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Grandiere Perez L, Duveau T, Lelong C, Dangeul F, Hitoto H, Blanchi S. Favorable effect of Karate Kata on self-esteem, anxiety and fatigue in people living with HIV. PSYCHOL HEALTH MED 2025:1-12. [PMID: 40019027 DOI: 10.1080/13548506.2025.2472050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Accepted: 02/13/2025] [Indexed: 03/01/2025]
Abstract
In the general population, and among people living with human immunodeficiency virus (PLHIV), sport activity is associated with better health, physically and psychologically. HIV is associated with low self-esteem. We hypothesized that Karate Kata practice could improve self-esteem in PLHIV. We conducted an interventional study with PLHIV in long-term care in our hospital. The main objective was to assess the effect of Karate Kata practice on self-esteem. The secondary objectives were to assess the effect of karate Kata on mood states, sleep, pain, balance and cognitive functions. The program consisted in group lessons of Karate Kata, 75 minutes, once a week, for 20 weeks. We compared the following points after versus before the Karate Kata program: self-esteem (Rosenberg scale), mood states (Profile of Mood States scale including anxiety, anger, confusion-perplexity, depression-discouragement, fatigue, vigor-activity and interpersonal relations), sleep (Pittsburg scale), pain (visual analog pain scale), balance (unipedal stance test) and cognitive functions (Dubois test). The 17 participants were 8 men and 9 women. The mean age was 53 years old. The self-esteem test (Rosenberg scale) was significantly improved after versus before Karate lessons: 31.9 versus 29.1 (p = 0.012). Likewise, anxiety, anger, fatigue and confusion-perplexity were lower after versus before Karate Kata lessons (respectively 8.1 versus 13.2, p = 0.024; 9.4 versus 15.8, p = 0.011; 6 versus 8.8, p = 0.035; 5.6 versus 8.3, p = 0.005). THUS, our study found that, for PLHIV, Karate Kata lessons had favorable effects on self-esteem, anxiety, anger, fatigue and confusion-perplexity. To conclude, as with physical activity in general, Karate Kata should be encouraged for PLHIV.ClinicalTrials.gov identifier (NCT number): NCT04560153.
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Affiliation(s)
- Lucia Grandiere Perez
- Service des Maladies infectieuses et tropicales, Centre Hospitalier Le Mans, LE Mans, France
| | - Thomas Duveau
- Département STAPS, Le Mans Université, LE Mans, EA, France
| | | | - Florence Dangeul
- Service des Maladies infectieuses et tropicales, Centre Hospitalier Le Mans, LE Mans, France
| | - Hikombo Hitoto
- Service des Maladies infectieuses et tropicales, Centre Hospitalier Le Mans, LE Mans, France
| | - Sophie Blanchi
- Service des Maladies infectieuses et tropicales, Centre Hospitalier Le Mans, LE Mans, France
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Gill SV, Shin D, Kim TW, Magane KM, Hereen T, Winter M, Helfrich C, Saitz R. A Fall Prevention Feasibility Trial for People With HIV and Alcohol Use. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2025; 45:85-94. [PMID: 38554013 DOI: 10.1177/15394492241238956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2024]
Abstract
Alcohol contributes to higher fall risk in people living with HIV (PLWH), yet fall prevention trials for PWH with alcohol use are lacking. To assess the feasibility of conducting a randomized controlled trial of a 10-week online fall prevention intervention tailored for PLWH with alcohol use. The intervention consisted of weekly virtual group discussions, individual phone check-ins, and home exercises. Of those eligible, 53.5% (23/43) enrolled (12 to the intervention and 11 to control). Mean age was 58 years; 82.6% had a past 6-month fall; 65.2% had alcohol use disorder; and 95.7% completed postintervention assessments. The intervention was highly rated (Client Satisfaction Questionnaire-8 score M = 30.4, SD = 1.6) with a wide range of group and individual phone session attendance. Preliminary analyses suggest the intervention may reduce the odds of falling and alcohol use frequency. Findings support the feasibility of a larger randomized trial. ClinicalTrials.gov Identifier: NCT04804579.
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Amiro K, Bowser M, Connell M, Desrosiers R, MacAlpine E, Shahzadi A, McArthur C, Quigley A. Gait Speed, Mobility, Balance, and Dual-Tasking Deficits Among People Living With HIV Globally: A Systematic Review and Meta-Analysis. J Assoc Nurses AIDS Care 2025; 36:3-42. [PMID: 39560216 DOI: 10.1097/jnc.0000000000000503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2024]
Abstract
ABSTRACT People living with HIV (PLWH) may experience premature physical deficits, including walking, mobility, and balance problems. The purpose was to measure deficits in walking, mobility, balance, and dual tasking in PLWH. The secondary objective was to make recommendations regarding the use of rehabilitation outcome measures. CINAHL, PubMed, and SPORTDiscus databases were searched. Two independent reviewers screened titles/abstracts and full-text articles, extracted data, and performed a quality assessment. Fifty-six articles with 14,053 PLWH and 8,454 uninfected controls were included. A meta-analysis revealed significantly worse performance among PLWH on the five times sit to stand mobility test versus controls (Cohen d = 0.68, 95% confidence interval [CI 0.08-1.29], p = .03). Meta-analyses revealed no differences between PLWH and controls for usual gait speed (Cohen d = -0.47, 95% CI [-1.10 to 0.15], p = .14) and fast gait speed (Cohen d = -0.39, 95% CI [-0.87 to 0.08], p = .10). Ten of 12 studies comparing PLWH with controls found differences in balance outcomes. PLWH have significantly worse mobility than uninfected controls.
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Affiliation(s)
- Kaylie Amiro
- Kaylie Amiro, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Miranda Bowser, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Madison Connell, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Remi Desrosiers, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Evangeline MacAlpine, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Anita Shahzadi, BSc, is a Physiotherapist and Masters Student, Dalhousie University, Halifax, Canada
- Caitlin McArthur, PhD, MScPT, BSc, is an Assistant Professor, Dalhousie University, Halifax, Canada
- Adria Quigley, PhD, MScPT, BSc, is an Assistant Professor, Dalhousie University, Halifax, Canada
| | - Miranda Bowser
- Kaylie Amiro, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Miranda Bowser, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Madison Connell, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Remi Desrosiers, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Evangeline MacAlpine, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Anita Shahzadi, BSc, is a Physiotherapist and Masters Student, Dalhousie University, Halifax, Canada
- Caitlin McArthur, PhD, MScPT, BSc, is an Assistant Professor, Dalhousie University, Halifax, Canada
- Adria Quigley, PhD, MScPT, BSc, is an Assistant Professor, Dalhousie University, Halifax, Canada
| | - Madison Connell
- Kaylie Amiro, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Miranda Bowser, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Madison Connell, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Remi Desrosiers, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Evangeline MacAlpine, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Anita Shahzadi, BSc, is a Physiotherapist and Masters Student, Dalhousie University, Halifax, Canada
- Caitlin McArthur, PhD, MScPT, BSc, is an Assistant Professor, Dalhousie University, Halifax, Canada
- Adria Quigley, PhD, MScPT, BSc, is an Assistant Professor, Dalhousie University, Halifax, Canada
| | - Remi Desrosiers
- Kaylie Amiro, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Miranda Bowser, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Madison Connell, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Remi Desrosiers, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Evangeline MacAlpine, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Anita Shahzadi, BSc, is a Physiotherapist and Masters Student, Dalhousie University, Halifax, Canada
- Caitlin McArthur, PhD, MScPT, BSc, is an Assistant Professor, Dalhousie University, Halifax, Canada
- Adria Quigley, PhD, MScPT, BSc, is an Assistant Professor, Dalhousie University, Halifax, Canada
| | - Evangeline MacAlpine
- Kaylie Amiro, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Miranda Bowser, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Madison Connell, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Remi Desrosiers, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Evangeline MacAlpine, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Anita Shahzadi, BSc, is a Physiotherapist and Masters Student, Dalhousie University, Halifax, Canada
- Caitlin McArthur, PhD, MScPT, BSc, is an Assistant Professor, Dalhousie University, Halifax, Canada
- Adria Quigley, PhD, MScPT, BSc, is an Assistant Professor, Dalhousie University, Halifax, Canada
| | - Anita Shahzadi
- Kaylie Amiro, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Miranda Bowser, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Madison Connell, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Remi Desrosiers, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Evangeline MacAlpine, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Anita Shahzadi, BSc, is a Physiotherapist and Masters Student, Dalhousie University, Halifax, Canada
- Caitlin McArthur, PhD, MScPT, BSc, is an Assistant Professor, Dalhousie University, Halifax, Canada
- Adria Quigley, PhD, MScPT, BSc, is an Assistant Professor, Dalhousie University, Halifax, Canada
| | - Caitlin McArthur
- Kaylie Amiro, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Miranda Bowser, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Madison Connell, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Remi Desrosiers, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Evangeline MacAlpine, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Anita Shahzadi, BSc, is a Physiotherapist and Masters Student, Dalhousie University, Halifax, Canada
- Caitlin McArthur, PhD, MScPT, BSc, is an Assistant Professor, Dalhousie University, Halifax, Canada
- Adria Quigley, PhD, MScPT, BSc, is an Assistant Professor, Dalhousie University, Halifax, Canada
| | - Adria Quigley
- Kaylie Amiro, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Miranda Bowser, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Madison Connell, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Remi Desrosiers, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Evangeline MacAlpine, MScPT, BSc, is a Physiotherapist, Dalhousie University, Halifax, Canada
- Anita Shahzadi, BSc, is a Physiotherapist and Masters Student, Dalhousie University, Halifax, Canada
- Caitlin McArthur, PhD, MScPT, BSc, is an Assistant Professor, Dalhousie University, Halifax, Canada
- Adria Quigley, PhD, MScPT, BSc, is an Assistant Professor, Dalhousie University, Halifax, Canada
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Ibeneme SC, Odoh E, Martins N, Ibeneme GC. Developing an HIV-specific falls risk prediction model with a novel clinical index: a systematic review and meta-analysis method. BMC Infect Dis 2024; 24:1402. [PMID: 39696054 PMCID: PMC11653889 DOI: 10.1186/s12879-024-10141-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Accepted: 10/29/2024] [Indexed: 12/20/2024] Open
Abstract
BACKGROUND Falls are a common problem experienced by people living with HIV yet predictive models specific to this population remain underdeveloped. We aimed to identify, assess and stratify the predictive strength of various physiological, behavioral, and HIV-specific factors associated with falls among people living with HIV and inform a predictive model for fall prevention. METHODS Systematic review and meta-analysis were conducted to explore predictors of falls in people living with HIV. Data was sourced, screened, extracted, and analyzed by two independent reviewers from eight databases up to January 2nd, 2024, following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) protocol. Evidence quality and bias were assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) and the Mixed Method Appraisal Tool (MMAT), respectively. Pooled odds ratios (OR) with 95% confidence intervals (CI) were computed using random-effects models to establish associations between predictors and falls risk. We applied established criteria (Bradford Hill's criteria, Rothman's and Nweke's viewpoints) to stratify risk factors and create a weighted predictive algorithm. RESULTS This review included 12 studies on falls/balance dysfunction in 117,638 participants (54,513 people living with HIV), with varying ages (45-50 years), sample sizes (32 - 26,373), study durations (6 months to 15 years), disease stages (CD4 + counts 347.2 cells/mm³ to ≥ 500 cells/µL) and fall definitions (self-reported histories to real-time reporting). Some predictors of falls in people living with HIV including depression, cannabis use, cognitive impairment/neurocognitive adverse effects (NCAE), hypertension, and stavudine-showed perfect risk responsiveness (Ri = 1), indicating their strong association with falls. Notably, cannabis use demonstrated the highest risk weight (Rw = 3.0, p < 0.05, 95%CI:1.51-5.82), followed by NCAE (Rw = 2.3, p < 0.05, 95%CI:1.66-3.21) and frailty with a broad confidence interval (Rw = 2.2, p < 0.05, 95%CI:0.73-14.40). Other significant predictors included hypertension (Rw = 1.8, p < 0.05, 95%CI:1.33-2.33), depression (Rw = 1.6, p < 0.05, 95%CI:1.22-2.18), stavudine use (Rw = 1.5, p < 0.05, 95%CI: 0.95-2.25), neuropathy (Rw = 1.3, p < 0.05, 95%CI:1.26-2.11), and polypharmacy (Rw = 1.2, p < 0.05, 95%CI:1.16-1.96). The fall risk threshold score was 12.8, representing the 76th percentile of the specific and sufficient risk weight. CONCLUSION Our meta-analysis identifies predictors of falls in people living with HIV, emphasizing physiological, behavioral, and HIV-specific factors. Integrating these into clinical practice could mitigate falls-related sequelae. We propose a novel approach to falls risk prediction using a novel clinical index, resulting in a HIV-specific falls risk assessment tool. TRIAL REGISTRATION The study protocol is registered with PROSPERO ID: CRD42023453556.
