Epigenetic aging in older people living with HIV in Eswatini: a pilot study of HIV and lifestyle factors and epigenetic aging.
Africa
Biological aging
DunedinPACE
Epigenetic age acceleration
Epigenetic aging
Epigenetic clock
Epigenetics
Eswatini
HIV
Older people living with HIV
Journal
Clinical epigenetics
ISSN: 1868-7083
Titre abrégé: Clin Epigenetics
Pays: Germany
ID NLM: 101516977
Informations de publication
Date de publication:
26 Feb 2024
26 Feb 2024
Historique:
received:
26
09
2023
accepted:
12
01
2024
medline:
26
2
2024
pubmed:
26
2
2024
entrez:
25
2
2024
Statut:
epublish
Résumé
People living with HIV (PLHIV) on effective antiretroviral therapy are living near-normal lives. Although they are less susceptible to AIDS-related complications, they remain highly vulnerable to non-communicable diseases. In this exploratory study of older PLHIV (OPLHIV) in Eswatini, we investigated whether epigenetic aging (i.e., the residual between regressing epigenetic age on chronological age) was associated with HIV-related parameters, and whether lifestyle factors modified these relationships. We calculated epigenetic aging focusing on the Horvath, Hannum, PhenoAge and GrimAge epigenetic clocks, and a pace of biological aging biomarker (DunedinPACE) among 44 OPLHIV in Eswatini. Age at HIV diagnosis was associated with Hannum epigenetic age acceleration (EAA) (β-coefficient [95% Confidence Interval]; 0.53 [0.05, 1.00], p = 0.03) and longer duration since HIV diagnosis was associated with slower Hannum EAA (- 0.53 [- 1.00, - 0.05], p = 0.03). The average daily dietary intake of fruits and vegetables was associated with DunedinPACE (0.12 [0.03, 0.22], p = 0.01). The associations of Hannum EAA with the age at HIV diagnosis and duration of time since HIV diagnosis were attenuated when the average daily intake of fruits and vegetables or physical activity were included in our models. Diet and self-perceived quality of life measures modified the relationship between CD4 Epigenetic age is more advanced in OPLHIV in Eswatini in those diagnosed with HIV at an older age and slowed in those who have lived for a longer time with diagnosed HIV. Lifestyle and quality of life factors may differentially affect epigenetic aging in OPLHIV. To our knowledge, this is the first study to assess epigenetic aging in OPLHIV in Eswatini and one of the few in sub-Saharan Africa.
Sections du résumé
BACKGROUND
BACKGROUND
People living with HIV (PLHIV) on effective antiretroviral therapy are living near-normal lives. Although they are less susceptible to AIDS-related complications, they remain highly vulnerable to non-communicable diseases. In this exploratory study of older PLHIV (OPLHIV) in Eswatini, we investigated whether epigenetic aging (i.e., the residual between regressing epigenetic age on chronological age) was associated with HIV-related parameters, and whether lifestyle factors modified these relationships. We calculated epigenetic aging focusing on the Horvath, Hannum, PhenoAge and GrimAge epigenetic clocks, and a pace of biological aging biomarker (DunedinPACE) among 44 OPLHIV in Eswatini.
RESULTS
RESULTS
Age at HIV diagnosis was associated with Hannum epigenetic age acceleration (EAA) (β-coefficient [95% Confidence Interval]; 0.53 [0.05, 1.00], p = 0.03) and longer duration since HIV diagnosis was associated with slower Hannum EAA (- 0.53 [- 1.00, - 0.05], p = 0.03). The average daily dietary intake of fruits and vegetables was associated with DunedinPACE (0.12 [0.03, 0.22], p = 0.01). The associations of Hannum EAA with the age at HIV diagnosis and duration of time since HIV diagnosis were attenuated when the average daily intake of fruits and vegetables or physical activity were included in our models. Diet and self-perceived quality of life measures modified the relationship between CD4
CONCLUSIONS
CONCLUSIONS
Epigenetic age is more advanced in OPLHIV in Eswatini in those diagnosed with HIV at an older age and slowed in those who have lived for a longer time with diagnosed HIV. Lifestyle and quality of life factors may differentially affect epigenetic aging in OPLHIV. To our knowledge, this is the first study to assess epigenetic aging in OPLHIV in Eswatini and one of the few in sub-Saharan Africa.
