All ETDs from UAB

Advisory Committee Chair

Jose R Fernandez

Advisory Committee Members

Olivio J Clay

Michael S Saag

E T Overton

Document Type

Dissertation

Date of Award

2018

Degree Name by School

Doctor of Philosophy (PhD) School of Health Professions

Abstract

As life expectancy for people living with HIV (PLWH) has increased, healthy aging in this community has become an emerging public health concern. Although the benefits of adopting healthy diets and regular physical activity are well-documented, implementing strategies for lifestyle modifications among older PLWH remains a challenge. The complex milieu of social, physiological and economic burdens encountered by PLWH exposes this population to increased risk for adverse health outcomes, especially from preventable metabolic diseases. The interaction of diet, physical activity and social determinants of health in persons who are HIV positive is an understudied area. The aim of this dissertation is to find answers which may potentially increase longevity and vitality during the midlife stage and effectively decrease the risk of developing chronic illness in PLWH. Specifically, this work attempts to answer the following: (i) What socioeconomic and psychological factors affect diet quality and dietary intake in older PLWH? (ii) Does high-dose vitamin D and calcium supplementation affect lipid and metabolic profiles in treatment naïve patients beginning ART? (iii) What are the general trends in physical activity patterns among PLWH in the US? (iv) How does physical activity affect long-term risk for developing cardiometabolic disease in this population? Our findings suggest that 1) The Food Security Questionnaire (FSQ) measuring food insecurity is significantly associated with diet quality and micronutrient intake in PLWH; 2) high dose vitamin D3 (4000 IU daily) and calcium supplementation (1000 mg calcium carbonate daily) in HIV-infected participants initiating ART with efavirenz/emtricitabine/tenofovir (EFV/FTC/TDF) does not significantly affect lipid and metabolic profiles; and 3) Prevalence of self-reported Low/Very Low physical activity is especially high among PLWH and 4) PLWH reporting Low and Very Low physical activity are at increased risk for developing diabetes, cardiovascular disease, hypertension, cerebrovascular disease, obesity and multimorbidity. In conclusion, our results confirm interventions that facilitate practical lifestyle modification within the appropriate psychosocial and economic context are needed in this growing population.

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