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Affiliation(s)
- Sam Chidi Ibeneme
- Department of Physiotherapy, David Umahi Federal University of Health Sciences, Uburu, Nigeria
- Department of Medical Rehabilitation, University of Nigeria Enugu Campus, Enugu, Nigeria
- University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, Gauteng, 2193, South Africa
- Development and Rehabilitation, International Institute of Sports Research, David Umahi Federal University of Health Sciences, Uburu, Ebonyi State, Nigeria
- Faculty III, Hochschule Hannover University of Applied Sciences & Arts, Hannover, Lower Saxony, 30159, Germany
| | - Eunice Odoh
- Department of Medical Rehabilitation, University of Nigeria Enugu Campus, Enugu, Nigeria
| | - Nweke Martins
- Department of Physiotherapy, David Umahi Federal University of Health Sciences, Uburu, Nigeria.
- Department of Physiotherapy, University of Pretoria, Pretoria, South Africa.
- Development and Rehabilitation, International Institute of Sports Research, David Umahi Federal University of Health Sciences, Uburu, Ebonyi State, Nigeria.
| | - Georgian Chiaka Ibeneme
- Department of Nursing Sciences, Faculty of Health Sciences & Technology, David Umahi Federal University of Health Sciences, Uburu, Ebonyi State, Nigeria
- Development and Rehabilitation, International Institute of Sports Research, David Umahi Federal University of Health Sciences, Uburu, Ebonyi State, Nigeria
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Osayi EO, Blake SC, Afolaranmi T, Ajayi O, Onyeji J, Sagay AS, Anderson A, Obindo TJ. Investigating the Barriers and Facilitators to Using Antiretroviral Therapy among Women Living with HIV in Plateau State, Nigeria. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:546. [PMID: 38791761 PMCID: PMC11121114 DOI: 10.3390/ijerph21050546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/27/2024] [Accepted: 02/05/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Women and girls account for more than 50% of the global HIV population. In Nigeria, the proportion of women living with HIV on long-term antiretroviral therapy (ART) has been on the rise. Despite this, little research exists on their experiences regarding antiretroviral therapy use, especially for women living with HIV (WLHIV) in Plateau State, Nigeria. This study investigates the barriers and facilitators influencing antiretroviral therapy use among women living with HIV. METHODS This study employed a qualitative research design, using focus groups, and included women (female sex workers, pregnant and non-pregnant women living with HIV) and the male partners of serodiscordant couples. Eligibility criteria were being 18 years of age or older, on antiretroviral therapy for more than one year/on pre-exposure prophylaxis (PrEP) for more than one month, and speaking English, Hausa, or both. Data coding utilized both inductive and deductive approaches, and standard content analysis was applied to develop emerging themes. RESULTS Of the 106 participants, 88 were women living with HIV, and 18 were men in serodiscordant couples. The first facilitator shared by the participants was feeling healthier and stronger due to the antiretroviral therapy, which was also expressed by the male participants on PrEP as feeling good while taking the drug. Additional facilitators shared by the participants included weight gain and having a more positive outlook on life. Participants also disproportionately described barriers to using antiretroviral therapy, including experiences with emotional challenges, physical discomfort, and side effects of ART. Such barriers were linked to feelings of past regret, frustration, and disappointment. CONCLUSION This study underscores the significance of maintaining a positive perspective on ART use, demonstrated by the connection between a positive outlook and weight gain, and highlights the hurdles that Plateau State's women living with HIV face in adhering to antiretroviral therapy. Policymakers and healthcare providers can utilize these findings to formulate targeted strategies aimed at minimizing identified barriers and enhancing antiretroviral therapy utilization among this population via peer- support groups, economic empowerment, and psychosocial support.
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Affiliation(s)
| | - Sarah C. Blake
- Department of Health Policy & Management, Rollins School of Public Health United States of America, Emory University, Atlanta, GA 30322, USA;
| | - Tolulope Afolaranmi
- Department of Community Medicine, Jos University Teaching Hospital, Jos 930241, Plateau, Nigeria;
| | - Oluseye Ajayi
- APIN Public Health Initiatives FCT, Abuja 900104, Nigeria;
| | - John Onyeji
- Faith Alive Foundation Hospital, Jos 930105, Plateau, Nigeria;
| | - Atiene S. Sagay
- Department of Obstetrics and Gynecology, Jos University Teaching Hospital, Jos 930241, Plateau, Nigeria;
| | - Albert Anderson
- Department of Medicine, Rollins School of Public Health United States of America, Emory University, Atlanta, GA 30322, USA;
| | - Taiwo J. Obindo
- Department of Psychiatry, Jos University Teaching Hospital, Jos 930241, Plateau, Nigeria;
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Kim TW, Bertholet N, Magane KM, Lloyd-Travaglini C, Winter MR, Samet JH, Erlandson KM, Stein MD, Bryant KJ, Saitz R, Heeren TC. Alcohol Consumption and Illicit Drug Use: Associations With Fall, Fracture, and Acute Health Care Utilization Among People With HIV Infection. J Acquir Immune Defic Syndr 2024; 95:391-398. [PMID: 38133581 PMCID: PMC10922845 DOI: 10.1097/qai.0000000000003372] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Given alcohol and/or other drug (AOD) use occurs among people with HIV (PWH), we examined its association with falls and fall-related outcomes and whether frailty moderates the association. SETTING Northeastern US city. METHODS We analyzed an observational cohort of PWH with current or past AOD use. Alcohol measures were any past 14-day heavy use, average alcohol/day, and days with heavy use. Drug use measures were past 30-day illicit use of cocaine, opioids, and sedatives. Repeated cross-sectional associations were estimated with separate multivariable generalized estimating equation regression models for each fall-related outcome. RESULTS Among PWH (n = 251; mean age 52 [SD = 10]), 35% reported heavy alcohol use, 24% cocaine, 16% illicit opioids, 13% illicit sedatives, and 35% any fall; 27% were frail. Heavy alcohol use was associated with a fall (AOR = 1.49, 95% CI: 1.08 to 2.07), multiple falls (AOR = 1.55 95% CI: 1.10 to 2.19), and fall/fracture-related emergency department visit or hospitalization (AOR = 1.81, 95% CI: 1.10 to 2.97). Higher average alcohol/day and more heavy drinking days were associated with multiple falls. Illicit sedative use was associated with a fall, multiple falls, and emergency department visit/hospitalization and opioid use with fracture. Frailty moderated the association of heavy alcohol use and a fall (AOR = 2.26, 95% CI: 1.28 to 4.01 in those frail) but not in those not frail. CONCLUSION The effect of AOD use on falls and fall-related outcomes was most pronounced with alcohol, particularly among frail PWH. Heavy alcohol, illicit sedative, and illicit opioid use are high-priority targets for preventing falls and fall-related consequences for PWH.
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Affiliation(s)
- Theresa W. Kim
- Boston University Chobanian and Avedisian School of Medicine
- Department of Medicine, Boston Medical Center
| | - Nicolas Bertholet
- Lausanne University Hospital and University of Lausanne, Switzerland
| | - Kara M. Magane
- Boston University School of Public Health, University of Colorado Anschutz Medical Campus
| | | | - Michael R. Winter
- Boston University School of Public Health, University of Colorado Anschutz Medical Campus
| | - Jeffrey H. Samet
- Boston University Chobanian and Avedisian School of Medicine
- Department of Medicine, Boston Medical Center
- Boston University School of Public Health, University of Colorado Anschutz Medical Campus
| | | | - Michael D. Stein
- Boston University School of Public Health, University of Colorado Anschutz Medical Campus
| | | | - Richard Saitz
- Boston University Chobanian and Avedisian School of Medicine
- Department of Medicine, Boston Medical Center
- Boston University School of Public Health, University of Colorado Anschutz Medical Campus
| | - Timothy C. Heeren
- Boston University School of Public Health, University of Colorado Anschutz Medical Campus
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Sullivan EV, Zahr NM, Sassoon SA, Pohl KM, Pfefferbaum A. Postural instability in HIV infection: relation to central and peripheral nervous system markers. AIDS 2023; 37:1085-1096. [PMID: 36927610 PMCID: PMC10164071 DOI: 10.1097/qad.0000000000003531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
OBJECTIVES Determine the independent contributions of central nervous system (CNS) and peripheral nervous system (PNS) metrics to balance instability in people with HIV (PWH) compared with people without HIV (PWoH). METHODS Volumetric MRI (CNS) and two-point pedal discrimination (PNS) were tested as substrates of stance instability measured with balance platform posturography. DESIGN 125 PWH and 88 PWoH underwent balance testing and brain MRI. RESULTS The PWH exhibited stability deficits that were disproportionately greater with eyes closed than eyes open compared with PWoH. Further analyses revealed that greater postural imbalance measured as longer sway paths correlated with smaller cortical and cerebellar lobular brain volumes known to serve sensory integration; identified brain/sway path relations endured after accounting for contributions from physiological and disease factors as potential moderators; and multiple regression identified PNS and CNS metrics as independent predictors of postural instability in PWH that differed with the use of visual information to stabilize balance. With eyes closed, temporal volumes and two-point pedal discrimination were significant independent predictors of sway; with eyes open, occipital volume was an additional predictor of sway. These relations were selective to PWH and were not detected in PWoH. CONCLUSION CNS and PNS factors were independent contributors to postural instability in PWH. Recognizing that myriad inputs must be detected by peripheral systems and brain networks to integrate sensory and musculoskeletal information for maintenance of postural stability, age- or disease-related degradation of either or both nervous systems may contribute to imbalance and liability for falls.