Identifiants
pubmed: 38403593
doi: 10.1186/s13148-024-01629-7
pii: 10.1186/s13148-024-01629-7
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
32Subventions
Organisme : NIEHS NIH HHS
ID : T32ES007322
Pays : United States
Informations de copyright
© 2024. The Author(s).
Références
Deeks SG, Lewin SR, Havlir DV. The end of AIDS: HIV infection as a chronic disease. Lancet. 2013;382(9903):1525–33.
pubmed: 24152939
pmcid: 4058441
Krentz HB, Kliewer G, Gill MJ. Changing mortality rates and causes of death for HIV-infected individuals living in Southern Alberta, Canada from 1984 to 2003. HIV Med. 2005;6(2):99–106.
pubmed: 15807715
Quinn TC. HIV epidemiology and the effects of antiviral therapy on long-term consequences. AIDS. 2008;22(Suppl 3):S7-12.
pubmed: 18845925
Porter K, Johnson AM, Phillips AN, Darbyshire JH. The practical significance of potential biases in estimates of the AIDS incubation period distribution in the UK register of HIV seroconverters. AIDS. 1999;13(14):1943–51.
pubmed: 10513654
Marcus JL, Leyden WA, Alexeeff SE, Anderson AN, Hechter RC, Hu H, et al. Comparison of overall and comorbidity-free life expectancy between insured adults with and without HIV infection, 2000–2016. JAMA Netw Open. 2020;3(6): e207954.
pubmed: 32539152
pmcid: 7296391
Trickey A, Sabin CA, Burkholder G, Crane H, d’Arminio Monforte A, Egger M, et al. Life expectancy after 2015 of adults with HIV on long-term antiretroviral therapy in Europe and North America: a collaborative analysis of cohort studies. Lancet HIV. 2023;10(5):e295–307.
pubmed: 36958365
pmcid: 10288029
Triant VA. Cardiovascular disease and HIV infection. Curr HIV/AIDS Rep. 2013;10(3):199–206.
pubmed: 23793823
pmcid: 3964878
Kalra S, Kalra B, Agrawal N, Unnikrishnan A. Understanding diabetes in patients with HIV/AIDS. Diabetol Metab Syndr. 2011;3(1):2.
pubmed: 21232158
pmcid: 3025836
Valcour V, Shikuma C, Shiramizu B, Watters M, Poff P, Selnes O, et al. Higher frequency of dementia in older HIV-1 individuals: the Hawaii Aging with HIV-1 Cohort. Neurology. 2004;63(5):822–7.
pubmed: 15365130
Chen CH, Chung CY, Wang LH, Lin C, Lin HL, Lin HC. Risk of cancer among HIV-infected patients from a population-based nested case–control study: implications for cancer prevention. BMC Cancer. 2015;15:133.
pubmed: 25885746
pmcid: 4369071
MacKellar D, Williams D, Bhembe B, Dlamini M, Byrd J, Dube L, et al. Peer-delivered linkage case management and same-day ART initiation for men and young persons with HIV infection-Eswatini, 2015–2017. MMWR Morb Mortal Wkly Rep. 2018;67(23):663–7.
pubmed: 29902168
pmcid: 6002033
Reniers G, Blom S, Calvert C, Martin-Onraet A, Herbst AJ, Eaton JW, et al. Trends in the burden of HIV mortality after roll-out of antiretroviral therapy in KwaZulu-Natal, South Africa: an observational community cohort study. Lancet HIV. 2017;4(3):e113–21.
pubmed: 27956187
Wing EJ. HIV and aging. Int J Infect Dis. 2016;53:61–8.
