High prevalence of suboptimal nutrient intake and comorbidities of people living with HIV on antiretroviral therapy

Abstract

Objectives

Nutritional alterations are common in people living with human immunodeficiency virus (PLWH). Suboptimal intake of key nutrients contributes to the development of comorbidities, disease progression, and mortality. We sought to determine the prevalence of suboptimal nutritional intake and evaluate associations with metabolic alterations and immune activation in PLWH on long-term antiretroviral treatment (ART).

Methods

This is a cross-sectional study composed of 72 PLWH on ART. Daily intake of macronutrients and micronutrients was calculated. Cholesterol, triglycerides and glucose levels were determined. Body composition and bone mineral density were assessed using dual-energy x-ray absorptiometry. T-cell immune activation (CD38⁺HLADR⁺) and inflammatory cytokines (interleukins 1 and 6 and tumor necrosis factor-α) were measured. Statistical analyses were conducted using STATA v18.

Results

Suboptimal intakes of fluoride (95.8%), iodine (90.2%), omega-6 (88.9%), potassium (86.1%), omega-3 (81.9%), vitamin E (79.1%), vitamin A (75%), magnesium (66.6%), manganese (58.3%), and molybdenum (50%) were observed. Obesity was observed in 52% of the studied population, and 51% had a low bone mineral density, 40% had hypertriglyceridemia, 14% had dyslipidemia, and 9% had hyperglycemia. A low intake of chromium was associated with a higher percentage of activated CD4⁺ T cells (P = 0.04), and a low intake of vitamin B3 was associated with a higher percentage of activated CD8⁺ T cells (P = 0.028). Moreover, a low intake of phosphorus and vitamin B3 was associated with increased levels of interleukins 1 and 6 and tumor necrosis factor-α in plasma (P < 0.05).

Conclusions

Our cohort of PLWH on ART has a high prevalence of suboptimal intake of diverse micronutrients and comorbidities. We saw no association between suboptimal intake and comorbidities. Studies focused on the particular nutritional requirements of PLWH are needed in order to design nutritional interventions to prevent deficiency states, delay the development of non–AIDS-associated comorbidities, and increase quality of life.