treated in part with lifestyle modification, including changes to dietary and physical habits. The purpose of this review is to highlight recent literature that characterizes current lifestyle habits in PWH as well as the effectiveness of lifestyle strategies to improve metabolic comorbidities prevalent in PWH.

Recent Findings

Recent studies have expanded our knowledge regarding the current lifestyle habits of PWH as well as the potential for lifestyle modification to prevent or improve comorbidities prevalent in PWH. Clinical trials focusing on lifestyle modification have shown some benefit of such interventions on traditional risk factors for comorbidities; however, significant heterogeneity exists between studies and results are not consistent.

Summary

Further clinical trials are needed including developing lifestyle strategies that are feasible, effective, and sustainable to prevent and decrease prevalence of comorbidities in this population.

Keywords

HIV Lifestyle modification Diet Physical activity Metabolic comorbidities Bone disease 

Notes

Compliance with Ethical Standards

Conflict of Interest

Ms. Fitch reports personal fees from Gilead Sciences, Inc., from Merck, outside the submitted work.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

  1. 1.
    Teeraananchai S, Kerr SJ, Amin J, Ruxrungtham K, Law MG. Life expectancy of HIV-positive people after starting combination antiretroviral therapy: a meta-analysis. HIV Med. 2017;18(4):256–66.PubMedCrossRefPubMedCentralGoogle Scholar
  2. 2.
    Lohse N, Obel N. Update of survival for persons with HIV infection in Denmark. Ann Intern Med. 2016;165(10):749–50.PubMedCrossRefPubMedCentralGoogle Scholar
  3. 3.
    Mahy M, Autenrieth CS, Stanecki K, Wynd S. Increasing trends in HIV prevalence among people aged 50 years and older: evidence from estimates and survey data. AIDS. 2014;28(Suppl 4):S453–9.PubMedPubMedCentralCrossRefGoogle Scholar
  4. 4.
    Smit M, Brinkman K, Geerlings S, Smit C, Thyagarajan K, Sighem A, et al. Future challenges for clinical care of an ageing population infected with HIV: a modelling study. Lancet Infect Dis. 2015;15(7):810–8.PubMedPubMedCentralCrossRefGoogle Scholar
  5. 5.
    Koethe JR, Jenkins CA, Lau B, Shepherd BE, Justice AC, Tate JP, et al. Rising obesity prevalence and weight gain among adults starting antiretroviral therapy in the United States and Canada. AIDS Res Hum Retrovir. 2016;32(1):50–8.PubMedCrossRefPubMedCentralGoogle Scholar
  6. 6.
    Triant VA, Lee H, Hadigan C, Grinspoon SK. Increased acute myocardial infarction rates and cardiovascular risk factors among patients with human immunodeficiency virus disease. J Clin Endocrinol Metab. 2007;92(7):2506–12.PubMedPubMedCentralCrossRefGoogle Scholar
  7. 7.
    Freiberg MS, Chang CC, Kuller LH, Skanderson M, Lowy E, Kraemer KL, et al. HIV infection and the risk of acute myocardial infarction. JAMA Intern Med. 2013;4:1–9.Google Scholar
  8. 8.
    Rao SG, Galaviz KI, Gay HC, Wei J, Armstrong WS, Del Rio C, et al. Factors associated with excess myocardial infarction risk in HIV-infected adults: a systematic review and meta-analysis. J Acquir Immune Defic Syndr. 2019;81(2):224–30.PubMedCrossRefPubMedCentralGoogle Scholar
  9. 9.
    Hoy J, Young B. Do people with HIV infection have a higher risk of fracture compared with those without HIV infection? Curr Opin HIV AIDS. 2016;11(3):301–5.PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    Hileman CO, Eckard AR, McComsey GA. Bone loss in HIV: a contemporary review. Curr Opin Endocrinol Diabetes Obes. 2015;22(6):446–51.PubMedPubMedCentralCrossRefGoogle Scholar
  11. 11.
    Llop M, Sifuentes WA, Banon S, Macia-Villa C, Perez-Elias MJ, Rosillo M, et al. Increased prevalence of asymptomatic vertebral fractures in HIV-infected patients over 50 years of age. Arch Osteoporos. 2018;13(1):56.PubMedCrossRefPubMedCentralGoogle Scholar
