Abstract
The quality of life of people living with HIV (PLWH) has remarkably increased thanks to the introduction of combined antiretroviral therapy. Still, PLWH are exposed to an increased risk of cardiovascular diseases, diabetes, chronic kidney disease, and liver disease. Hence, the purpose of this review is to summarize the current knowledge about diagnosis and nutritional management with specific indication of macro and micronutrients intake for the main comorbidities of PLWH. In fact, a prompt diagnosis and management of lifestyle behaviors are fundamental steps to reach the “fourth 90”. To achieve an early diagnosis of these comorbidities, clinicians have at their disposal algorithms such as the Framingham Score to assess cardiovascular risk; transient elastography and liver biopsy to detect NAFLD and NASH; and markers such as the oral glucose tolerance test and GFR to identify glucose impairment and renal failure, respectively. Furthermore, maintenance of ideal body weight is the goal for reducing cardiovascular risk and to improve diabetes, steatosis and fibrosis; while Mediterranean and low-carbohydrate diets are the dietetic approaches proposed for cardioprotective effects and for glycemic control, respectively. Conversely, diet management of chronic kidney disease requires different nutritional assessment, especially regarding protein intake, according to disease stage and eventually concomitant diabetes.
Highlights
The introduction of combined antiretroviral therapy has remarkably reduced the morbidity and mortality of people living with HIV (PLWH) in recent decades by reducing AIDS-related complications, substantially improving their quality of life
Legend: Cardiovascular diseases (CVD) = Cardiovascular disease; PLWH = People Living With HIV; body mass index (BMI) = Body Mass Index
Legend: PLWH = People Living With HIV; chronic kidney disease (CKD) = Chronic Kidney Disease; UA/C = urine albumin/creatinine; UP/C = urine protein/creatinine; glomerular filtration rates (GFR) = Glomerular Filtration Rate; CKD-EPI = Chronic Kidney Disease Epidemiology Collaboration
Summary
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. The importance of nutritional intervention was exhibited by a 2019 clinical controlled trial showing how dietary modifications can improve oxidative stress associated with metabolic and chronic comorbidities (obesity, hypertension, diabetes, and dyslipidemia), by increasing the consumption of food containing antioxidant molecules such as polyphenols, by reducing the adipose tissue and improving the gut microbiome [13]. In this setting, the recent COVID-19 pandemic has contributed to further worsening lifestyle habits both in PLWH and in the general population, as sedentary, low physical activity, and unhealthy eating behaviors became common in the course of “locking-down”. The purpose of this review is to summarize the current knowledge about prompt diagnosis of comorbidities in PLWH and the consequent related nutritional management, taking into account metabolic dysfunctions and cART metabolic toxicity, and providing practical dietary indications to physicians and nutrition specialists
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