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ABSTRACT: 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.
The Journal of the Association of Nurses in AIDS Care: JANAC 01/2013; 24(1 Suppl):S103-11. · 0.96 Impact Factor
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ABSTRACT: We integrated complementary and alternative medicine (CAM)-related content into selected core courses in our master's-level curriculum. To facilitate students' application of the content, we developed evidence-based online case studies and evaluated their effectiveness by comparing students' pretest and posttest scores on multiple-choice quizzes. Findings suggest that evidence-based online case studies are an effective strategy for teaching graduate nursing students about the clinical issues surrounding patients' use of CAM therapies.
Journal of professional nursing: official journal of the American Association of Colleges of Nursing 03/2012; 28(2):125-9. · 0.76 Impact Factor
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ABSTRACT: BACKGROUND: HIV infection is associated with dyslipidemia and increased risk for cardiovascular events. Few studies have described lipid status in medically-underserved, HIV-infected ethnic minorities, a group that is characterized by health disparities. OBJECTIVE: The objective was to characterize the lipid profile of a medically-underserved, largely ethnic minority sample of HIV-infected persons using standard lipid panels and nuclear magnetic resonance (NMR) -derived lipoprotein particle profiles. METHODS: Participants were recruited from a randomized controlled trial of a dietary supplement to manage HIV-related dyslipidemia (N=132). At the initial screening visit, sociodemographic, clinical, and behavioral data were collected, and fasting peripheral venous blood specimens were obtained and lipid status was analyzed using the standard lipid panel and the NMR-derived lipoprotein particle profile. RESULTS: Using NMR-derived LDL particle cutoffs, a higher percentage of participants was outside the target range (50%) than when standard LDL cholesterol NCEP cutoffs were used (24%). Antiretroviral therapy, especially protease inhibitor-containing regimens, was associated with higher LDL particle concentration. CONCLUSION: Substantial numbers of medically-underserved, asymptomatic HIV-infected minorities may be at increased risk for CHD based on NMR-derived lipoprotein values.
Journal of Clinical Lipidology 12/2009; 3(6):379-384. · 1.58 Impact Factor
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Medsurg nursing: official journal of the Academy of Medical-Surgical Nurses 05/2004; 13(2):131-4.
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ABSTRACT: 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.
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.
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.
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.
Nutrition 03/2002; 18(2):201-4. · 3.03 Impact Factor
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ABSTRACT: 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.
Journal of the Association of Nurses in AIDS Care · 1.09 Impact Factor
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ABSTRACT: Surveys of research-intensive doctoral programs in nursing reveal few differences between the doctor of nursing science (DNSc) and the doctor of philosophy (PhD) degrees in nursing. Yet the proportion of DNSc programs relative to PhD programs in nursing has declined progressively over the past 10 years. Recently, Rush University College of Nursing formed a task force to examine whether Rush should continue to offer the DNSc degree or change to a PhD in nursing program. Task force members interviewed 21 nurse leaders representing 18 universities granting doctoral degrees in nursing about their perceptions of the DNSc and PhD in nursing degrees, the focus of their doctoral programs, why their nursing school chose the degree it currently offers, and whether Rush should retain the DNSc degree. This article describes the results of those interviews, how their comments helped the task force re-evaluate its goals for doctoral education, and the rationale for ultimately choosing to retain the DNSc degree.
Journal of Professional Nursing 19(4):223-9. · 0.89 Impact Factor
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Joyce K Keithley
Journal of Parenteral and Enteral Nutrition 26(4):256. · 3.29 Impact Factor
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AWHONN Lifelines 7(5):414-20.
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ABSTRACT: 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.
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.
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.
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.
Journal of Parenteral and Enteral Nutrition 26(1):6-14. · 3.29 Impact Factor
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ABSTRACT: Highly active antiretroviral therapy has been implicated in the development of metabolic toxicities, including insulin resistance. Because it is "clinically silent," insulin resistance is often undetected, thus precluding the initiation of treatments that may prevent progression to frank diabetes. Previous studies have documented associations between dyslipidemic profiles and insulin resistance in patients who do not have the human immunodeficiency virus (HIV). Therefore, we explored whether serum lipids, parameters that are routinely measured in patients who have HIV or the acquired immunodeficiency syndrome, could be used to facilitate the identification of insulin resistance in patients infected with HIV.
Thirty-three adult patients who had clinically stable HIV infection and treated with highly active antiretroviral therapy fasted overnight and underwent phlebotomy to measure the following parameters: insulin levels, blood glucose, triacylglycerols, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and total cholesterol.
Of the 33 participants, 15 had dyslipidemia, defined according to Adult Treatment Panel (ATP) III criteria, and 18 did not have dyslipidemia. The two groups did not differ significantly with respect to mean fasting insulin levels (P = 0.68). Only two participants had insulin levels that were higher than the laboratory reference range. No significant correlations were found between fasting insulin levels and any lipid parameters.
Serum lipids are not predictive of fasting insulin levels in adult patients who are treated with highly active antiretroviral therapy. The findings are limited by the low prevalence of insulin resistance in the study sample and the small sample size.
Nutrition 20(11-12):1022-5. · 3.03 Impact Factor
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ABSTRACT: 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).
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.
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).
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.
Nutrition 18(7-8):688-90. · 3.03 Impact Factor
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ABSTRACT: Human immunodeficiency virus (HIV) infection is associated with dyslipidemia and increased risk for cardiovascular events; however, the use ofstatins in HIV-infected people is complicated by pharmacokinetic interactions and overlapping toxicities with antiretroviral medications. Policosanol is a dietary supplement derived from sugar cane that is widely used as a statin alternative in Latin America.
To collect feasibility data on sugar cane-derived policosanol to normalize dyslipidemic profiles in a sample of medically underserved HIV-infected people.
Randomized, controlled, double-blind clinical trial. Setting: Two infectious disease outpatient clinics located in a Health Resources Service Administration-designated medically underserved neighborhood in Chicago, Illinois.
Fifty-four clinically stable HIV-infected people (91% black) with at least one lipid abnormality that warranted dietary modifications and/or drug therapy.
Participants received either 20 mg/day of policosanol or placebo for 12 weeks, followed by a 4-week washout and crossover to the other arm.
Efficacy measures included the standard lipid panel (low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides) and nuclear magnetic resonance (NMR)-derived lipoprotein particle profiles. Safety measures included CD4+ T lymphocyte counts, plasma HIV ribonucleic acid levels, serum creatinine, and liver function tests.
Policosanol supplementation was not associated with normalization of any dyslipidemic parameters as measured by the standard lipid panel or NMR spectroscopy-measured lipoprotein size or concentration. The supplement was well tolerated and was not associated with any changes in parameters of HIV disease progression.
Our findings corroborate recent studies conducted outside Cuba that have failed to find any lipid modulatory effects for policosanol.
Alternative therapies in health and medicine 17(2):30-5. · 1.77 Impact Factor
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ABSTRACT: 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.
The Journal of the Association of Nurses in AIDS Care: JANAC 20(4):260-74. · 0.96 Impact Factor
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ABSTRACT: 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.
Journal of the Association of Nurses in AIDS care.
