HIV Flashcards
Describe the red flags associated with HIV that healthcare professionals should be aware of.
- CD4 count less than 200, detectable viral load
- unintentional weight loss
- forgetting ARVs
- excessive weight gain
- central adiposity
- bone fractures
- isolation
- low mood
- stigma
Describe the impact of HIV stigma on successful weight loss according to the STOP diabetes in HIV study.
The STOP diabetes in HIV study found that HIV stigma can hinder successful weight loss. Participants feared disclosing their HIV status, leading to a sense of futility in changing diet or exercise. Deliberate weight loss could also result in loss of cultural identity and disclosure of HIV status, acting as significant barriers. Duncan et al (2020)
How does fear of disclosure of HIV status affect participation in weight loss interventions, as observed in the STOP diabetes in HIV study?
In the STOP diabetes in HIV study, participants were more willing to disclose diabetes than HIV. Those who declined participation or struggled to meet intervention goals often had an external health locus of control, blaming their diabetes risk on HIV medications. This fear of disclosure led to a sense of futility in trying to change diet or exercise. Duncan et al (2020)
Describe the challenges faced by individuals with HIV in managing weight loss goals while navigating concerns about HIV disclosure and potential stigma.
Individuals with HIV encounter challenges in managing weight loss goals due to fears of HIV disclosure and associated stigma. These challenges include reluctance to lose weight to avoid HIV status speculation, concerns about cultural identity loss, and the emotional impact of potential rejection and shame.
Describe the findings regarding cardiovascular disease events in the statin group compared to the placebo group in the study by Grinspoon et al. (2023) What was the hazard ratio indicating?
- CVD events were 4.81 per 1000 patient years in the statin group vs - 7.32 in the placebo group.
- The hazard ratio was 0.65, suggesting a 35% lower likelihood of CVD events with statin therapy.
How was diet quality assessed in the REPREIVE diet sub-study? What were the key findings regarding diet quality among participants?
Diet quality was assessed using 13 questions from the REAP questionnaire, scored on a scale of 0-30.
58% of participants had good or optimal diet quality, while 42% had suboptimal or poor quality.
Suboptimal diet quality was more common in younger individuals, Black ethnicity, smokers, and frequent alcohol drinkers.
Fitch et al (2022),
Define the implications from the REPREIVE study and its sub-studies regarding cardiovascular disease risk and management strategies.
The implications include recognizing inflammation as a key CVD risk factor, the need for early statin initiation in low-risk individuals, the significant reduction in CVD events with early statin use, the importance of lifestyle interventions to reduce CVD risk and inflammation, and addressing poor diet quality.
Describe the variation in type 2 diabetes risk among individuals with HIV. What factors contribute to increased insulin resistance in this population?
T2D risk in HIV varies, with some having little increased risk while others face double the risk. Factors contributing to increased insulin resistance include obesity, inflammation, and antiretroviral medications. Poorer T2D outcomes are observed in HIV+ individuals compared to HIV- matched counterparts.
What were the key findings regarding atherosclerotic plaques and inflammation in the REPRIEVE mechanistic sub-study by Grinspoon et al 2023?
- 49% of participants had atherosclerotic plaques, even in those with low CVD risk.
- Plaques were associated with higher inflammation levels (p=0.008). Inflammation was a more significant risk factor than hypertension, LDL, or age for plaque development.
Describe the findings related to osteopaenia, osteoporosis, and fracture risk in HIV+ individuals compared to HIV- individuals from the Twins study at Thomas’ Hospital.
In HIV+ individuals from the Twins study at Thomas’ Hospital, osteopaenia was found in 42.8%, osteoporosis in 17.6%, and a 22% higher lifetime fracture risk compared to HIV- individuals.
How does HIV affect cognitive function and brain aging? What is HIV-associated Neurocognitive Decline (HAND) and what are its common symptoms? What conditions are associated with HAND?
HIV causes premature cognitive and brain aging. HAND, reported in 30-50% of HIV+ individuals, presents with impairments in attention, working memory, learning efficiency, and motor slowing. It is associated with diabetes, obesity, HCV, renal impairment, and vascular disease.
Define the impact of weight gain following initiation of HAART. How does it relate to mortality, type 2 diabetes, and cardiovascular disease risk? How can weight gain be prevented post HAART initiation?
Weight gain post HAART initiation is associated with lower mortality for non-overweight individuals, but higher risk of type 2 diabetes and CVD. Referral to a dietitian at initiation can prevent weight gain. Aim for BMI 18.5-25 post HAART.
Describe the diet and activity intervention goals recommended by the STOP Diabetes in HIV study. What dietary advice is combined in this study?
The STOP Diabetes in HIV study recommends combining DASH and Mediterranean diets for diet and activity intervention goals.
What considerations should be made for inpatients and outpatients in terms of preparation and support in a healthcare setting for HIV patients?
For inpatients, consider nutrition support for different cultural backgrounds, confidentiality, discharge planning, and follow-up. For outpatients, consider stigma, isolation, food security, and prevention of comorbidities.
Describe the key biochemistry parameters that should be assessed and monitored in HIV patients. What blood tests are essential for evaluating metabolic and nutritional status?
Essential biochemistry parameters for HIV patients include cholesterol levels, triglycerides, glucose/HbA1c, Vitamin D, parathyroid hormone, calcium, phosphate, and testosterone levels.
