Growth in HIV-Infected Children on Long-Term Antiretroviral Therapy

OBJECTIVES:

To describe growth in HIV-infected children on long-term antiretroviral therapy (ART) and to assess social, clinical, immunological and virological factors associated with suboptimal growth.

METHODS:

This observational cohort study included all HIV-infected children at an urban ART site in South Africa who were younger than 5 years at ART initiation and with more than 5 years of follow-up. Growth was assessed using weight-for-age Z-scores (WAZ), height-for-age Z-scores (HAZ) and body mass index (BMI)-for-age Z-scores (BAZ). Children were stratified according to pre-treatment anthropometry and age. Univariate and mixed linear analysis were used to determine associations between independent variables and weight and height outcomes.

RESULTS:

The majority of the 159 children presented with advanced clinical disease (90%) and immunosuppression (89%). Before treatment underweight, stunting and wasting were common (WAZ<-2= 50%, HAZ<-2= 73%, BAZ<-2= 19%). Weight and BMI improved during the initial 12 months, while height improved over the entire 5-year period. Height at study exit was significantly worse for children with growth impairment at ART initiation (p<0.001), although infants (<1 year) demonstrated superior improvement in terms of BMI (p=0.04). Tuberculosis was an independent risk factor for suboptimal weight (p=0.01) and height (p=0.02) improvement. Weight gain was also hindered by lack of electricity (p=0.04). Immune reconstitution and virological suppression were not associated with being underweight or stunted at study end point.

CONCLUSIONS:

Malnutrition was a major clinical concern for this cohort of HIV-infected children. Early ART initiation, tuberculosis co-infection management and nutritional interventions are crucial to ensure optimal growth in HIV-infected children. This article is protected by copyright. All rights reserved.

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By:  Feucht UD¹, van Bruwaene L^1,2, Becker PJ³, Kruger M⁴.

¹Department of Paediatrics, Kalafong hospital, University of Pretoria, Pretoria, South Africa.

²University Hospital Gasthuisberg, Leuven, Belgium.

³Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.

⁴Department of Paediatrics and Child Health, University of Stellenbosch, Tygerberg, South Africa.

Trop Med Int Health. 2016 Feb 23. doi: 10.1111/tmi.12685.

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Food Insecurity in HIV-Hepatitis C Virus Co-Infected Individuals in Canada: The Importance of Co-Morbidities

While research has begun addressing food insecurity (FI) in HIV-positive populations, knowledge regarding FI among individuals living with HIV-hepatitis C virus (HCV) co-infection is limited. 

This exploratory study examines sociodemographic, socioeconomic, behavioral, and clinical factors associated with FI in a cohort of HIV-HCV co-infected individuals in Canada. We analyzed longitudinal data from the Food Security and HIV-HCV Co-infection Study of the Canadian Co-infection Cohort collected between November 2012-June 2014 at 15 health centres. FI was measured using the Household Food Security Survey Module and classified using Health Canada criteria. Generalized estimating equations were used to assess factors associated with FI. 

Among 525 participants, 59 % experienced FI at their first study visit (baseline). Protective factors associated with FI (p < 0.05) included: enrolment at a Quebec study site, employment, and average personal monthly income. Risk factors for FI included: recent injection drug use, trading away food, and recent experiences of depressive symptoms. 

FI is common in this co-infected population. Engagement of co-infected individuals in substance use treatments, harm reduction programs, and mental health services may mitigate FI in this vulnerable subset of the HIV-positive population.

Purchase full article at:   http://goo.gl/d20K1v

By:  Cox J1,2,3, Hamelin AM4, McLinden T4, Moodie EE4, Anema A5,6, Rollet-Kurhajec KC7, Paradis G4, Rourke SB8,9,10, Walmsley SL11,12, Klein MB7; Canadian Co-infection Cohort Investigators.

• 1Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Purvis Hall, 1020 Pine Avenue West, Montreal, QC, H3A 1A2, Canada. joseph.cox@mcgill.ca.
• 2Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada. joseph.cox@mcgill.ca.
• 3CIHR Canadian HIV Trials Network, Vancouver, BC, Canada. joseph.cox@mcgill.ca.
• 4Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Purvis Hall, 1020 Pine Avenue West, Montreal, QC, H3A 1A2, Canada.
• 5Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
• 6Department of Medicine, Boston Children's Hospital, Boston, MA, USA.
• 7Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada.
• 8Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
• 9The Ontario HIV Treatment Network, Toronto, ON, Canada.
• 10Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
• 11Department of Medicine, University of Toronto, Toronto, ON, Canada.
• 12Division of Infectious Diseases, University Health Network, Toronto, ON, Canada. 