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Affiliation(s)
- Edith V. Sullivan
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Natalie M. Zahr
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
- Center for Health Sciences, SRI International, Menlo Park, CA
| | | | - Kilian M. Pohl
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
- Center for Health Sciences, SRI International, Menlo Park, CA
| | - Adolf Pfefferbaum
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
- Center for Health Sciences, SRI International, Menlo Park, CA
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8
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Demnitz-King H, Saba L, Lau Y, Munns L, Zabihi S, Schlosser M, Del-Pino-Casado R, Orgeta V, Marchant NL. Association between anxiety symptoms and Alzheimer's disease biomarkers in cognitively healthy adults: A systematic review and meta-analysis. J Psychosom Res 2023; 166:111159. [PMID: 36709611 DOI: 10.1016/j.jpsychores.2023.111159] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/22/2022] [Accepted: 01/16/2023] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Anxiety has been identified as both a risk factor and prodromal symptom for Alzheimer's disease (AD) and related dementias, however, the underlying neurobiological correlates remain unknown. The aim of this systematic review and meta-analysis was to examine the association between anxiety symptoms and two defining markers of AD neuropathology: amyloid-beta (Aβ) and tau. METHODS Systematic literature searches were conducted across 5 databases. Studies investigating the relationship between anxiety and AD neuropathology (i.e., Aβ and/or tau) in cognitively healthy adults were eligible. Where possible, effect sizes were combined across studies, for Aβ and tau separately, using random-effects meta-analyses. Sensitivity analyses were performed to assess whether results differed according to anxiety type (i.e., state and trait) and biomarker assessment modality (i.e., positron emission tomography and cerebrospinal fluid). RESULTS Twenty-seven studies reporting data from 14 unique cohorts met eligibility criteria. Random-effects meta-analyses revealed no associations between self-reported anxiety symptoms and either Aβ (13 studies, Fisher's z = 0.02, 95% confidence interval [CI] -0.01-0.05, p = 0.194) or tau (4 studies, Fisher's z = 0.04, 95% CI -0.02-0.09, p = 0.235). Results remained unchanged across sensitivity analyses. CONCLUSIONS In cognitively healthy adults, meta-analytic syntheses revealed no associations between anxiety symptoms and either Aβ or tau. There is a critical need, however, for larger studies with follow-up periods to examine the effect of anxiety symptom onset, severity, and chronicity on AD neuropathology. Additionally, further research investigating other potential neurobiological correlates is crucial to advance scientific understanding of the relationship between anxiety and dementia.
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Affiliation(s)
| | - Lisa Saba
- Division of Psychiatry, University College London, London, United Kingdom
| | - Yolanda Lau
- Division of Psychiatry, University College London, London, United Kingdom
| | - Lydia Munns
- Division of Psychiatry, University College London, London, United Kingdom; Department of Psychology, University of York, York, United Kingdom
| | - Sedigheh Zabihi
- Division of Psychiatry, University College London, London, United Kingdom
| | - Marco Schlosser
- Division of Psychiatry, University College London, London, United Kingdom; Department of Psychology, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
| | | | - Vasiliki Orgeta
- Division of Psychiatry, University College London, London, United Kingdom
| | - Natalie L Marchant
- Division of Psychiatry, University College London, London, United Kingdom.
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9
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Kehler DS, Milic J, Guaraldi G, Fulop T, Falutz J. Frailty in older people living with HIV: current status and clinical management. BMC Geriatr 2022; 22:919. [PMID: 36447144 PMCID: PMC9708514 DOI: 10.1186/s12877-022-03477-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 09/23/2022] [Indexed: 12/05/2022] Open
Abstract
This paper will update care providers on the clinical and scientific aspects of frailty which affects an increasing proportion of older people living with HIV (PLWH). The successful use of combination antiretroviral therapy has improved long-term survival in PLWH. This has increased the proportion of PLWH older than 50 to more than 50% of the HIV population. Concurrently, there has been an increase in the premature development of age-related comorbidities as well as geriatric syndromes, especially frailty, which affects an important minority of older PLWH. As the number of frail older PLWH increases, this will have an important impact on their health care delivery. Frailty negatively affects a PLWH's clinical status, and increases their risk of adverse outcomes, impacting quality of life and health-span. The biologic constructs underlying the development of frailty integrate interrelated pathways which are affected by the process of aging and those factors which accelerate aging. The negative impact of sarcopenia in maintaining musculoskeletal integrity and thereby functional status may represent a bidirectional interaction with frailty in PLWH. Furthermore, there is a growing body of literature that frailty states may be transitional. The recognition and management of related risk factors will help to mitigate the development of frailty. The application of interdisciplinary geriatric management principles to the care of older PLWH allows reliable screening and care practices for frailty. Insight into frailty, increasingly recognized as an important marker of biologic age, will help to understand the diversity of clinical status occurring in PLWH, which therefore represents a fundamentally new and important aspect to be evaluated in their health care.
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Affiliation(s)
- D. Scott Kehler
- grid.55602.340000 0004 1936 8200Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, NS Canada ,grid.55602.340000 0004 1936 8200School of Physiotherapy, Faculty of Health, Dalhousie University, Room 402 Forrest Building 5869 University Ave, B3H 4R2, PO Box 15000 Halifax, NS Canada
| | - Jovana Milic
- grid.7548.e0000000121697570Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanni Guaraldi
- grid.7548.e0000000121697570Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Tamas Fulop
- grid.86715.3d0000 0000 9064 6198Department of Medicine, Geriatric Division, Research Center On Aging, Université de Sherbrooke, Sherbrooke, QC Canada
| | - Julian Falutz
- grid.63984.300000 0000 9064 4811Division of Geriatric Medicine, Division of Infectious Diseases, Comprehensive HIV Aging Initiative, McGill University Health Center, Montreal, QC Canada
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10
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De Luca V, Femminella GD, Patalano R, Formosa V, Lorusso G, Rivetta C, Di Lullo F, Mercurio L, Rea T, Salvatore E, Korkmaz Yaylagul N, Apostolo J, Silva RC, Dantas C, van Staalduinen WH, Liotta G, Iaccarino G, Triassi M, Illario M. Assessment Tools of Biopsychosocial Frailty Dimensions in Community-Dwelling Older Adults: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16050. [PMID: 36498125 PMCID: PMC9739796 DOI: 10.3390/ijerph192316050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/21/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
Frailty is a complex interplay between several factors, including physiological changes in ageing, multimorbidities, malnutrition, living environment, genetics, and lifestyle. Early screening for frailty risk factors in community-dwelling older people allows for preventive interventions on the clinical and social determinants of frailty, which allows adverse events to be avoided. By conducting a narrative review of the literature employing the International Narrative Systematic Assessment tool, the authors aimed to develop an updated framework for the main measurement tools to assess frailty risks in older adults, paying attention to use in the community and primary care settings. This search focused on the biopsychosocial domains of frailty that are covered in the SUNFRAIL tool. The study selected 178 reviews (polypharmacy: 20; nutrition: 13; physical activity: 74; medical visits: 0; falls: 39; cognitive decline: 12; loneliness: 15; social support: 5; economic constraints: 0) published between January 2010 and December 2021. Within the selected reviews, 123 assessment tools were identified (polypharmacy: 15; nutrition: 15; physical activity: 25; medical visits: 0; falls: 26; cognitive decline: 18; loneliness: 9; social support: 15; economic constraints: 0). The narrative review allowed us to evaluate assessment tools of frailty domains to be adopted for multidimensional health promotion and prevention interventions in community and primary care.
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Affiliation(s)
- Vincenzo De Luca
- Dipartimento di Sanità Pubblica, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Grazia Daniela Femminella
- Dipartimento di Scienze Mediche Traslazionali, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Roberta Patalano
- Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Valeria Formosa
- Specializzazione in Igiene e Medicina Preventiva, Università degli Studi di Roma Tor Vergata, 00133 Roma, Italy
| | - Grazia Lorusso
- Specializzazione in Igiene e Medicina Preventiva, Università degli Studi di Roma Tor Vergata, 00133 Roma, Italy
| | - Cristiano Rivetta
- Specializzazione in Igiene e Medicina Preventiva, Università degli Studi di Roma Tor Vergata, 00133 Roma, Italy
| | - Federica Di Lullo
- Specializzazione in Igiene e Medicina Preventiva, Università degli Studi di Roma Tor Vergata, 00133 Roma, Italy
| | - Lorenzo Mercurio
- Dipartimento di Sanità Pubblica, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Teresa Rea
- Dipartimento di Sanità Pubblica, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Elena Salvatore
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | | | - Joao Apostolo
- Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Avenida Bissaya Barreto, 3004-011 Coimbra, Portugal
| | - Rosa Carla Silva
- Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Avenida Bissaya Barreto, 3004-011 Coimbra, Portugal
| | | | | | - Giuseppe Liotta
- Dipartimento di Biomedicina e Prevenzione, Università degli Studi di Roma Tor Vergata, 00133 Roma, Italy
| | - Guido Iaccarino
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Maria Triassi
- Dipartimento di Sanità Pubblica, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Maddalena Illario
- Dipartimento di Sanità Pubblica, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
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11
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Wahyudi ER, Putri RF, Yunihastuti E, Shatri H. Risk of Falls in HIV-Infected Patients on Antiretroviral Therapy and Its Associated Factors. HIV AIDS (Auckl) 2022; 14:355-363. [PMID: 35942410 PMCID: PMC9356599 DOI: 10.2147/hiv.s372204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/22/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Methods Results Conclusion
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Affiliation(s)
- Edy Rizal Wahyudi
- Department of Internal Medicine, Faculty of Medicine Universitas Indonesia – Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Rizki Febriani Putri
- Department of Internal Medicine, Faculty of Medicine Universitas Indonesia – Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Evy Yunihastuti
- Department of Internal Medicine, Faculty of Medicine Universitas Indonesia – Cipto Mangunkusumo Hospital, Jakarta, Indonesia
- Correspondence: Evy Yunihastuti, Email
| | - Hamzah Shatri
- Department of Internal Medicine, Faculty of Medicine Universitas Indonesia – Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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12
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Berner K, Gouelle A, Strijdom H, Essop MF, Webster I, Louw Q. Mobility Deviations in Adults With Human Immunodeficiency Virus: A Cross-Sectional Assessment Using Gait Analysis, Functional Performance, and Self-Report. Open Forum Infect Dis 2021; 8:ofab425. [PMID: 34557560 PMCID: PMC8454513 DOI: 10.1093/ofid/ofab425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 08/16/2021] [Indexed: 11/22/2022] Open
Abstract
Background Little is known about how human immunodeficiency virus (HIV) affects walking biomechanics, or about associations between HIV-related gait deviations, functional performance, and self-reported outcomes. This paper reports on (1) gait biomechanics and variability in people with HIV (PWH) and (2) associations with clinical tests, self-reported function, and falls. Methods A cross-sectional study tested consecutively sampled PWH (n = 50) and HIV-seronegative participants ([SNP] n = 50). Participants underwent 3-dimensional gait analysis, performed clinical tests (short walk and single leg stance tests with and without dual tasking, chair-rise tests, and a physical performance battery), and completed questionnaires about function and falls. Between-group comparisons were done using analysis of covariance. Linear correlations between gait variability, clinical tests, and patient-reported outcomes were established. Results People with HIV and SNP had comparable median ages (PWH = 36.6, interquartile range [IQR] = 32.0–45.6]; SNP = 31.1, IQR = 23.2–45.1). Compared with SNP, PWH walked slower (adjusted mean difference [MD] = −0.2 meters per second [m/s], 95% confidence interval [CI] = −0.3 to −0.1) with greater variability (adjusted MD = 14.7 variability score points, 95% CI = 9.9–19.5). Moreover, PWH were slower in five-times sit-to-stand (5STS) performance (adjusted MD = 1.9 seconds, 95% CI = 1.00–2.9). Significant deviations in hip kinematics (increased flexion; adjusted MDs = 2.4°–2.8°, P = .012–.016) and knee kinematics (reduced flexion; adjusted MDs = 2.3°–3.7°, P = .007–.027) were found in PWH during dual-task (DT) walking. The PWH’s 5STS moderately correlated with larger gait variability (usual pace r = −0.5; dual task r = −0.6), poorer self-reported mobility (r = 0.4) and self-care function (r = 0.5), and fear of falling (P = .003). Conclusions People with HIV presented with biomechanical deviations suggestive of a slowed and variable gait, especially under cognitive challenges. Five-times STS may be useful to screen for gait deviations in PWH.
