Human Immunodeficiency Virus (HIV), a viral infection previously known as the wasting disease, has become a chronic yet manageable disease due to the advent of Highly Active Antiretroviral Treatments (HAART).(1) HIV is characterized by chronic systemic inflammation including inflammation of the gastrointestinal (GI) barrier.(2) The virus depletes specific Cluster of Differentiation 4 [CD4] + Thymus cells [T-cells] in the gut-associated lymphoid tissue causing the intestinal barrier to become inflamed, leaky, and more permeable. (3) Inflammation in the gut may contribute to persons living with HIV (PLWHIV) having GI symptoms, such as nausea, vomiting, and diarrhea. Many of these symptoms cause weight changes, affecting adherence to HAART.(4) As the gut becomes more permeable, microbes can translocate into the systemic circulation and cause systemic inflammation. Chronic systemic inflammation may contribute to the progression of the disease, systemic dysregulation, and cardiovascular (CV) instability.(5) Microbial translocation is associated with hypertension and GI symptoms in persons living with HIV.(6) Hypertension and the inflammatory process driven by HIV alters the endothelial function of these patients.(5)
Although HAART has prolonged life, studies suggest that it may also be associated with weight gain,(7–9) CV disease, and GI symptoms.(4, 7) Weight gain after initiating HAART occurs frequently and is associated with lower mortality, thus it is looked upon as a favorable outcome.(9) However, excessive weight gain may lead to an increased risk of chronic conditions such as hypertension, Diabetes Mellitus, and CV disease.(7) In fact, CV disease is the leading cause of death among PLWHIV.(8)
Current literature has shown that weight changes in PLWHIV on HAART have significant implications for health outcomes. CV disease and PLWHIV on HAART must have ongoing investigations to identify factors that will guide care over the lifespan. Gastrointestinal symptoms such as nausea, vomiting, diarrhea, and loss of appetite affect health outcomes for PLWHIV on HAART. Increases in body mass index are common in HIV positive minorities and women. Symptoms were found to vary with patient race, age, and disease progression.(9, 10) Racial differences in conjunction with symptom presentation influence treatment options. The clinician selects the proper treatment based on weight status (e.g., weight gain, weight loss), race, and symptoms (especially loss of appetite, acquired immunodeficiency syndrome [AIDS] classification, diarrhea, vomiting, and overeating). The selection of a specified treatment option is of paramount importance because the grid of care options varies, care options even oppose one another for certain groups. The care for Black/African American PLWHIV on HAART that lose weight and have a loss of appetite is quite different than the care for Black/African American PLWHIV on HAART who gain weight and overeat. The proper choice of treatment option improves patients’ outcomes and accuracy of care provided by practitioners.
Limited clinical research exists on the topics of changes in weight status, race classification, gastrointestinal health, and CV health among PLWHIV on HAART. Clinicians benefit from knowledge regarding this population that will guide personalized care that targets each specific demographic group based on the needs based on their weight status, their demographics, and presenting symptoms. The health disparities for patients classified as Black/African American in terms of CV disease and HIV disease are well documented in nursing science. There is a higher burden of CV risk factors and CV disease in patients Black/Africa American.(11) Additionally, it is 13 times more likely that a Black/African American over the age of 50 will receive an HIV diagnosis than a White/Caucasian over 50. To address these disparities, providers must provide ongoing and personalized care for this population.(12) As such, monitoring for PLWHIV on HAART may require stratification and personalization based on demographics and symptoms. The differences found may be attributable to patients’ race, sex, weight status, comorbidities, and presenting symptoms. Moreover, as PLWHIV on HAART age, comorbidities require closer examination especially in terms of racial differences.(13)
Current literature associated with weight status and multiple morbidities in PLWHIV either examine the change in weight status/body mass index [BMI] related to race after HAART initiation,(14) changes in BMI across a life span,(15) multiple morbidities and obesity without examining the effects of race(16) or multiple morbidities and aging,(17) with some attention to weight/obesity.(8) Although research has been conducted on this topic, there is limited clinical research investigating these variables in a clinical population. Most research included epidemiological large, cross-sectional studies and literature reviews. The present study is a secondary data analysis of a clinical population. Therefore, the aim of this study was to investigate the association of race (Black and non-Black [Asian, Mixed-race and Whites]), weight status (weight gain and weight loss), and gastrointestinal and cardiovascular symptoms (nausea, vomiting, shortness of breath, chest pain) and co-morbidities (Hypertension, Coronary artery disease, heart failure) among persons living with HIV/AIDS. The findings of this study will contribute to the growing body of research addressing adverse effects experienced by PLWHIV on HAART and provide important information related to personalized treatment, especially related to race.