  12. 12.
    Tuomilehto J, Lindstrom J, Eriksson JG, Valle TT, Hamalainen H, Ilanne-Parikka P, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001;344(18):1343–50.CrossRefGoogle Scholar
  13. 13.
    Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393–403.PubMedCrossRefPubMedCentralGoogle Scholar
  14. 14.
    Gong Q, Zhang P, Wang J, Ma J, An Y, Chen Y, et al. Morbidity and mortality after lifestyle intervention for people with impaired glucose tolerance: 30-year results of the Da Qing diabetes prevention outcome study. Lancet Diabetes Endocrinol. 2019;7(6):452–61.PubMedCrossRefPubMedCentralGoogle Scholar
  15. 15.
    Huovinen V, Ivaska KK, Kiviranta R, Bucci M, Lipponen H, Sandboge S, et al. Bone mineral density is increased after a 16-week resistance training intervention in elderly women with decreased muscle strength. Eur J Endocrinol. 2016;175(6):571–82.PubMedCrossRefPubMedCentralGoogle Scholar
  16. 16.
    Ross AC, Manson JE, Abrams SA, Aloia JF, Brannon PM, Clinton SK, et al. The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. J Clin Endocrinol Metab. 2011;96(1):53–8.PubMedCrossRefPubMedCentralGoogle Scholar
  17. 17.
    Stone NJ, Robinson J, Lichtenstein AH, Bairey Merz CN, Lloyd-Jones DM, Blum CB, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association task force on practice guidelines. J Am Coll Cardiol. 2013.Google Scholar
  18. 18.
    National Osteoporosis Foundation. Clinician’s guide to prevention and treatment of osteoporosis. Washington: National Osteoporosis Foundation; 2014.Google Scholar
  19. 19.
    Aberg JA, Kaplan JE, Libman H, Emmanuel P, Anderson JR, Stone VE, et al. Primary care guidelines for the management of persons infected with human immunodeficiency virus: 2009 update by the HIV medicine association of the Infectious Diseases Society of America. Clin Infect Dis. 2009;49(5):651–81.PubMedCrossRefPubMedCentralGoogle Scholar
  20. 20.
    Schwingshackl L, Bogensberger B, Hoffmann G. Diet quality as assessed by the healthy eating index, alternate healthy eating index, dietary approaches to stop hypertension score, and health outcomes: an updated systematic review and meta-analysis of cohort studies. J Acad Nutr Diet. 2018;118(1):74–100 e11.PubMedCrossRefPubMedCentralGoogle Scholar
  21. 21.
    de Koning L, Chiuve SE, Fung TT, Willett WC, Rimm EB, Hu FB. Diet-quality scores and the risk of type 2 diabetes in men. Diabetes Care. 2011;34(5):1150–6.PubMedPubMedCentralCrossRefGoogle Scholar
  22. 22.
    Guenther PM, Reedy J, Krebs-Smith SM. Development of the healthy eating index-2005. J Am Diet Assoc. 2008;108(11):1896–901.PubMedCrossRefPubMedCentralGoogle Scholar
  23. 23.
    Weiss JJ, Sanchez L, Hubbard J, Lo J, Grinspoon SK, Fitch KV. Diet quality is low and differs by sex in people with HIV. J Nutr. 2019;149(1):78–87.PubMedCrossRefPubMedCentralGoogle Scholar
  24. 24.
    Webel AR, Moore SM, Longenecker CT, Currie J, Horvat Davey C, Perazzo J, et al. Randomized controlled trial of the system CHANGE intervention on behaviors related to cardiovascular risk in HIV + adults. J Acquir Immune Defic Syndr. 2018;78(1):23–33.PubMedPubMedCentralCrossRefGoogle Scholar
  25. 25.
    Anema A, Fielden SJ, Shurgold S, Ding E, Messina J, Jones JE, et al. Association between food insecurity and procurement methods among people living with HIV in a high resource setting. PLoS One. 2016;11(8):e0157630.PubMedPubMedCentralCrossRefGoogle Scholar
  26. 26.
    Pieroth R, Rigassio Radler D, Guenther PM, Brewster PJ, Marcus A. The relationship between social support and diet quality in middle-aged and older adults in the United States. J Acad Nutr Diet. 2017;117(8):1272–8.PubMedCrossRefPubMedCentralGoogle Scholar
  27. 27.