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Affiliation(s)
- Karina Berner
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Arnaud Gouelle
- Gait and Balance Academy, ProtoKinetics, Havertown, Pennsyvania, USA.,Laboratory Performance, Santé, Métrologie, Société, UFR STAPS, (Unit for Teaching and Research - Sciences and Techniques for Physical Activities and Sports), Reims, France
| | - Hans Strijdom
- Centre for Cardio-metabolic Research in Africa, Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - M Faadiel Essop
- Centre for Cardio-metabolic Research in Africa, Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Cape Town, South Africa
| | - Ingrid Webster
- Centre for Cardio-metabolic Research in Africa, Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Quinette Louw
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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13
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Armstead AB, Wilkerson JM, Gemeinhardt G, Nyitray A, Collins DM. Antiretroviral Therapy Adherence, Functional Independence, and Falls among People with HIV. Occup Ther Health Care 2021; 35:318-335. [PMID: 34137654 DOI: 10.1080/07380577.2021.1938337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Chronic disease management coupled with education may improve outcomes for those with chronic disease. As Human Immunodeficiency Virus (HIV) is now a chronic disease, addressing the needs of as people living with HIV (PLWH) is essential as they experience an accelerated aging process due to the mechanisms of the disease and medications taken. Although studies exist on the management of chronic HIV, few discuss the implications of medication adherence and activities of daily living related to falls among PLWH. To inform occupational therapy services for PLWH, this case-control study used extracted data from the electronic medical records of PLWH who had received occupational therapy (OT) at a large academic hospital. Two-hundred-and-four subjects were included in the final dataset; sixty-eight were cases that reported a fall within the last 12 months, while 136 were controls which were PLWH who had not sustained a fall. The association between falls and antiretroviral therapy adherence indicated males who were ART non-adherent and had balance deficits were more likely to fall. The association between ADL dysfunction and falls among PLWH showed those more likely to fall had moderate ADL dysfunction and balance deficits. The findings suggest further examination of the person factors of PLWH who are categorized clinically as non-adherent with antiretroviral therapy and have ADL dysfunction may improve health outcomes and reduce falls when paired with occupation-based interventions.
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Affiliation(s)
- Amber B Armstead
- School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA.,Department of Occupational Therapy, School of Health Professions, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - J Michael Wilkerson
- School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA
| | - Gretchen Gemeinhardt
- School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA
| | - Alan Nyitray
- School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA
| | - Diane M Collins
- Department of Occupational Therapy, School of Health Professions, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
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14
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Pedroso RV, Fraga FJ, Pavarini SCI, Nascimento CMC, Ayán C, Cominetti MR. A Systematic Review of Altered P300 Event-Related Potential in Apolipoprotein E4 ( APOE4) Carriers. Clin EEG Neurosci 2021; 52:193-200. [PMID: 32945192 DOI: 10.1177/1550059420959966] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Apolipoprotein ε4 allele (APOE4) is the strongest genetic risk factor for Alzheimer's disease and seems to be related to cognitive decline and damaged event-related potential P300, which is a sensitive measure to assess cognitive processing. OBJECTIVE This research aims to critically review the existing scientific evidence regarding the association between APOE4 and P300. METHODS A systematic review was carried out up to January 2020 on the following databases: Web of Science, Scopus and Medline/PubMed. Articles were considered for inclusion if they are original research that provided information regarding the association between APOE4 and P300, available in English, Spanish, or Portuguese, and available in full text. The methodological quality of the studies selected was evaluated using the quality assessment tool for observational cohort and cross-sectional studies recommended by Cochrane. RESULTS Out of 993 studies, 14 met the inclusion criteria. The results obtained showed that APOE4 is related to a longer P300 latency. However, the data supplied do not allow us to confirm if this relationship also occurs in amplitude measures. Moreover, it was observed that APOE genotype may influence P300 in different ages, from younger individuals to demented older people. CONCLUSION Evidence shows that APOE4 negatively influences cortical activities related to cognitive functions, as indicated by P300.
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Affiliation(s)
- Renata Valle Pedroso
- Department of Gerontology, 67828Federal University of São Carlos, São Carlos, SP, Brazil
| | - Francisco José Fraga
- Engineering, Modelling and Applied Social Sciences Center (CECS), 488580Federal University of the ABC (UFABC), Santo André, SP, Brazil
| | | | | | - Carlos Ayán
- Well-Move Research Group, Department of Special Didactics, 16784University of Vigo, Vigo, Spain.,IIS Galicia Sur, Vigo, Spain
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15
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Robinson-Papp J, Gensler G, Navis A, Sherman S, Ellis RJ, Gelman BB, Kolson DL, Letendre SL, Singer EJ, Valdes-Sueiras M, Morgello S. Characteristics of Motor Dysfunction in Longstanding Human Immunodeficiency Virus. Clin Infect Dis 2021; 71:1532-1538. [PMID: 31587032 DOI: 10.1093/cid/ciz986] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 10/03/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Cognitive dysfunction in human immunodeficiency virus (HIV) has decreased, but milder forms of HIV-associated neurocognitive disorders (HAND) persist along with motor dysfunction. The HIV Motor Scale (HMS) is a validated tool that captures motor abnormalities on routine neurologic examination and which is associated with cognitive impairment in HIV. In this study, we applied a modified HMS (MHMS) to a nationwide cohort of people with longstanding HIV to characterize and understand the factors contributing to motor dysfunction. METHODS The National NeuroAIDS Tissue Consortium is a nationwide longitudinal cohort study. Participants undergo regular assessments including neurological examination, neuropsychological testing, and immunovirologic data collection. Data from examinations were used to calculate the MHMS score, which was then correlated with history of AIDS-related central nervous system (CNS) disorders (ARCD; eg, prior CNS opportunistic infection), cerebrovascular disease (CVD), and HAND. RESULTS Sixty-nine percent of participants showed an abnormality on the MHMS, with 27% classified as severe. Results did not vary based on demographic or immunologic variables. The most common abnormalities seen were gait (54%), followed by coordination (39%) and strength (25%), and these commonly co-occurred. CVD (P = .02), history of ARCD (P = .001), and HAND (P = .001) were all associated with higher (ie, worse) HMS in univariate analyses; CVD and ARCD persisted in multivariate analyses. CVD was also marginally associated with symptomatic HAND. CONCLUSIONS Complex motor dysfunction remains common in HIV and is associated with CVD, ARCD, and to a lesser extent, HAND. Future studies are needed to understand the longitudinal trajectory of HIV-associated motor dysfunction, its neural substrates, and impact on quality of life.
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Affiliation(s)
- Jessica Robinson-Papp
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Allison Navis
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Ronald J Ellis
- Department of Neurosciences, University of California, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, California, USA
| | - Benjamin B Gelman
- Department of Pathology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Dennis L Kolson
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Scott L Letendre
- Department of Psychiatry, University of California, San Diego, California, USA.,Department of Medicine, University of California, San Diego, California, USA
| | - Elyse J Singer
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Miguel Valdes-Sueiras
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Susan Morgello
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York.,Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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16
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Santerre M, Arjona SP, Allen CN, Callen S, Buch S, Sawaya BE. HIV-1 Vpr protein impairs lysosome clearance causing SNCA/alpha-synuclein accumulation in neurons. Autophagy 2021; 17:1768-1782. [PMID: 33890542 DOI: 10.1080/15548627.2021.1915641] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Despite the promising therapeutic effects of combinatory antiretroviral therapy (cART), 20% to 30% of HIV/AIDS patients living with long term infection still exhibit related cognitive and motor disorders. Clinical studies in HIV-infected patients revealed evidence of basal ganglia dysfunction, tremors, fine motor movement deficits, gait, balance, and increased risk of falls. Among older HIV+ adults, the frequency of cases with SNCA/α-synuclein staining is higher than in older healthy persons and may predict an increased risk of developing a neurodegenerative disease. The accumulation of SNCA aggregates known as Lewy Bodies is widely described to be directly linked to motor dysfunction. These aggregates are naturally removed by Macroautophagy/autophagy, a cellular housekeeping mechanism, that can be disturbed by HIV-1. The molecular mechanisms involved in linking HIV-1 proteins and autophagy remain mostly unclear and necessitates further exploration. We showed that HIV-1 Vpr protein triggers the accumulation of SNCA in neurons after decreasing lysosomal acidification, deregulating lysosome positioning, and the expression levels of several proteins involved in lysosomal maturation. Viruses and retroviruses such as HIV-1 are known to manipulate autophagy in order to use it for their replication while blocking the degradative final step, which could destroy the virus itself. Our study highlights how the suppression of neuronal autophagy by HIV-1 Vpr is a mechanism leading to toxic protein aggregation and neurodegeneration.Abbreviations: BLOC1: Biogenesis of Lysosome-related Organelles Complex 1; CART: combinatory antiretroviral therapy; CVB: coxsackievirus; DAPI: 4',6-diamidino-2-phenylindole; DENV: dengue virus; GFP: green fluorescent protein; HCV: hepatitis C virus; HCMV: human cytomegalovirus; HIV: human immunodeficiency virus; Env: HIV-1 envelope glycoproteins; GAPDH: glyceraldehyde-3-phosphate dehydrogenase; VSV: Indiana vesiculovirus; LTR: Long Terminal Repeat; LAMP1: lysosomal associated membrane protein 1; MAP1LC3B/LC3B: microtubule associated protein 1 light chain 3 beta; MLBs: multilamellar bodies; RIPA: Radioimmunoprecipitation assay buffer; SDS-PAGE: sodium dodecyl sulfate-polyacrylamide gel electrophoresis; Tat: transactivator of TAR; TEM: transmission electron microscope; Vpr: Viral protein R.