pubmed: 27756678
Negin J, Cumming RG. HIV infection in older adults in sub-Saharan Africa: extrapolating prevalence from existing data. Bull World Health Organ. 2010;88(11):847–53.
pubmed: 21076566
pmcid: 2971515
Roomaney RA, van Wyk B, Pillay-van Wyk V. Aging with HIV: increased risk of HIV comorbidities in older adults. Int J Environ Res Public Health. 2022;19(4):2359.
pubmed: 35206544
pmcid: 8872228
Neugut AI, El-Sadr WM, Ruff P. The looming threat: cancer in Sub-Saharan Africa. Oncologist. 2021;26(12):e2099–101.
pubmed: 34473874
pmcid: 8649061
Meir-Shafrir K, Pollack S. Accelerated aging in HIV patients. Rambam Maimonides Med J. 2012;3(4): e0025.
pubmed: 23908849
pmcid: 3678823
McMillan JM, Krentz H, Gill MJ, Hogan DB. Managing HIV infection in patients older than 50 years. CMAJ. 2018;190(42):E1253–8.
pubmed: 30348740
pmcid: 6199165
Bloch M. Frailty in people living with HIV. AIDS Res Ther. 2018;15(1):19.
pubmed: 30445966
pmcid: 6240180
Kruger MJ, Nell TA. Bone mineral density in people living with HIV: a narrative review of the literature. AIDS Res Ther. 2017;14(1):35.
pubmed: 28747190
pmcid: 5530558
Aberg JA. Aging and HIV infection: focus on cardiovascular disease risk. Top Antivir Med. 2020;27(4):102–5.
pubmed: 32224501
pmcid: 7162677
Pao V, Lee GA, Grunfeld C. HIV therapy, metabolic syndrome, and cardiovascular risk. Curr Atheroscler Rep. 2008;10(1):61–70.
pubmed: 18366987
pmcid: 3166347
Lam JO, Hou CE, Hojilla JC, Anderson AN, Gilsanz P, Alexeeff SE, et al. Comparison of dementia risk after age 50 between individuals with and without HIV infection. AIDS. 2021;35(5):821–8.
pubmed: 33394681
Capeau J. Premature aging and premature age-related comorbidities in HIV-infected patients: facts and hypotheses. Clin Infect Dis. 2011;53(11):1127–9.
pubmed: 21998279
Coetzee L, Bogler L, De Neve JW, Bärnighausen T, Geldsetzer P, Vollmer S. HIV, antiretroviral therapy and non-communicable diseases in sub-Saharan Africa: empirical evidence from 44 countries over the period 2000 to 2016. J Int AIDS Soc. 2019;22(7): e25364.
pubmed: 31353831
pmcid: 6661400
Yuyun MF, Sliwa K, Kengne AP, Mocumbi AO, Bukhman G. Cardiovascular diseases in Sub-Saharan Africa compared to high-income countries: an epidemiological perspective. Glob Heart. 2020;15(1):15.
pubmed: 32489788
pmcid: 7218780
Oblak L, van der Zaag J, Higgins-Chen AT, Levine ME, Boks MP. A systematic review of biological, social and environmental factors associated with epigenetic clock acceleration. Ageing Res Rev. 2021;69: 101348.
pubmed: 33930583
Gavazzi G, Krause KH. Ageing and infection. Lancet Infect Dis. 2002;2(11):659–66.
pubmed: 12409046
Moore LD, Le T, Fan G. DNA methylation and its basic function. Neuropsychopharmacology. 2013;38(1):23–38.
pubmed: 22781841
Horvath S. DNA methylation age of human tissues and cell types. Genome Biol. 2013;14(10):R115.
pubmed: 24138928
pmcid: 4015143
Hannum G, Guinney J, Zhao L, Zhang L, Hughes G, Sadda S, et al. Genome-wide methylation profiles reveal quantitative views of human aging rates. Mol Cell. 2013;49(2):359–67.
pubmed: 23177740
Levine ME, Lu AT, Quach A, Chen BH, Assimes TL, Bandinelli S, et al. An epigenetic biomarker of aging for lifespan and healthspan. Aging (Albany NY). 2018;10(4):573–91.