    Macallan DE, Noble C, Baldwin C, Jebb SA, Prentice AM, Coward WA, et al. Energy expenditure and wasting in human immunodeficiency virus infection. N Engl J Med. 1995;333:83–8.PubMedCrossRefPubMedCentralGoogle Scholar
  28. 28.
    Joy T, Keogh HM, Hadigan C, Lee H, Dolan SE, Fitch K, et al. Dietary fat intake and relationship to serum lipid levels in HIV-infected patients with metabolic abnormalities in the HAART era. AIDS. 2007;21(12):1591–600.PubMedPubMedCentralCrossRefGoogle Scholar
  29. 29.
    Hessol NA, Ameli N, Cohen MH, Urwin S, Weber KM, Tien PC. The association between diet and physical activity on insulin resistance in the women’s interagency HIV study. J Acquir Immune Defic Syndr. 2013;62(1):74–80.PubMedPubMedCentralCrossRefGoogle Scholar
  30. 30.
    Marzel A, Kouyos RD, Reinschmidt S, Balzer K, Garon F, Spitaleri M, et al. Dietary patterns and physical activity correlate with total cholesterol independently of lipid-lowering drugs and antiretroviral therapy in aging people living with human immunodeficiency virus. Open Forum Infect Dis. 2018;5(4):ofy067.PubMedPubMedCentralCrossRefGoogle Scholar
  31. 31.
    Galli L, Rubinacci A, Cocorullo D, Salpietro S, Spagnuolo V, Gianotti N, et al. Optimal dietary calcium intake in HIV treated patients: no femoral osteoporosis but higher cardiovascular risk. Clin Nutr. 2014;33(2):363–6.PubMedCrossRefPubMedCentralGoogle Scholar
  32. 32.
    Sales SH, Matta SM, da Silva DC, Assone TA, Fonseca LA, Duarte AJ, et al. High frequency of deficient consumption and low blood levels of 25-hydroxyvitamin D in HIV-1-infected adults from Sao Paulo city. Brazil Sci Rep. 2015;5:12990.PubMedCrossRefPubMedCentralGoogle Scholar
  33. 33.
    Li Vecchi V, Soresi M, Giannitrapani L, Mazzola G, La Sala S, Tramuto F, et al. Dairy calcium intake and lifestyle risk factors for bone loss in hiv-infected and uninfected Mediterranean subjects. BMC Infect Dis. 2012;12:192.PubMedCrossRefPubMedCentralGoogle Scholar
  34. 34.
    Silveira EA, Santos A, Falco MO, Cardoso RC, Vitorino PVO. Association of physical inactivity with hypertension and low educational level in people living with HIV/AIDS. AIDS Care. 2018;30(8):1004–9.PubMedCrossRefPubMedCentralGoogle Scholar
  35. 35.
    Dirajlal-Fargo S, Webel AR, Longenecker CT, Kinley B, Labbato D, Sattar A, et al. The effect of physical activity on cardiometabolic health and inflammation in treated HIV infection. Antivir Ther. 2016;21(3):237–45.PubMedCrossRefGoogle Scholar
  36. 36.
    Global recommendations on physical activity for health. In: Organization WH, editor. Switzerland 2010.Google Scholar
  37. 37.
    Piercy KL, Troiano RP, Ballard RM, Carlson SA, Fulton JE, Galuska DA, et al. The physical activity guidelines for Americans. JAMA. 2018;320(19):2020–8.PubMedCrossRefPubMedCentralGoogle Scholar
  38. 38.
    Vancampfort D, Mugisha J, De Hert M, Probst M, Firth J, Gorczynski P, et al. Global physical activity levels among people living with HIV: a systematic review and meta-analysis. Disabil Rehabil. 2018;40(4):388–97.PubMedCrossRefPubMedCentralGoogle Scholar
  39. 39.
    Eckard AR, Jiang Y, Debanne SM, Funderburg NT, McComsey GA. Effect of 24 weeks of statin therapy on systemic and vascular inflammation in HIV-infected subjects receiving antiretroviral therapy. J Infect Dis. 2014;209(8):1156–64.PubMedPubMedCentralCrossRefGoogle Scholar
  40. 40.
    Perazzo JD, Webel AR, Fichtenbaum CJ, McComsey GA. Bone health in people living with HIV: the role of exercise and directions for future research. J Assoc Nurses AIDS Care. 2018;29(2):330–7.PubMedCrossRefPubMedCentralGoogle Scholar
  41. 41.
    Forde C, Loy A, O'Dea S, Mulcahy F, Gormley J, Daly C. Physical activity is associated with metabolic health in men living with HIV. AIDS Behav. 2018;22(6):1965–71.PubMedCrossRefPubMedCentralGoogle Scholar
  42. 42.