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Affiliation(s)
- Maryline Santerre
- Molecular Studies of Neurodegenerative Diseases Lab, FELS Cancer Institute for Personalized Medicine and Department of Neurology Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Sterling P Arjona
- Molecular Studies of Neurodegenerative Diseases Lab, FELS Cancer Institute for Personalized Medicine and Department of Neurology Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Charles Ns Allen
- Molecular Studies of Neurodegenerative Diseases Lab, FELS Cancer Institute for Personalized Medicine and Department of Neurology Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Shannon Callen
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, USA
| | - Shilpa Buch
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, USA
| | - Bassel E Sawaya
- Molecular Studies of Neurodegenerative Diseases Lab, FELS Cancer Institute for Personalized Medicine and Department of Neurology Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA.,Department of Neurology Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
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17
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Charumbira MY, Berner K, Louw Q. Physiotherapists' awareness of risk of bone demineralisation and falls in people living with HIV: a qualitative study. BMC Health Serv Res 2021; 21:333. [PMID: 33849529 PMCID: PMC8045224 DOI: 10.1186/s12913-021-06343-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 04/03/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Recent research has indicated a seemingly increased propensity for both falls and accelerated bone loss in people living with HIV (PLWH). Physiotherapists play a crucial role in optimising function and quality of life of PLWH through prevention of falls and reducing the harm that results. AIM This study aimed to explore physiotherapists' awareness of falls risk and accelerated bone demineralisation in PLWH and their perceptions of current falls prevention strategies in the care of PLWH in selected regions of sub-Saharan Africa. METHOD An exploratory descriptive qualitative research method was employed to explore physiotherapists' perceptions and experiences regarding bone health and falls in PLWH. In-depth semi-structured telephonic interviews were used to collect data from 21 physiotherapists working in primary HIV care. Transcribed interview data were coded in Atlas.ti.8® and analysed using inductive thematic analysis. RESULTS The primary study revealed a lack of awareness by physiotherapists of falls risk and bone demineralisation in PLWH. As such, physiotherapists did not link falls or fractures to HIV or antiretroviral therapy (ART) when they did observe such events during their general patient assessments. However, in retrospect, some physiotherapists were able to recognise risk factors linked to falls in those with HIV. Current services for falls prevention, as perceived by the physiotherapists, were sub-optimal. CONCLUSION Physiotherapists may need to be more aware of the potential risk of falls and bone demineralisation in PLWH and routinely assess for these phenomena in both older and younger PLWH.
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Affiliation(s)
- Maria Y Charumbira
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 241, Cape town, 8000, South Africa.
| | - Karina Berner
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 241, Cape town, 8000, South Africa
| | - Quinette Louw
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 241, Cape town, 8000, South Africa
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18
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Brennan C, Laubscher M, Maqungo S, Graham SM. Bibliometric analysis of research on the effects of human immunodeficiency virus in orthopaedic and trauma surgery. World J Orthop 2021; 12:169-177. [PMID: 33816143 PMCID: PMC7995343 DOI: 10.5312/wjo.v12.i3.169] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 01/12/2021] [Accepted: 02/04/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There is little research investigating how human immunodeficiency virus (HIV) affects outcomes in orthopaedic surgery. With advances in treatment, HIV has become a chronic health problem and the chance of orthopaedic surgeons encountering it in clinical practice is increasing.
AIM To ascertain the quantity and quality of peer-reviewed publications in orthopaedic journals about HIV.
METHODS A search of the Web of Science database was carried out, identifying any articles relating to HIV published in orthopaedic journals. These were assessed for geographic origin and level of evidence.
RESULTS Of 48.7% of orthopaedic journals listed on the Web of Science database had published articles relating to HIV. There were 168 articles about HIV in orthopaedic journals with only 40.5% (n = 68) published in the time frame we analysed (January 2007 to September 2017). Very few articles came from low-income countries and any articles published from that setting were collaborations. All of the articles were low level of evidence.
CONCLUSION There is a need for more high level orthopaedic and trauma research investigating the effects of HIV, particularly research from low-income countries, where higher level research will help to guide improvements in their treatment of its musculoskeletal manifestations and complications.
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Affiliation(s)
- Ciaran Brennan
- Department of Orthopaedics, Royal Cornwall Hospital, Truro TR13LQ, United Kingdom
- Orthopaedic Research Unit, University of Cape Town, Cape Town 7925, South Africa
| | - Maritz Laubscher
- Orthopaedic Research Unit, University of Cape Town, Cape Town 7925, South Africa
- Division of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town 7925, South Africa
| | - Sithombo Maqungo
- Orthopaedic Research Unit, University of Cape Town, Cape Town 7925, South Africa
- Division of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town 7925, South Africa
| | - Simon Matthew Graham
- Orthopaedic Research Unit, University of Cape Town, Cape Town 7925, South Africa
- Division of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town 7925, South Africa
- Institute of Population Health Sciences, University of Liverpool, Liverpool L97AL, United Kingdom
- Department of Orthopaedic and Trauma Surgery, Liverpool University Teaching Hospitals Trust, Liverpool L97AL, United Kingdom
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool L97AL, United Kingdom
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19
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Charumbira MY, Berner K, Louw QA. Falls in people living with HIV: a scoping review. BMJ Open 2020; 10:e034872. [PMID: 33148721 PMCID: PMC7674634 DOI: 10.1136/bmjopen-2019-034872] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 09/23/2020] [Accepted: 09/29/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Recent research has indicated seemingly increased propensity for falls and accelerated bone demineralisation in people living with HIV (PLWH). We aim to map out the extent and nature of existing research relating to falls in PLWH and describe the relationship between bone demineralisation and falls in PLWH. METHODS A scoping review was done following Arksey & O'Malley's methodological framework and recommendations from Joanna Briggs Institute. Four databases were searched until October 2019 for peer-reviewed studies available in English reporting on the definition, prevalence, assessment, risk factors and interventions for falls in PLWH as well as information on bone demineralisation linked to falls in PLWH. Narrative reviews were excluded. Two reviewers independently performed the extraction using a predesigned Excel sheet. A descriptive analysis of extracted information was done. RESULTS Fourteen studies on falls in older PLWH were identified, with all but one study conducted in high-income countries. Prevalence of falls in PLWH ranged from 12% to 41%. Variable assessment tools/tests were used to assess potential risk factors, but it remains to be determined which are more predictive and appropriate for use among PLWH. Considerable agreement existed for risk factors regarding use of medications while evidence regarding functional and cognitive impairments were variable. Few studies compared risk factors for falls in PLWH with those in age-matched and sex-matched seronegative population. There is currently no evidence for interventions to prevent or reduce falls risk in PLWH. CONCLUSION More research is needed on falls in younger cohorts of PLWH and in sub-Saharan Africa where HIV is most prevalent and more robust clades exist. More studies need to report on data in seronegative controls to determine risk factors unique to PLWH. More intervention studies targeted at falls prevention and promotion of bone health are required. Quality clinical practice guidelines highlighting validated assessment tools and outcome measures need to be developed.
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Affiliation(s)
- Maria Yvonne Charumbira
- Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Karina Berner
- Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Quinette Abegail Louw
- Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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20
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Ryan AS, Roy A, Oursler KK. Gait and Balance Biomechanics in Older Adults With and Without Human Immunodeficiency Virus. AIDS Res Hum Retroviruses 2020; 35:1089-1094. [PMID: 31547668 DOI: 10.1089/aid.2019.0102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Balance deficits impose limitations and can impede safe walking contributing to falls and falls-related complications. The objective of this study was to perform an in-depth balance assessment and compare domains of limitations in older men with and without HIV infection. Fifteen sedentary African American men either with HIV (n = 6) or without HIV (n = 9 controls) participated. Standing balance was assessed under quiet stance on dual synchronized force plates during three 30 s trials with eyes open. Participants also completed standardized clinical instruments of balance, including the Berg Balance Scale (BBS) and Dynamic Gait Index (DGI). Older participants with HIV have lower BBS and DGI scores than controls (both p < .05). Adults with HIV have nearly twice the magnitude greater center of pressure (COP) sway variability than controls (1.42 ± 1.20 cm2 vs. 0.71 ± 0.1 cm2, p < .05). These data demonstrating differences in COP sway area between groups may further support evidence of potential fall risk and contribute to frailty in older adults with HIV.
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Affiliation(s)
- Alice S. Ryan
- VA Maryland Health Care System, Baltimore VA Medical Center, Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
- Baltimore VA Medical Center, Geriatric Research, Education and Clinical Center (GRECC), VA Maryland Health Care System, Baltimore, Maryland
- Division of Infectious Disease, Department of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia
- Salem Veterans Affairs Medical Center, Salem, Virginia
| | - Anindo Roy
- VA Maryland Health Care System, Baltimore VA Medical Center, Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
- Baltimore VA Medical Center, Geriatric Research, Education and Clinical Center (GRECC), VA Maryland Health Care System, Baltimore, Maryland
- Division of Infectious Disease, Department of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia
- Salem Veterans Affairs Medical Center, Salem, Virginia
| | - Krisann K. Oursler
- VA Maryland Health Care System, Baltimore VA Medical Center, Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
- Baltimore VA Medical Center, Geriatric Research, Education and Clinical Center (GRECC), VA Maryland Health Care System, Baltimore, Maryland
- Division of Infectious Disease, Department of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia
- Salem Veterans Affairs Medical Center, Salem, Virginia
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21
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Berner K, Cockcroft J, Louw Q. Kinematics and temporospatial parameters during gait from inertial motion capture in adults with and without HIV: a validity and reliability study. Biomed Eng Online 2020; 19:57. [PMID: 32709239 PMCID: PMC7379351 DOI: 10.1186/s12938-020-00802-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 07/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inertial measurement unit (IMU)-based motion capture systems are gaining popularity for gait analysis outside laboratories. It is important to determine the performance of such systems in specific patient populations. We aimed to validate and determine within-day reliability of an IMU system for measuring lower limb gait kinematics and temporal-spatial parameters (TSP) in people with and without HIV. METHODS Gait was recorded in eight adults with HIV (PLHIV) and eight HIV-seronegative participants (SNP), using IMUs and optical motion capture (OMC) simultaneously. Participants performed six gait trials. Fifteen TSP and 28 kinematic angles were extracted. Intraclass correlations (ICC), root-mean-square error (RMSE), mean absolute percentage error and Bland-Altman analyses were used to assess concurrent validity of the IMU system (relative to OMC) separately in PLHIV and SNP. IMU reliability was assessed during within-session retest of trials. ICCs were used to assess relative reliability. Standard error of measurement (SEM) and percentage SEM were used to assess absolute reliability. RESULTS Between-system TSP differences demonstrated acceptable-to-excellent ICCs (0.71-0.99), except for double support time and temporophasic parameters (< 0.60). All TSP demonstrated good mean absolute percentage errors (≤7.40%). For kinematics, ICCs were acceptable to excellent (0.75-1.00) for all but three range of motion (ROM) and four discrete angles. RMSE and bias were 0.0°-4.7° for all but two ROM and 10 discrete angles. In both groups, TSP reliability was acceptable to excellent for relative (ICC 0.75-0.99) (except for one temporal and two temporophasic parameters) and absolute (%SEM 1.58-15.23) values. Reliability trends of IMU-measured kinematics were similar between groups and demonstrated acceptable-to-excellent relative reliability (ICC 0.76-0.99) and clinically acceptable absolute reliability (SEM 0.7°-4.4°) for all but two and three discrete angles, respectively. Both systems demonstrated similar magnitude and directional trends for differences when comparing the gait of PLHIV with that of SNP. CONCLUSIONS IMU-based gait analysis is valid and reliable when applied in PLHIV; demonstrating a sufficiently low precision error to be used for clinical interpretation (< 5° for most kinematics; < 20% for TSP). IMU-based gait analysis is sensitive to subtle gait deviations that may occur in PLHIV.
