Joyce K. Keithley

HIV Infection and Obesity: A Review of the Evidence

&NA; This article provides a review of recent evidence pertinent to the prevalence, morbidities, and predictive value of overweight and obesity in PLWH. Implications for clinical outcomes are discussed, and recommendations for patient management and future research are advanced.

Comparison of standard and immune-enhancing oral formulas in asymptomatic HIV-infected persons: a multicenter randomized controlled clinical trial

BACKGROUND Both standard and immune-enhancing oral formulas are widely used to forestall HIV wasting and to promote immune function. However, there is little scientific evidence to support the differential effects of these formulas in asymptomatic HIV disease. The aim of this study was to compare the effects of an immune-enhancing oral formula and a standard oral formula on nutrition and immune measures in asymptomatic HIV-infected persons. A secondary aim was to evaluate the feasibility of maintaining a diverse sample of outpatients on a long-term oral formula protocol. METHODS In this multicenter controlled nonblinded study, 90 asymptomatic HIV-infected persons with CD4 cell counts between 275 and 550 cells/mm3 were randomized to a control group; a standard oral formula group (Ensure Plus); or an immune-enhancing oral formula group (Advera). All groups received basic nutrition counseling. Participants were evaluated on nutrition, immune, and feasibility measures at 3-month intervals during the 12-month study period. Differences in nutrition and immune measures among the 3 groups were analyzed using the Kruskal-Wallis and Wilcoxon tests. Wilcoxon tests and correlation coefficients were used to analyze feasibility data. RESULTS Sixty-six outpatients completed the 12-month study protocol. Among the 3 groups, there were no significant differences with respect to body weight, bioelectrical impedance analysis (BIA)-derived body cell and fat mass, daily caloric intake, and serum albumin at any of the study visits. Moreover, absolute CD4+ T lymphocytes and percentages did not significantly differ at any time point among the 3 groups. Acceptability and tolerance of the formulas were high for both the standard and immune-enhancing oral formula groups. CONCLUSIONS Within the context and limitations of this study, standard and immune-enhancing oral formulas consumed daily for 1 year had no differential effects on nutrition or immune parameters in asymptomatic HIV-infected persons.

A pilot study of the safety and efficacy of cholestin in treating HIV-related dyslipidemia

OBJECTIVE We collected preliminary safety and efficacy data on the effects of Cholestin, a statin-containing dietary supplement, in individuals with dsylipidemia related to human immunodeficiency virus. METHODS Fourteen adults with dsylipidemia related to human immunodeficiency virus characterized by hypercholesterolemia, hypertriacylglycerolemia, or both participated in a randomized, double-blind, placebo-controlled pilot study in an infectious disease clinic based in an academic medical center. Participants were randomly assigned to receive 1.2 g of Cholestin twice daily (n = 7) or placebo (n = 7) for 8 wk. The main outcome measures were safety (hepatic function tests, plasma human immunodeficiency virus-1 RNA levels, CD4(+) cell counts, adverse effects) and efficacy (fasting serum cholesterol: total, high- and low-density lipoproteins, and fasting serum triacylglycerols). Safety and efficacy outcomes were evaluated at 2- and 8-wk intervals. RESULTS Twelve participants (n = 6 per group) completed the 8-wk treatment protocol. After 8 wk of treatment with Cholestin, there were significant declines from baseline in mean (+/- standard error of the mean) fasting total cholesterol (-30.8 +/- 8.8 versus 7.7 +/- 5.6; P = 0.01) and low-density lipoprotein cholesterol (-32.2 +/- 7.2 versus 26.3 +/- 14.2; P = 0.01) versus placebo. Moreover, the decline in fasting total cholesterol was significant (-40.2 +/- 4.8 versus 2.8 +/- 11.9; P = 0.006) after 2 wk of therapy, at which time the low-density lipoprotein cholesterol approached significance (-30.2 +/- 7.4 versus 4.4 +/- 15.2; P = 0.068). High-density lipoprotein cholesterol and triacylglycerol levels did not change at either time point. No adverse effects were seen with Cholestin. CONCLUSIONS Cholestin may safely lower total and low-density lipoprotein cholesterol in patients with dsylipidemia related to human immunodeficiency virus. Larger and longer-term trials of this approach are warranted.

Factors associated with physical activity levels in African-American women with type 2 diabetes.

Purpose: To examine how family/friend social support, exercise self‐efficacy, physical environment, sense of community, social issues and roles, socioeconomic status, and body image discrepancy influence physical activity levels in African American females with type 2 diabetes. Data sources: A sample of 50 African American females with type 2 diabetes was recruited from a Midwest diabetes center for this descriptive, cross‐sectional, correlational study. A series of self‐report instruments were administered to examine the relationships between the independent study variables and physical activity levels. Conclusions: Results of the study suggested that higher levels of exercise self‐efficacy, family social support for exercise, and a decrease in physical environmental barriers may serve to increase physical activity levels in this population. No significant relationships were observed between the other study variables and physical activity levels. Implications for practice: Nurse practitioners working with African American females with type 2 diabetes need to assess family social support, exercise self‐efficacy, and physical environmental barriers and plan interventions that incorporate family support and the principles of self‐efficacy while minimizing environmental barriers. Further exploration is warranted to examine the relationship between body image discrepancy and physical activity in this population.