pubmed: 29676998
Lu AT, Quach A, Wilson JG, Reiner AP, Aviv A, Raj K, et al. DNA methylation GrimAge strongly predicts lifespan and healthspan. Aging (Albany NY). 2019;11(2):303–27.
pubmed: 30669119
Belsky DW, Caspi A, Corcoran DL, Sugden K, Poulton R, Arseneault L, et al. DunedinPACE, a DNA methylation biomarker of the pace of aging. Elife. 2022;11:e73420.
pubmed: 35029144
pmcid: 8853656
Salameh Y, Bejaoui Y, El Hajj N. DNA methylation biomarkers in aging and age-related diseases. Front Genet. 2020;11:171.
pubmed: 32211026
pmcid: 7076122
Joyce BT, Gao T, Zheng Y, Ma J, Hwang SJ, Liu L, et al. Epigenetic age acceleration reflects long-term cardiovascular health. Circ Res. 2021;129(8):770–81.
pubmed: 34428927
pmcid: 8484046
Faul JD, Kim JK, Levine ME, Thyagarajan B, Weir DR, Crimmins EM. Epigenetic-based age acceleration in a representative sample of older Americans: Associations with aging-related morbidity and mortality. Proc Natl Acad Sci USA. 2023;120(9): e2215840120.
pubmed: 36802439
pmcid: 9992763
Horvath S, Levine AJ. HIV-1 infection accelerates age according to the epigenetic clock. J Infect Dis. 2015;212(10):1563–73.
pubmed: 25969563
pmcid: 4621253
Schoepf IC, Esteban-Cantos A, Thorball CW, Rodés B, Reiss P, Rodríguez-Centeno J, et al. Epigenetic ageing accelerates before antiretroviral therapy and decelerates after viral suppression in people with HIV in Switzerland: a longitudinal study over 17 years. Lancet Healthy Longev. 2023;4(5):e211–8.
pubmed: 37148893
Gamble-George JC, Longenecker CT, Webel AR, Au DH, Brown AF, Bosworth H, et al. ImPlementation REsearCh to DEvelop Interventions for People Living with HIV (the PRECluDE consortium): combatting chronic disease comorbidities in HIV populations through implementation research. Prog Cardiovasc Dis. 2020;63(2):79–91.
pubmed: 32199901
pmcid: 7237329
Lagrange RD, Mitchell SJ, Lewis M, Abramowitz S, D'Angelo LJ. Health protective behaviors among young people living with HIV/AIDS. J AIDS Clin Res. 2012;01(S1).
Ngcobo S, Scheepers S, Mbatha N, Grobler E, Rossouw T. Roles, barriers, and recommendations for community health workers providing community-based HIV care in Sub-Saharan Africa: a review. AIDS Patient Care STDS. 2022;36(4):130–44.
pubmed: 35438523
pmcid: 9057893
Harris TG, Rabkin M, El-Sadr WM. Achieving the fourth 90: healthy aging for people living with HIV. AIDS. 2018;32(12):1563–9.
pubmed: 29762172
Alkhatib A, Nnyanzi LA, Mujuni B, Amanya G, Ibingira C. Preventing multimorbidity with lifestyle interventions in Sub-Saharan Africa: a new challenge for public health in low and middle-income countries. Int J Environ Res Public Health. 2021;18(23):12449.
pubmed: 34886172
pmcid: 8656800
Harris TG, Floren S, Mantell JE, Nkambule R, Lukhele NG, Malinga BP, et al. HIV and aging among adults aged 50 years and older on antiretroviral therapy in Eswatini. Afr J AIDS Res. 2021;20(1):107–15.
pubmed: 33685372
Ware JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30(6):473–83.
pubmed: 1593914
Riley L, Guthold R, Cowan M, Savin S, Bhatti L, Armstrong T, et al. The World Health Organization STEPwise approach to noncommunicable disease risk-factor surveillance: methods, challenges, and opportunities. Am J Public Health. 2016;106(1):74–8.