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Affiliation(s)
- Karina Berner
- Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000, South Africa.
| | - John Cockcroft
- Central Analytical Facilities, Neuromechanics Unit, Stellenbosch University, Private Bag X1, Matieland, 7602, South Africa
| | - Quinette Louw
- Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000, South Africa
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22
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Erlandson KM, Travison TG, Zhu H, Magaziner J, Correa-de-Araujo R, Cawthon PM, Bhasin S, Manini T, Fielding RA, Palella FJ, Kingsley L, Lake JE, Sharma A, Tien PC, Weber KM, Yin MT, Brown TT. Application of Selected Muscle Strength and Body Mass Cut Points for the Diagnosis of Sarcopenia in Men and Women With or at Risk for HIV Infection. J Gerontol A Biol Sci Med Sci 2020; 75:1338-1345. [PMID: 32301484 PMCID: PMC7302174 DOI: 10.1093/gerona/glaa083] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Persons with HIV may experience greater mobility limitations than uninfected populations. Accurate tools are needed to identify persons at greatest risk of decline. We evaluated the performance of novel muscle weakness metrics (grip, grip/body mass index [BMI], grip/weight, grip/total body fat, grip/arm lean mass) and association with slowness and falls in older persons with or at risk for HIV infection as part of the work of the Sarcopenia Definitions and Outcomes Consortium (SDOC). METHODS We assessed the prevalence of sarcopenia among 398 men (200 HIV+, 198 HIV-) from the Multicenter AIDS Cohort Study and 247 women (162 HIV+, 85 HIV-) from the Women's Interagency HIV Study using previously validated muscle weakness metrics discriminative of slowness. Sensitivity and specificity were used to compare new muscle weakness and slowness criteria to previously proposed sarcopenia definitions. RESULTS The prevalence of muscle weakness ranged from 16% to 66% among men and 0% to 47% among women. Grip/BMI was associated with slowness among men with HIV only. Grip/BMI had low sensitivity (25%-30%) with moderate to high specificity (68%-89%) for discriminating of slowness; all proposed metrics had poor performance in the discrimination of slowness (area under the curve [AUC] < 0.62) or fall status (AUC < 0.56). The combination of muscle weakness and slowness was not significantly associated with falls (p ≥ .36), with a low sensitivity in identifying those sustaining one or more falls (sensitivity ≤ 16%). DISCUSSION Clinical utility of new sarcopenia metrics for identification of slowness or falls in men and women with or at risk for HIV is limited, given their low sensitivity.
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Affiliation(s)
- Kristine M Erlandson
- Department of Medicine, University of Colorado-Anschutz Medical Campus, Aurora, Colorado
| | - Thomas G Travison
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
| | - Hao Zhu
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
| | - Jay Magaziner
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Rosaly Correa-de-Araujo
- Division of Geriatrics and Clinical Gerontology, National Institutes of Health, National Institute on Aging, Bethesda, Maryland
| | - Peggy M Cawthon
- California Pacific Medical Research Institute, San Francisco
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Shalender Bhasin
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Todd Manini
- Department of Aging and Geriatric Research, University of Florida, Gainesville
| | - Roger A Fielding
- Jean Mayer USDA Human Nutrition Research Center, Tufts University, Boston, Massachusetts
| | - Frank J Palella
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lawrence Kingsley
- Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | - Jordan E Lake
- Department of Medicine, University of Texas Health Science Center at Houston
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Phyllis C Tien
- Department of Medicine, University of California San Francisco
- Department of Veterans Affairs Medical Center, San Francisco, California
| | - Kathleen M Weber
- Cook County Health and Hektoen Institute of Medicine, Chicago, Illinois
| | - Michael T Yin
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Todd T Brown
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
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Quigley A, MacKay-Lyons M. Physical deficits among people living with HIV: a review of the literature and implications for rehabilitation. PHYSICAL THERAPY REVIEWS 2019. [DOI: 10.1080/10833196.2019.1701763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Adria Quigley
- Department of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Marilyn MacKay-Lyons
- Department of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
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24
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Masters MC, Perez J, Tassiopoulos K, Andrade A, Ellis R, Yang J, Brown TT, Palella FJ, Erlandson KM. Gait Speed Decline Is Associated with Hemoglobin A1C, Neurocognitive Impairment, and Black Race in Persons with HIV. AIDS Res Hum Retroviruses 2019; 35:1065-1073. [PMID: 31468979 DOI: 10.1089/aid.2019.0101] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Gait speed declines at a faster rate in persons with HIV (PWH) than in the general population but the risk factors associated with this decline are not well understood. In the AIDS Clinical Trials Group (ACTG) A5322 (HAILO, HIV Infection, Aging, and Immune Function Long-term Observational Study), an observational cohort study of PWH ≥40 years of age, those who developed slow gait during the first 3 years of follow-up were compared with persons who maintained normal speed. Associations with demographic and clinical covariates were assessed using multivariable logistic regression. Of 929 participants, 81% were men, 31% Black, and 20% Hispanic. Median age was 51 years [interquartile range (IQR) = 46-56]. At study entry, 92% had plasma HIV RNA <50 copies/mL with median CD4 count 631 cells/mm3 (IQR = 458-840). At study entry, 7% of participants had slow gait, 16% had neurocognitive impairment (NCI), and 12% had diabetes. Over 3 years, 87% maintained normal gait speed, 3% maintained a slow gait, 6% developed a slow gait, and 4% improved from slow to normal gait speed. In multivariable models, hemoglobin A1C (HbA1C) percentage, per one unit increase [odds ratio (OR) = 1.36; 95% confidence interval (CI) = 1.03-1.81; p = .033], NCI (OR = 3.47; 95% CI = 1.57-7.69 p = .002), and black versus white race (OR = 2.45; 95% CI = 1.08-5.59; p = .032) at entry were significantly associated with development of slow gait compared with those maintaining normal gait speed. The association between baseline HbA1C and development of slow gait speed highlights an intervenable target to prevent progression of physical function limitations.
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Affiliation(s)
- Mary Clare Masters
- Division of Infectious Diseases, Northwestern University, Chicago, Illinois
| | - Jeremiah Perez
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Katherine Tassiopoulos
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | | | - Ronald Ellis
- Department of Neurosciences, University of California, San Diego, California
| | - Jingyan Yang
- Mailman School of Public Health, Columbia University, New York, New York
| | - Todd T. Brown
- Division of Endocrinology, Diabetes, & Metabolism, Johns Hopkins University, Baltimore, Maryland
| | - Frank J. Palella
- Division of Infectious Diseases, Northwestern University, Chicago, Illinois
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Berner K, Strijdom H, Essop MF, Webster I, Morris L, Louw Q. Fall History and Associated Factors Among Adults Living With HIV-1 in the Cape Winelands, South Africa: An Exploratory Investigation. Open Forum Infect Dis 2019; 6:ofz401. [PMID: 31660363 PMCID: PMC6785680 DOI: 10.1093/ofid/ofz401] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 09/06/2019] [Indexed: 02/06/2023] Open
Abstract
Background People with HIV-1 (PWH) exhibit a high fall incidence and increased fracture risk. As little is known about fall frequency and associated factors in PWH residing in lower-middle-income countries (LMIC), we investigated fall frequency, bone quality, and factors associated with fall history in a South African cohort. Methods Fifty PWH without obvious predisposing factors for mobility impairments attending 2 public primary care clinics in the Western Cape region participated. Demographic, clinical, and physical performance data were collected. Falls were assessed retrospectively over 12 months. Mobility and balance were evaluated using a physical performance battery. Bone mineral density was screened using quantitative ultrasound (QUS). Associations between variables and falls grouping were analyzed using chi-square tests, t tests, and Mann-Whitney U tests, and effect sizes (ES) were calculated. Results Thirty-four percent of PWH (median age, 36.6 years) reported falling during the past year, and 41.2% of fallers reported multiple falls. Fallers had more mobility problems (P = .013), higher fear of falling (P = .007), higher fracture history (P = .003), worse balance performance (P < .001), higher proportions of detectable viral loads (P = .021), and poorer bone quality (P = .040). Differences were of medium to large ES. Conclusions This exploratory study is the first to show that relatively young South African PWH without obvious predisposing factors for gait and balance impairments experience falls. The observed fall-associated factors warrant further research using larger samples and longitudinal designs to ascertain fall predictors within this population.
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Affiliation(s)
- Karina Berner
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Hans Strijdom
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - M Faadiel Essop
- Cardio-Metabolic Research Group (CMRG), Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Ingrid Webster
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Linzette Morris
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Quinette Louw
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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26
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Zahr NM, Pohl KM, Pfefferbaum A, Sullivan EV. Central Nervous System Correlates of "Objective" Neuropathy in Alcohol Use Disorder. Alcohol Clin Exp Res 2019; 43:2144-2152. [PMID: 31386216 PMCID: PMC6779503 DOI: 10.1111/acer.14162] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 07/24/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND Among the neurological consequences of alcoholism is peripheral neuropathy. Relative to human immunodeficiency virus (HIV) or diabetes-related neuropathies, neuropathy associated with alcohol use disorders (AUD) is understudied. In both the diabetes and HIV literature, emerging evidence supports a central nervous system (CNS) component to peripheral neuropathy. METHODS In seeking a central substrate for AUD-related neuropathy, the current study was conducted in 154 individuals with AUD (43 women, age 21 to 74 years) and 99 healthy controls (41 women, age 21 to 77 years) and explored subjective symptoms (self-report) and objective signs (perception of vibration, deep tendon ankle reflex, position sense, 2-point discrimination) of neuropathy separately. In addition to regional brain volumes, risk factors for AUD-related neuropathy, including age, sex, total lifetime ethanol consumed, nutritional indices (i.e., thiamine, folate), and measures of liver integrity (i.e., γ-glutamyltransferase), were evaluated. RESULTS The AUD group described more subjective symptoms of neuropathy and was more frequently impaired on bilateral perception of vibration. From 5 correlates, the number of AUD-related seizures was most significantly associated with subjective symptoms of neuropathy. There were 15 correlates of impaired perception of vibration among the AUD participants: Of these, age and volume of frontal precentral cortex were the most robust predictors. CONCLUSIONS This study supports CNS involvement in objective signs of neuropathy in AUD.