Safety and Efficacy of Glucomannan for Weight Loss in Overweight and Moderately Obese Adults

Background. Few safe and effective dietary supplements are available to promote weight loss. We evaluated the safety and efficacy of glucomannan, a water-soluble fiber supplement, for achieving weight loss in overweight and moderately obese individuals consuming self-selected diets. Methods. Participants were randomly assigned to take 1.33 grams of glucomannan or identically looking placebo capsules with 236.6 mL (8 ounces) of water one hour before breakfast, lunch, and dinner for 8 weeks. The primary efficacy outcome was change in body weight after 8 weeks. Other efficacy outcomes were changes in body composition, hunger/fullness, and lipid and glucose concentrations. Safety outcomes included gastrointestinal symptoms/tolerance and serum liver enzymes and creatinine levels. Results. A total of 53 participants (18–65 years of age; BMI 25–35 kg/m2) were enrolled and randomized. The two groups did not differ with respect to baseline characteristics and compliance with the study supplement. At 8 weeks, there was no significant difference between the glucomannan and placebo groups in amount of weight loss (−.40 ± .06 and −.43 ± .07, resp.) or other efficacy outcomes or in any of the safety outcomes. Conclusions. Glucomannan supplements administered over 8 weeks were well tolerated but did not promote weight loss or significantly alter body composition, hunger/fullness, or lipid and glucose parameters. This trial is registered with NCT00613600.

Bioelectrical impedance analysis (BIA) in HIV infection: Principles and clinical applications

Wasting is a common manifestation of AIDS that diminishes quality of life and is predictive of death. Body composition changes can occur in asymptomatic HIV infection, suggesting that early detection and treatment could potentially prevent the downward spiral to serious wasting. Bioelectrical impedance analysis (BIA) is a method for estimating body composition that is gaining widespread use among HIV-infected populations. In this article, the principles underlying BIA and its appropriate applications and limitations in HIV/AIDS are described.

Complementary and Alternative Therapies to Manage HIV-Related Symptoms

Persons with HIV infection report substantial use of complementary and alternative medical (CAM) therapies for symptom management. Anecdotal reports from patients indicate that CAM approaches are helpful; however, there is limited scientific information on the safety and efficacy of these therapies in the HIV population. The purpose of this review is to critically appraise the scientific evidence for selected CAM therapies that are used by HIV-infected persons to manage three common symptoms: nutritional alterations, pain, and depression.

HIV-associated wasting.

HIV-associated wasting continues to be a problem, particularly in individuals who use drugs and have food insecurity, high viral loads, and low-income levels. There is some evidence to suggest that nutrition counseling with or without oral nutritional supplements, anabolic/androgenic agents, and aerobic exercise with or without resistive exercise are likely to be effective in combating HIV-associated wasting. Limited or no evidence exists for the efficacy of herbal supplements, appetite stimulants, macronutrient and micronutrient supplements, and cytokine modulators for wasting in HIV-infected individuals. Most studies reviewed were of uneven quality, and few looked at significant endpoints such as disease progression and mortality.

A pilot study of the safety and efficacy of supplemental arginine to enhance immune function in persons with HIV/AIDS

OBJECTIVE We collected preliminary data on the safety and efficacy of supplemental arginine to improve natural killer cell cytotoxicity in a sample of persons with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). METHODS In a randomized, double-blind, placebo-controlled pilot study in an academic medical center-based infectious disease clinic, 11 clinically stable, HIV-infected adults had been treated with highly active, antiretroviral therapy and had HIV plasma RNA levels of less than 10 000 copies/mL. Participants were randomly assigned to receive 19.6 g of arginine/d (n = 6) or placebo (n = 5) for 14 d. Plasma HIV RNA levels, neuropsychologic functioning, and self-reported adverse events were analyzed for safety of treatment. Efficacy was measured by natural killer cell cytotoxicity. RESULTS None of the participants experienced any adverse clinical, virologic, or neuropsychologic events that necessitated withdrawal from the study. The arginine-supplemented group showed a mean natural killer cell cytotoxicity increase of 18.9 lytic units, whereas the placebo group showed an increase of 0.3 lytic units. This difference was not statistically significant (P = 0.79). CONCLUSIONS Short-term arginine supplementation is safe for persons with HIV/AIDS. Additional studies with larger samples and longer periods are warranted to determine the effects of arginine supplementation on other indices of immune function and on clinical outcomes such as intercurrent illnesses.

Integrative Review: Effects of Music on Cancer Pain in Adults.

PROBLEM IDENTIFICATION To evaluate the literature for musics effect on adult cancer pain.
. LITERATURE SEARCH An electronic literature search from 1986-2014 was conducted to evaluate the effects of quantitative music among adults with cancer pain in settings including homes, hospitals, and palliative care units. Databases used were PubMed (MEDLINE) and Scopus.
 DATA EVALUATION The study designs, methods, measures, outcomes, and limitations were evaluated independently by the primary author and verified by the second author. The primary outcome measure of interest was the effect of music in cancer pain. SYNTHESIS Of 82 studies, 5 of them--totaling 248 participants--met eligibility criteria. Review of findings suggests a paucity of innovative approaches for using music to mitigate cancer pain among adults. Psychological outcomes, anxiety, depression, and mood were understudied. Advanced pain, multiple cancer types, and lack of racial diversity characterize the samples.
 CONCLUSIONS Modern treatments for cancer have improved survival rates; however, patients often experience tumor- and treatment-related pain. Pharmacologic and nonpharmacologic methods may minimize cancer pain. The use of music as an adjunct to pain medication requires additional studies, particularly on mechanisms of its effect on pain among diverse, large samples with multiple cancer pain types. A limitation of this review is the small number of available studies to date. IMPLICATIONS FOR PRACTICE The evidence for music therapy in the management of pain is limited. Integrative methods using music may represent an important intervention that nurses may be able to suggest as an inexpensive, nontoxic, and readily available intervention for potentially minimizing cancer pain.