Nutritional Status in People Living With HIV and Trends in HIV Prevalence Using NHANES (1999–2012)

Abstract

BackgroundUnder‐nutrition is an independent predictor of mortality in people living with Human Immunodeficiency Virus (PLHIV). Introduction of the highly active antiretroviral therapy (ART) has improved the nutritional status in PLHIV but has not completely eliminated malnutrition.AimTo understand the current nutritional status in PLHIV and to study the trends in prevalence of HIV status using NHANES (1999–2012).MethodsNHANES 1999–2012 was used to estimate the prevalence of PLHIV in U.S. adults (n=16,083; ages 19–15) and for calculating selective biochemical parameters and biomarkers. Two 24‐hour dietary recalls were used to estimate energy adjusted mean values for micro‐ and macro‐nutrients; height and weight were used to calculate BMI.ResultsThe overall prevalence of HIV infection in U.S. adults was 0.44% (CI: 0.26–0.75) in 1999–2002, 0.53% (CI: 0.35–0.78) in 2003–2006, and started to decline thereafter to 0.25% (95% CI: 0.12–0.51) in the 2011–2012. HIV prevalence was highest in non‐Hispanic blacks followed by Mexican Americans and non‐Hispanic whites across all survey years. The mean age of PLHIV ranged from 35.4 years to 49.6 years. The body mass index (BMI) was lower in men and higher in women living with HIV compared to respective negative controls. Energy expenditure was significantly lower in women living with HIV compared to men living with HIV. Macronutrient intake was similar between PLHIV and HIV negative controls in both men and women. All the micronutrients were similar between PLHIV and controls except the levels of vitamin E was significantly lower in women living with HIV compared to the HIV negative controls. Micronutrient and macronutrient intake were similar between men and women living with HIV, except women had greater BMI and lower energy expenditure, while men had higher dietary fat intake. Women living with HIV had insufficient levels of vitamin D (37 nmol/L) and significantly lower levels of RBC folate (509 nmol/L) and Serum Folate (19 nmol/L). Mean triglycerides in men living with HIV was (410 mg/dL). There were no differences in the electrolyte levels and other biochemical markers compared to negative controls.ConclusionsWith the initiation of ART the nutrient intake in PLHIV has improved and is similar compared to HIV negative population. Women living with HIV have lower levels of vitamin D and folic acid. They have higher BMI and lower energy expenditure compared to men in spite of consuming similar quantities of micro‐ and micro‐nutrients, warranting life‐style modifications.