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Affiliation(s)
- Natalie M Zahr
- Neuroscience Program, (NMZ, KMP, AP), SRI International, Menlo Park, California
- Department of Psychiatry and Behavioral Sciences, (NMZ, KMP, AP, EVS), Stanford University School of Medicine, Stanford, California
| | - Kilian M Pohl
- Neuroscience Program, (NMZ, KMP, AP), SRI International, Menlo Park, California
- Department of Psychiatry and Behavioral Sciences, (NMZ, KMP, AP, EVS), Stanford University School of Medicine, Stanford, California
| | - Adolf Pfefferbaum
- Neuroscience Program, (NMZ, KMP, AP), SRI International, Menlo Park, California
- Department of Psychiatry and Behavioral Sciences, (NMZ, KMP, AP, EVS), Stanford University School of Medicine, Stanford, California
| | - Edith V Sullivan
- Department of Psychiatry and Behavioral Sciences, (NMZ, KMP, AP, EVS), Stanford University School of Medicine, Stanford, California
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27
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Zahr NM, Pohl KM, Pfefferbaum A, Sullivan EV. Dissociable Contributions of Precuneus and Cerebellum to Subjective and Objective Neuropathy in HIV. J Neuroimmune Pharmacol 2019; 14:436-447. [PMID: 30741374 PMCID: PMC6689464 DOI: 10.1007/s11481-019-09837-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 01/25/2019] [Indexed: 01/22/2023]
Abstract
Neuropathy, typically diagnosed by the presence of either symptoms or signs of peripheral nerve dysfunction, remains a frequently reported complication in the antiretroviral (ART)-treated HIV population. This study was conducted in 109 healthy controls and 57 HIV-infected individuals to investigate CNS regions associated with neuropathy. An index of objective neuropathy was computed based on 4 measures: deep tendon ankle reflex, vibration sense (great toes), position sense (great toes), and 2-point discrimination (feet). Subjective neuropathy (self-report of pain, aching, or burning; pins and needles; or numbness in legs or feet) was also evaluated. Structural MRI data were available for 126/166 cases. The HIV relative to the healthy control group was impaired on all 4 signs of neuropathy. Within the HIV group, an objective neuropathy index of 1 (bilateral impairment on 1 measure) or 2 (bilateral impairment on at least 2/4 measures) was associated with older age and a smaller volume of the cerebellar vermis. Moderate to severe symptoms of neuropathy were associated with more depressive symptoms, reduced quality of life, and a smaller volume of the parietal precuneus. This study is consistent with the recent contention that ART-treated HIV-related neuropathy has a CNS component. Distinguishing subjective symptoms from objective signs of neuropathy allowed for a dissociation between the precuneus, a brain region involved in conscious information processing and the vermis, involved in fine tuning of limb movements. Graphical Abstract In HIV patients, objective signs of neuropathy correlated with smaller cerebellar vermis (red) volumes whereas subjective symptoms of neuropathy were associated with smaller precuneus (blue) volumes.
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Affiliation(s)
- Natalie M Zahr
- Neuroscience Program, SRI International, 333 Ravenswood Ave., Menlo Park, CA, 94025, USA.
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd., Stanford, CA, 94305, USA.
| | - Kilian M Pohl
- Neuroscience Program, SRI International, 333 Ravenswood Ave., Menlo Park, CA, 94025, USA
| | - Adolf Pfefferbaum
- Neuroscience Program, SRI International, 333 Ravenswood Ave., Menlo Park, CA, 94025, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd., Stanford, CA, 94305, USA
| | - Edith V Sullivan
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd., Stanford, CA, 94305, USA
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Dastgheyb RM, Sacktor N, Franklin D, Letendre S, Marcotte T, Heaton R, Grant I, McArthur J, Rubin LH, Haughey NJ. Cognitive Trajectory Phenotypes in Human Immunodeficiency Virus-Infected Patients. J Acquir Immune Defic Syndr 2019; 82:61-70. [PMID: 31107302 PMCID: PMC6692206 DOI: 10.1097/qai.0000000000002093] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE The presentation of cognitive impairments in HIV-infected individuals has transformed since the introduction of antiretroviral therapies. Although the overall prevalence of cognitive impairments has not changed considerably, frank dementia is now infrequent, and milder forms of cognitive impairments predominate. Mechanistic insights to the underlying causes of these residual cognitive impairments have been elusive, in part due to the heterogenous etiology of cognitive dysfunction in this population. Here, we sought to categorize longitudinal change in HIV-infected patients based on the performance in specific cognitive domains. DESIGN This study consisted of 193 participants from the CHARTER cohort with detailed demographic, clinical, and neuropsychological testing data obtained from 2 study visits interspersed by ∼6 months. Cognitive testing assessed executive function, learning and delayed recall, working memory, verbal fluency, speed of information processing, and motor skills. Change scores were calculated for each domain between the 2 study visits. Dimension reduction and clustering was accomplished by principal component analysis of change scores and k-means clustering to identify cognitive domains that group together and groups of subjects with similar patterns of change. RESULTS We identified 4 distinct cognitive change phenotypes that included declines in: (1) verbal fluency, (2) executive function (3) learning and recall, and (4) motor function, with approximately equal numbers of participants in each phenotype. CONCLUSIONS Each of the 4 cognitive change phenotypes identify deficits that imply perturbations in specific neural networks. Future studies will need to validate if cognitive change phenotypes are associated with alterations in associated neural pathways.
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Affiliation(s)
- Raha M. Dastgheyb
- The Johns Hopkins University School of Medicine, Department of Neurology, Baltimore, MD
| | - Ned Sacktor
- The Johns Hopkins University School of Medicine, Department of Neurology, Baltimore, MD
| | - Donald Franklin
- HIV Neurobehavioral Research Program and Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA
| | - Scott Letendre
- HIV Neurobehavioral Research Program and Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA
| | - Thomas Marcotte
- HIV Neurobehavioral Research Program and Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA
| | - Robert Heaton
- HIV Neurobehavioral Research Program and Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA
| | - Igor Grant
- HIV Neurobehavioral Research Program and Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA
| | - Justin McArthur
- The Johns Hopkins University School of Medicine, Department of Neurology, Baltimore, MD
| | - Leah H. Rubin
- The Johns Hopkins University School of Medicine, Department of Neurology, Baltimore, MD
| | - Norman J. Haughey
- The Johns Hopkins University School of Medicine, Department of Neurology, Baltimore, MD
- The Johns Hopkins University School of Medicine, Department of Psychiatry, Baltimore, MD
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29
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Quigley A, O'Brien KK, Brouillette MJ, MacKay-Lyons M. Evaluating the Feasibility and Impact of a Yoga Intervention on Cognition, Physical Function, Physical Activity, and Affective Outcomes in People Living With HIV: Protocol for a Randomized Pilot Trial. JMIR Res Protoc 2019; 8:e13818. [PMID: 31115343 PMCID: PMC6547772 DOI: 10.2196/13818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/16/2019] [Accepted: 04/16/2019] [Indexed: 12/19/2022] Open
Abstract
Background Despite lower mortality rates due to combination antiretroviral therapy, people living with HIV (PLWH) are grappling with increasingly complex health issues, including cognitive impairments in areas such as memory, attention, processing speed, and motor function. Yoga has been shown to be an effective form of exercise and mindfulness-based stress reduction for many clinical populations. However, no randomized trials have evaluated the impact of yoga on cognitive and physical function among PLWH. Objective The aim of this pilot randomized trial was to determine the feasibility of a yoga intervention to lay the groundwork for a full-scale, multisite, community-based trial for PLWH. Specific objectives are to (1) assess the feasibility of study protocol and procedures, (2) compare cognition in the yoga group with the usual care control group after 12 weeks of the intervention in PLWH, and (3) compare the effects of the 12-week yoga intervention versus control on balance, walking speed, physical activity, mental health, medication adherence, and quality of life among PLWH. Methods We propose a pilot randomized trial with 2 parallel groups (yoga versus control). We will recruit 25 PLWH (>35 years) from community and health organizations in Halifax, Canada. After baseline assessment with blinded assessors, participants will be randomly assigned to the yoga or control group, using a random computer generator. Participants in the yoga group will engage in supervised 60-min group-based yoga sessions 3 times a week for 12 weeks at a yoga studio. Participants in the control group will maintain their current physical activity levels throughout the study. Results As per the Consolidated Standards of Reporting Trials extension for pilot studies, means of all outcomes, mean change, and 95% CIs will be calculated for each group separately. Two-tailed independent t tests and Fisher exact tests will be used to compare groups at baseline. We will analyze quantitative postintervention questionnaire responses using Chi-square tests, and open-ended responses will be analyzed thematically. Intention-to-treat and per-protocol analyses will be used to analyze secondary variables. Changes in outcome variables will be examined between groups and within groups. Effect sizes will be reported for each outcome. A priori adherence and satisfaction criteria will be met if participants attend >70% of the yoga sessions and if >70% of the participants are satisfied with the intervention as determined by a postparticipation questionnaire. Study enrollment began in January 2018, with results expected for October 2019. Conclusions This pilot randomized trial will be the first to investigate the feasibility and effect of a yoga intervention on cognitive and physical outcomes among PLWH. This work will inform the feasibility of further investigations in terms of capacity building, participant recruitment and retention, and assessment and intervention protocols. Trial Registration ClinicalTrials.gov NCT03071562; https://clinicaltrials.gov/ct2/show/NCT03071562 (Archived by WebCite at http://www.webcitation.org/785sfhWkw) International Registered Report Identifier (IRRID) DERR1-10.2196/13818
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Affiliation(s)
- Adria Quigley
- Department of Physiotherapy, Dalhousie University, Halifax, NS, Canada
| | - Kelly K O'Brien
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | | | - Marilyn MacKay-Lyons
- Department of Physiotherapy, Dalhousie University, Halifax, NS, Canada.,Department of Medicine, Dalhousie University, Halifax, NS, Canada.,Nova Scotia Health Authority, Halifax, NS, Canada
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30
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da Silva Pontes L, Callegari B, Magno L, Moraes A, Silva BG, Manso K, Barros B, Araújo AP, Silva MC, Dias GA, Vasconcelos BH, Costa E Silva A, Libonati RM, Souza GS. Variations in plantar pressure and balance in HIV-infected children in antiretroviral therapy. Sci Rep 2019; 9:4344. [PMID: 30867540 PMCID: PMC6416285 DOI: 10.1038/s41598-019-41028-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 02/28/2019] [Indexed: 12/19/2022] Open
Abstract
Balance disorders have been poorly investigated and somewhat neglected in people infected with the human immunodeficiency virus, especially in children, whose have intrinsic and extrinsic risk factors that may compromise the balance. To evaluate the foot plantar pressures and the balance in children with acquired immunodeficiency. We recruited 53 children aged between 6 and 15 years: 33 healthy children, and 20 children with positive serology for the human immunodeficiency virus. A physical examination included anthropometric, reflexes, tactile sensitivity of the foot and orthopedic evaluation. We also collected data of them using Pediatric Equilibrium Scale, baropodometry, and stabilometry. We considered significance level of 0.05 for statistics. Both groups were aged-, sex-matched and similar body mass index and scores of the Pediatric Equilibrium Scale. Three infected children had altered tactile sensitivity, and none had orthopedic or reflex alteration. Infected children had higher mean plantar pressure in the hindfoot than of the control group (p = 0.02). There was higher maximum plantar pressure in the hindfoot of the infected children than of the controls (p = 0.04). Controls had lower maximum plantar pressure in the forefoot than the infected children (p = 0.04). Infected children had larger displacement of the center of pressure (p = 0.006), larger mean velocity of displacement (p = 0.006), and longer duration between successive peaks of displacement than the controls (p = 0.02). Children living with the human immunodeficiency virus discharges great plantar pressures in the hindfoot and to present balance disturbances in the absence of neurological symptomatology.
