A Step Closer to the “Fourth 90”: A Practical Narrative Review of Diagnosis and Management of Nutritional Issues of People Living with HIV

Abstract

The quality of life of people living with HIV (PLWH) has remarkably increased thanks to the introduction of combined antiretroviral therapy. Still, PLWH are exposed to an increased risk of cardiovascular diseases, diabetes, chronic kidney disease, and liver disease. Hence, the purpose of this review is to summarize the current knowledge about diagnosis and nutritional management with specific indication of macro and micronutrients intake for the main comorbidities of PLWH. In fact, a prompt diagnosis and management of lifestyle behaviors are fundamental steps to reach the “fourth 90”. To achieve an early diagnosis of these comorbidities, clinicians have at their disposal algorithms such as the Framingham Score to assess cardiovascular risk; transient elastography and liver biopsy to detect NAFLD and NASH; and markers such as the oral glucose tolerance test and GFR to identify glucose impairment and renal failure, respectively. Furthermore, maintenance of ideal body weight is the goal for reducing cardiovascular risk and to improve diabetes, steatosis and fibrosis; while Mediterranean and low-carbohydrate diets are the dietetic approaches proposed for cardioprotective effects and for glycemic control, respectively. Conversely, diet management of chronic kidney disease requires different nutritional assessment, especially regarding protein intake, according to disease stage and eventually concomitant diabetes.

Prevalence of steatotic liver disease, MASLD, MetALD and significant fibrosis in people with HIV in the United States

“…In an ageing population of PWH that is largely on ART and treated for hepatitis B and C viral infections, NAFLD has emerged as the most common cause of liver disease. [6][7][8][17][18][19][20][21][22][23][24][25] In prior studies of persons with HIV mono-infection, NAFLD prevalence was reported in the range of 15%-59%. 7,9,[26][27][28][29][30] Clearly, case/phenotype definitions and alcohol use thresholds dictate the frequencies of each SLD category.…”

“…In an ageing population of PWH that is largely on ART and treated for hepatitis B and C viral infections, NAFLD has emerged as the most common cause of liver disease 6–8,17–25 . In prior studies of persons with HIV mono‐infection, NAFLD prevalence was reported in the range of 15%–59% 7,9,26–30 .…”

Long-Term Treatment Success with Bictegravir/Emtricitabine/Tenofovir Alafenamide (BIC/FTC/TAF)

“…2,3 The attainment of such ambitious treatment goals requires robust combination ART such as bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF). 4 The INSTI-based single-tablet regimen (STR), Biktarvy ® (BIC/FTC/TAF), can meet the high demands of a contemporary ART. 5 BIC/ FTC/TAF is taken once daily, with or without food, 6 and is indicated 1 in Switzerland for the treatment of HIV type 1 (HIV-1) infection in treatmentnaive adults or as a replacement for the current antiretroviral therapy.…”

Physical activity and diet for Type 2 Diabetes reduction among older people living with HIV in Harare

“…Substantiating the benefits of physical activity and a healthy diet as self-care to reduce the risk of Type 2 Diabetes, Duncan et al ( 2020 ) conducted a 6-month intervention with older PLWH in the United Kingdom (UK) and found that physical activity and adhering to a healthy diet resulted in weight reduction by 7% and a lowered Homeostatic Model Assessment for Insulin Resistance (HOMA -IR) score of older PLWH. Similarly, Bavaro et al ( 2021 ) assert that self-care practices to reduce weight through diet control and physical activity achieve glycaemic control.…”