    Vancampfort D, Mugisha J, Richards J, De Hert M, Probst M, Stubbs B. Physical activity correlates in people living with HIV/AIDS: a systematic review of 45 studies. Disabil Rehabil. 2018;40(14):1618–29.PubMedCrossRefPubMedCentralGoogle Scholar
  43. 43.
    Simonik A, Vader K, Ellis D, Kesbian D, Leung P, Jachyra P, et al. Are you ready? Exploring readiness to engage in exercise among people living with HIV and multimorbidity in Toronto, Canada: a qualitative study. BMJ Open. 2016;6(3):e010029.PubMedPubMedCentralCrossRefGoogle Scholar
  44. 44.
    Rehm KE, Konkle-Parker D. Physical activity levels and perceived benefits and barriers to physical activity in HIV-infected women living in the deep south of the United States. AIDS Care. 2016;28(9):1205–10.PubMedPubMedCentralCrossRefGoogle Scholar
  45. 45.
    Henry BL, Quintana E, Moore DJ, Garcia J, Montoya JL. Focus groups inform a mobile health intervention to promote adherence to a Mediterranean diet and engagement in physical activity among people living with HIV. BMC Public Health. 2019;19(1):101.PubMedPubMedCentralCrossRefGoogle Scholar
  46. 46.
    Capili B, Anastasi JK, Chang M, Ogedegbe O. Barriers and facilitators to engagement in lifestyle interventions among individuals with HIV. J Assoc Nurses AIDS Care. 2014;25(5):450–7.PubMedPubMedCentralCrossRefGoogle Scholar
  47. 47.
    Webel AR, Barkley J, Longenecker CT, Mittelsteadt A, Gripshover B, Salata RA. A cross-sectional description of age and gender differences in exercise patterns in adults living with HIV. J Assoc Nurses AIDS Care. 2015;26(2):176–86.PubMedCrossRefPubMedCentralGoogle Scholar
  48. 48.
    Ladapo JA, Richards AK, DeWitt CM, Harawa NT, Shoptaw S, Cunningham WE, et al. Disparities in the quality of cardiovascular care between HIV-infected versus HIV-uninfected adults in the United States: a cross-sectional study. J Am Heart Assoc. 2017;6(11):e007107.PubMedPubMedCentralCrossRefGoogle Scholar
  49. 49.
    Levy ME, Greenberg AE, Hart R, Powers Happ L, Hadigan C, Castel A. High burden of metabolic comorbidities in a citywide cohort of HIV outpatients: evolving health care needs of people aging with HIV in Washington. DC HIV Med. 2017;18(10):724–35.PubMedCrossRefPubMedCentralGoogle Scholar
  50. 50.
    Davidson N, Sowden D. Evaluation of screening practices for low bone mass and prevalence of osteoporosis and fractures in people living with human immunodeficiency virus attending a sexual health clinic. Intern Med J. 2019;49(9):1119–24.PubMedCrossRefPubMedCentralGoogle Scholar
  51. 51.
    Alvarez E, Belloso WH, Boyd MA, Inkaya AC, Hsieh E, Kambugu A, et al. Which HIV patients should be screened for osteoporosis: an international perspective. Curr Opin HIV AIDS. 2016;11(3):268–76.PubMedCrossRefPubMedCentralGoogle Scholar
  52. 52.
    Zanetti HR, da Cruz LG, Lourenco CL, Ribeiro GC, de Ferreira Jesus Leite MA, Neves FF, et al. Nonlinear resistance training enhances the lipid profile and reduces inflammation marker in people living with HIV: a randomized clinical trial. J Phys Act Health. 2016;13(7):765–70.PubMedCrossRefPubMedCentralGoogle Scholar
  53. 53.
    Bonato M, Galli L, Passeri L, Longo V, Pavei G, Bossolasco S, et al. A pilot study of brisk walking in sedentary combination antiretroviral treatement (cART)-treated patients: benefit on soluble and cell inflammatory markers. BMC Infect Dis. 2017;17(1):61.PubMedPubMedCentralCrossRefGoogle Scholar
  54. 54.
    Cutrono SE, Lewis JE, Perry A, Signorile J, Tiozzo E, Jacobs KA. The effect of a community-based exercise program on inflammation, metabolic risk, and fitness levels among persons living with HIV/AIDS. AIDS Behav. 2016;20(5):1123–31.PubMedCrossRefPubMedCentralGoogle Scholar
  55. 55.
    Roos R, Myezwa H, van Aswegen H, Musenge E. Effects of an education and home-based pedometer walking program on ischemic heart disease risk factors in people infected with HIV: a randomized trial. J Acquir Immune Defic Syndr. 2014;67(3):268–76.PubMedCrossRefPubMedCentralGoogle Scholar