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Affiliation(s)
- Lucieny da Silva Pontes
- Universidade do Estado do Pará, Belém, Pará, Brazil
- Universidade Federal do Pará, Belém, Pará, Brazil
| | | | | | | | | | - Kaio Manso
- Universidade Federal do Pará, Belém, Pará, Brazil
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31
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Crane HM, Miller ME, Pierce J, Willig AL, Case ML, Wilkin AM, Brown S, Asirot MG, Fredericksen RJ, Saag MS, Landay AL, High KP. Physical Functioning Among Patients Aging With Human Immunodeficiency Virus (HIV) Versus HIV Uninfected: Feasibility of Using the Short Physical Performance Battery in Clinical Care of People Living With HIV Aged 50 or Older. Open Forum Infect Dis 2019; 6:ofz038. [PMID: 30882010 PMCID: PMC6411210 DOI: 10.1093/ofid/ofz038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 02/05/2019] [Indexed: 01/08/2023] Open
Abstract
Background The Short Physical Performance Battery (SPPB) is a well regarded physical functioning assessment including balance, gait speed, and chair-stand tests. Its use has not been widely assessed in human immunodeficiency virus (HIV) care. We evaluated the feasibility of integrating the SPPB into care of aging people living with HIV (PLWH) and compared SPPB performance with aged HIV-uninfected individuals. Methods We enrolled PLWH aged ≥50 at 3 HIV clinics and compared their SPPB scores and subscores with older HIV-uninfected adults in the Health, Aging, and Body Composition (Health ABC) study. We conducted regression analyses on age stratified by sex and adjusting for site, and we calculated percentage variance explained by age among PLWH and HIV-uninfected adults. Results The SPPB was feasible to implement in clinical care and did not require licensed professionals; 176 PLWH completed it with a mean completion time of 7.0 minutes (standard deviation = 2.6). Overall mean SPPB score among PLWH was 10.3 (median 11.0, 25th percentile 9.0, 75th percentile 12.0). People living with HIV were younger than HIV-uninfected individuals (55 vs 74 years old). Mean SPPB scores and most subscores were similar among PLWH and older HIV-uninfected individuals despite the ~20-year age difference. Regression analyses of gait speed revealed similar slopes in PLWH and HIV-uninfected individuals; however, separate intercepts were needed for PLWH. Mean gait speeds were faster in older HIV-uninfected men and women (P < .01), yet relationships with age within PLWH and HIV uninfected were similar. Conclusions The SPPB can be implemented into busy HIV clinics. Despite the ~20-year age difference, mean scores were similar among PLWH and older HIV-uninfected individuals, although gait speed was faster among HIV-uninfected individuals.
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Affiliation(s)
- Heidi M Crane
- Department of Medicine, University of Washington, Seattle
| | - Michael E Miller
- Departments of Biostatistical Sciences, Winston-Salem, North Carolina
| | - June Pierce
- Departments of Biostatistical Sciences, Winston-Salem, North Carolina
| | - Amanda L Willig
- Department of Medicine, University of Alabama Birmingham, Chicago, Illinois
| | | | - Aimee M Wilkin
- Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Sharon Brown
- Department of Medicine, University of Washington, Seattle
| | | | | | - Michael S Saag
- Department of Medicine, University of Alabama Birmingham, Chicago, Illinois
| | - Alan L Landay
- Department of Medicine, Rush University, Chicago, Illinois
| | - Kevin P High
- Medicine, Wake Forest University, Winston-Salem, North Carolina
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32
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Spies G, Denckla CA, Mall S, Levin J, Seedat S, Nakasujja N, Kinyanda E. The relationship between cognitive change and physical health and behavioural outcomes in a Ugandan cohort of adults living with HIV - a longitudinal study. AIDS Care 2018; 31:803-808. [PMID: 30421989 DOI: 10.1080/09540121.2018.1545987] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
We investigated changes in cognitive function and physical health and behavioural outcomes (HIV disease progression, health-seeking behaviour, adherence to HIV medications and risky sexual behaviour) at baseline and 12 months later among 1126 Ugandan adults living with HIV. Overall, cognitive function improved from baseline to follow-up, except for gait speed, which was slower at follow-up compared to baseline. There were improvements in physical health and behavioural outcomes by follow-up, with greater improvements among individuals on ART compared to those not on ART. Change in gait speed over time significantly predicted risky sexual behaviours at follow-up. This is the first study to investigate the longitudinal relationships between cognitive function and health outcomes among Ugandan adults living with HIV and provide insights into the possible links between cognitive function and negative clinical and behavioural health outcomes in people living with HIV.
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Affiliation(s)
- G Spies
- a Department of Psychiatry, Faculty of Medicine and Health Sciences , Stellenbosch University , Cape Town , South Africa
| | - C A Denckla
- b Department of Epidemiology , Harvard T. H. Chan School of Public Health , Cambridge , MA , USA
| | - S Mall
- c Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - J Levin
- c Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa.,d Statistical Section , MRC/UVRI Uganda Research Unit on AIDS , Entebbe , Uganda
| | - S Seedat
- a Department of Psychiatry, Faculty of Medicine and Health Sciences , Stellenbosch University , Cape Town , South Africa
| | - N Nakasujja
- e Department of Psychiatry , Makerere University , Kampala , Uganda
| | - E Kinyanda
- e Department of Psychiatry , Makerere University , Kampala , Uganda.,f Mental Health Project, MRC/LSHTM/UVRI and Senior Wellcome Trust Fellow , Uganda
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33
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Bauer LO. HIV/AIDS and an overweight body mass are associated with excessive intra-individual variability in response preparation. J Neurovirol 2018; 24:577-586. [PMID: 29777461 PMCID: PMC6202127 DOI: 10.1007/s13365-018-0644-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 04/03/2018] [Accepted: 04/26/2018] [Indexed: 12/24/2022]
Abstract
Factors other than HIV/AIDS may influence the cognitive function of patients living with this disease. The present study tested the influence of a common comorbid problem-an overweight body mass. It also examined intra-task variabilities in performance and brain activation as potentially more sensitive indicators of dysfunction than their mean levels. One-hundred seventy-eight participants were recruited and categorized by HIV-1 serostatus (-/+) and body mass (BMI < 26/≥ 26 kg/m2). They performed a simple time estimation task during which response time accuracy and electroencephalographic readiness potentials were recorded. A few hours later, they completed a battery of tests measuring balance and gait. The analyses revealed an advantage of variability over the mean in differentiating groups: the presence of HIV-1 and an overweight body mass were independently and additively associated with greater variability across trials in readiness potential amplitude and response accuracy. The analysis also showed that intra-task variability in the readiness potential, but not in response accuracy, was predictive of decrements in single and tandem leg balance and gait velocity. The present findings suggest that an elevated body mass is associated with, and may contribute to, problems in brain function and motor behavior experienced by patients in the current era. The findings recommend a careful consideration of the manner in which these problems are measured. When the problems are episodic and subtle, measures of central tendency may be less than ideal.
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Affiliation(s)
- Lance O Bauer
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT, 06030-1403, USA.
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34
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Silva RE, Baldim JL, Chagas-Paula DA, Soares MG, Lago JHG, Gonçalves RV, Novaes RD. Predictive metabolomic signatures of end-stage renal disease: A multivariate analysis of population-based data. Biochimie 2018; 152:14-30. [PMID: 29913183 DOI: 10.1016/j.biochi.2018.06.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 06/13/2018] [Indexed: 01/27/2023]
Abstract
The variability of molecular signatures and predictive low molecular weight markers of chronic kidney disease (CKD) in different populations are poorly understood. Thus, in a large sample with 4763 people we compare the molecular signatures and metabolites with diagnostic relevance in plasma and urine of CKD patients of different geographical origins. From an integrated model based on dynamic networks and multivariate statistics, metabolites with predictive value obtained from targeted and untargeted molecular analysis, interactions between metabolic pathways affected by CKD, and the methodological quality of metabolomic studies were analyzed. The metabolites 3-methylhistidine, citrulline, kynurenine, p-cresol sulfate, urea, and citrate presented consistent expression in all population groups. Only increased kynurenine and p-cresol sulfate in plasma samples obtained acceptable scores as CKD biomarkers, independent of geographic origin. Metabolites such as leucine, alanine, isoleucine, serine, histidine, and citrate were nodal points, indicating that protein metabolism pathways are similarly impaired in Asian, European and North American patients. Based on our integrated model, we show that the metabolome of CKD patients exhibits a strong geographic influence, leading to unique metabolic signatures. Contrary to the likelihood of molecular similarities between geographically distinct populations, metabolic convergences in protein metabolism pathways and the molecules kynurenine and p-cresol sulfate were relevant as general predictors of CKD. In general, the quality assessment indicated that the current evidence is based on research models with variable methodological quality, whose limitations described in this study should be considered in the refinement of molecular approaches.
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Affiliation(s)
- Robson E Silva
- School of Medicine, Federal University of Alfenas, Alfenas, 37130-001, Minas Gerais, Brazil
| | - João L Baldim
- Center of Human and Natural Sciences, Federal University of ABC, 09210-580, Santo André, SP, Brazil
| | - Daniela A Chagas-Paula
- Institute of Chemistry, Federal University of Alfenas, Alfenas, 37130-001, Minas Gerais, Brazil
| | - Marisi G Soares
- Institute of Chemistry, Federal University of Alfenas, Alfenas, 37130-001, Minas Gerais, Brazil
| | - João H G Lago
- Center of Human and Natural Sciences, Federal University of ABC, 09210-580, Santo André, SP, Brazil
| | - Reggiani V Gonçalves
- Department of Animal Biology, Federal University of Viçosa, Viçosa, 36570-000, Minas Gerais, Brazil
| | - Rômulo D Novaes
- Institute of Biomedical Sciences, Department of Structural Biology, Federal University of Alfenas, Alfenas, 37130-001, Minas Gerais, Brazil.
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35
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Deschamps-Lenhardt S, Martin-Cabezas R, Hannedouche T, Huck O. Association between periodontitis and chronic kidney disease: Systematic review and meta-analysis. Oral Dis 2018; 25:385-402. [DOI: 10.1111/odi.12834] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 01/07/2017] [Accepted: 01/22/2018] [Indexed: 12/18/2022]
Affiliation(s)
- S Deschamps-Lenhardt
- Faculté de chirurgie-dentaire; Periodontology; Université de Strasbourg; Strasbourg France
- Pôle de médecine et chirurgie bucco-dentaire; Hôpitaux universitaires de Strasbourg; Strasbourg France
| | - R Martin-Cabezas
- Faculté de chirurgie-dentaire; Periodontology; Université de Strasbourg; Strasbourg France
- Pôle de médecine et chirurgie bucco-dentaire; Hôpitaux universitaires de Strasbourg; Strasbourg France
| | - T Hannedouche
- Faculté de Médecine; Université de Strasbourg et Service de néphrologie; Hôpitaux Universitaires de Strasbourg; Strasbourg France
| | - O Huck
- Faculté de chirurgie-dentaire; Periodontology; Université de Strasbourg; Strasbourg France
- Pôle de médecine et chirurgie bucco-dentaire; Hôpitaux universitaires de Strasbourg; Strasbourg France
- INSERM (French National Institute of Health and Medical Research); Regenerative Nanomedicine; UMR 1260; Fédération de Médecine Translationnelle de Strasbourg (FMTS); Strasbourg France
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