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What Do Prisoners Eat? Nutrient Intakes & Food Practices in a High-Secure Prison

There are limited studies on the adequacy of prisoner diet and food practices, yet understanding these are important to inform food provision and assure duty of care for this group. 

The aim of this study was to assess the dietary intakes of prisoners to inform food and nutrition policy in this setting. This research used a cross-sectional design with convenience sampling in a 945-bed male high-secure prison. Multiple methods were used to assess food available at the group level, including verification of food portion, quality and practices. A pictorial tool supported the diet history method. Of 276 eligible prisoners, 120 dietary interviews were conducted and verified against prison records, with 106 deemed plausible. 

The results showed the planned food to be nutritionally adequate, with the exception of vitamin D for older males and long-chain fatty acids, with Na above upper limits. The Australian dietary targets for chronic disease risk were not achieved. High energy intakes were reported with median 13·8 (se 0·3) MJ. Probability estimates of inadequate intake varied with age groups: Mg 8 % (>30 years), 2·9 % (70 years), 1·5 % (<70 years); folate 3·5 %; Zn and I 2·7 %; and vitamin A 2·3 %. Nutrient intakes were greatly impacted by self-funded snacks. 

Results suggest the intakes to be nutritionally favourable when compared with males in the community. This study highlights the complexity of food provision in the prison environment and also poses questions for population-level dietary guidance in delivering appropriate nutrients within energy limits.

Purchase full article at:   http://goo.gl/eYjTy4

By:  Hannan-Jones M1, Capra S1.

• 1School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences,The University of Queensland, Brisbane, Qld 4072, Australia.
• Br J Nutr. 2016 Feb 22:1-10.  

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Frailty, Food Insecurity & Nutritional Status in People Living with HIV

BACKGROUND:

Nutritional status and food insecurity are associated with frailty in the general U.S. population, yet little is known about this in the aging population of people living with HIV (PLWH).

OBJECTIVES:

Given the potential importance of nutrition and the amenability to intervention, we examined the association between nutritional status, food insecurity, and frailty in PLWH.

PARTICIPANTS:

50 PLWH, age ≥45 years, recruited from a cohort study examining risk factors for cardiovascular disease.

MEASUREMENTS:

Frailty, duration of HIV, use of antiretroviral therapy, disease history, food insecurity, physical function, and physical activity were assessed by questionnaire. Dietary intake was assessed using 3-day food records. Blood was drawn for CD4+ cell count, hemoglobin, hematocrit, and lipid levels. Physical measurements included height, weight, and skinfold thickness.

RESULTS:

The prevalence of frailty was 16% (n=8), 44% were pre-frail (n=22) and 40% were not frail (n=20). The number of reported difficulties with 20 activities of daily living was highest in frail (mean 10.4±3.9 SD), followed by pre-frail (6.5±4.6), and lowest in not frail participants (2.0±2.3). Seven (88%) of the frail PLWH lost weight with an average weight loss of 22.9 pounds; 6 (75%) reported unintentional weight loss, and all 6 of these met the frailty criteria for weight loss of 10 or more pounds. Nine (45%) of the not frail PLWH reported losing weight with an average weight loss of 6.2 pounds; 5 (23%) reported unintentional weight loss of <10 pounds. Frail PLWH were more likely to report being food insecure than not frail PLWH (63% vs. 10%, p=0.02), and tended to have lower energy intake than not frail PLWH.

CONCLUSION:

Research is needed on targeted interventions to improve food security and activities of daily living in PLWH for both the prevention and improvement of frailty.

Below:  Weight loss by frailty status

Full article at:   http://goo.gl/q62j5W

By:   E. SMIT,1 C. WANKE,2 K. DONG,2 A. GROTHEER,2 S. HANSEN,2 S. SKINNER,2 and A.M. TANG2

¹School of Biological and Population Health Sciences, Oregon State University, Corvallis, OR, USA

²Department of Public Health and Community Medicine, Tufts School of Medicine, Boston, MA, USA.

Corresponding author: Ellen Smit; School of Biological and Population Health Sciences, Oregon State University, Milam 135, Corvallis, OR 97331, USA. Phone: +1 (541) 737-3833; Email: ude.etatsnogero@timS.nellE 

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