  56. 56.
    Ezema CI, Onwunali AA, Lamina S, Ezugwu UA, Amaeze AA, Nwankwo MJ. Effect of aerobic exercise training on cardiovascular parameters and CD4 cell count of people living with human immunodeficiency virus/acquired immune deficiency syndrome: a randomized controlled trial. Niger J Clin Pract. 2014;17(5):543–8.PubMedCrossRefPubMedCentralGoogle Scholar
  57. 57.
    Balducci S, Zanuso S, Cardelli P, Salvi L, Bazuro A, Pugliese L, et al. Effect of high- versus low-intensity supervised aerobic and resistance training on modifiable cardiovascular risk factors in type 2 diabetes; the Italian diabetes and exercise study (IDES). PLoS One. 2012;7(11):e49297.PubMedPubMedCentralCrossRefGoogle Scholar
  58. 58.
    Reeds DN, Pietka TA, Yarasheski KE, Cade WT, Patterson BW, Okunade A, et al. HIV infection does not prevent the metabolic benefits of diet-induced weight loss in women with obesity. Obesity (Silver Spring). 2017;25(4):682–8.PubMedCentralCrossRefGoogle Scholar
  59. 59.
    Stradling C, Thomas GN, Hemming K, Taheri S, Taylor S, Ross J, et al. The Mediterranean portfolio diet in HIV dyslipidaemia: a randomized controlled trial. Seattle: Conference on Retroviruses and Opportunistic Infections; 2018.Google Scholar
  60. 60.
    Bloch M, Jayewardene A, Vincent T, Linton N, Quan D, Gowers A. Effectiveness of a team intervention in reducing modifiable cardiovascular disease risk in HIV-infected subjects on antiretroviral therapy. J Int AIDS Soc. 2014;17(4 Suppl 3):19546.PubMedPubMedCentralCrossRefGoogle Scholar
  61. 61.
    Duncan AD, Peters BS, Rivas C, Goff LM Reducing risk of type 2 diabetes in HIV: a mixed-methods investigation of the STOP-diabetes diet and physical activity intervention. Diabetic Med. 2019Google Scholar
  62. 62.
    Saumoy M, Alonso-Villaverde C, Navarro A, Olmo M, Vila R, Ramon JM, et al. Randomized trial of a multidisciplinary lifestyle intervention in HIV-infected patients with moderate-high cardiovascular risk. Atherosclerosis. 2016;246:301–8.PubMedCrossRefPubMedCentralGoogle Scholar
  63. 63.
    Wing RR, Becofsky K, Wing EJ, McCaffery J, Boudreau M, Evans EW, et al. Behavioral and cardiovascular effects of a behavioral weight loss program for people living with HIV. AIDS Behav. 2019.Google Scholar
  64. 64.
    Santos WR, Paes PP, Ferreira-Silva IA, Santos AP, Vercese N, Machado DR, et al. Impact of strength training on bone mineral density in patients infected with HIV exhibiting lipodystrophy. J Strength Cond Res. 2015;29(12):3466–71.PubMedCrossRefPubMedCentralGoogle Scholar
  65. 65.
    Overton ET, Chan ES, Brown TT, Tebas P, McComsey GA, Melbourne KM, et al. Vitamin D and calcium attenuate bone loss with antiretroviral therapy initiation: a randomized trial. Ann Intern Med. 2015;162(12):815–24.PubMedPubMedCentralCrossRefGoogle Scholar
  66. 66.
    Yin MT, RoyChoudhury A, Bucovsky M, Colon I, Ferris DC, Olender S, et al. A randomized placebo-controlled trial of low- versus moderate-dose vitamin D3 supplementation on bone mineral density in postmenopausal women with HIV. J Acquir Immune Defic Syndr. 2019;80(3):342–9.PubMedCrossRefPubMedCentralGoogle Scholar
  67. 67.
    Schouten J, Wit FW, Stolte IG, Kootstra NA, van der Valk M, Geerlings SE, et al. Cross-sectional comparison of the prevalence of age-associated comorbidities and their risk factors between HIV-infected and uninfected individuals: the AGEhIV cohort study. Clin Infect Dis. 2014;59(12):1787–97.CrossRefGoogle Scholar
  68. 68.
    Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease. Circulation. 2019;17:CIR0000000000000678.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Metabolism UnitMassachusetts General Hospital and Harvard Medical SchoolBostonUSA

Personalised recommendations