pubmed: 26696288
pmcid: 4695948
Aryee MJ, Jaffe AE, Corrada-Bravo H, Ladd-Acosta C, Feinberg AP, Hansen KD, et al. Minfi: a flexible and comprehensive bioconductor package for the analysis of Infinium DNA methylation microarrays. Bioinformatics. 2014;30(10):1363–9.
pubmed: 24478339
pmcid: 4016708
Xu Z, Niu L, Li L, Taylor JA. ENmix: a novel background correction method for Illumina HumanMethylation450 BeadChip. Nucleic Acids Res. 2016;44(3): e20.
pubmed: 26384415
Xu Z, Langie SA, De Boever P, Taylor JA, Niu L. RELIC: a novel dye-bias correction method for illumina methylation BeadChip. BMC Genom. 2017;18(1):4.
Lowe R, Rakyan VK. Correcting for cell-type composition bias in epigenome-wide association studies. Genome Med. 2014;6(3):23.
pubmed: 25031617
pmcid: 4062059
Houseman EA, Kelsey KT, Wiencke JK, Marsit CJ. Cell-composition effects in the analysis of DNA methylation array data: a mathematical perspective. BMC Bioinform. 2015;16:95.
Chen BH, Marioni RE, Colicino E, Peters MJ, Ward-Caviness CK, Tsai PC, et al. DNA methylation-based measures of biological age: meta-analysis predicting time to death. Aging (Albany NY). 2016;8(9):1844–65.
pubmed: 27690265
Wang S, Zhang Q, Hui H, Agrawal K, Karris MAY, Rana TM. An atlas of immune cell exhaustion in HIV-infected individuals revealed by single-cell transcriptomics. Emerg Microbes Infect. 2020;9(1):2333–47.
pubmed: 32954948
pmcid: 7646563
Houseman EA, Accomando WP, Koestler DC, Christensen BC, Marsit CJ, Nelson HH, et al. DNA methylation arrays as surrogate measures of cell mixture distribution. BMC Bioinform. 2012;13:86.
Akusjarvi SS, Neogi U. Biological aging in people living with HIV on successful antiretroviral therapy: do they age faster? Curr HIV/AIDS Rep. 2023;20(2):42–50.
pubmed: 36695947
pmcid: 10102129
Smith RL, de Boer R, Brul S, Budovskaya Y, van Spek H. Premature and accelerated aging: HIV or HAART? Front Genet. 2012;3:328.
pubmed: 23372574
Horvath S, Lin DTS, Kobor MS, Zoller JA, Said JW, Morgello S, et al. HIV, pathology and epigenetic age acceleration in different human tissues. Geroscience. 2022;44(3):1609–20.
pubmed: 35411474
pmcid: 9213580
Balasubramaniam M, Pandhare J, Dash C. Immune control of HIV. J Life Sci (Westlake Village). 2019;1(1):4–37.
pubmed: 31468033
Salam N, Rane S, Das R, Faulkner M, Gund R, Kandpal U, et al. T cell ageing: effects of age on development, survival & function. Indian J Med Res. 2013;138(5):595–608.
pubmed: 24434315
pmcid: 3928693
Wilson EM, Sereti I. Immune restoration after antiretroviral therapy: the pitfalls of hasty or incomplete repairs. Immunol Rev. 2013;254(1):343–54.
pubmed: 23772630
pmcid: 3694599
Deeks SG, Tracy R, Douek DC. Systemic effects of inflammation on health during chronic HIV infection. Immunity. 2013;39(4):633–45.
pubmed: 24138880
pmcid: 4012895
Chen L, Deng H, Cui H, Fang J, Zuo Z, Deng J, et al. Inflammatory responses and inflammation-associated diseases in organs. Oncotarget. 2018;9(6):7204–18.
pubmed: 29467962
Franceschi C, Campisi J. Chronic inflammation (inflammaging) and its potential contribution to age-associated diseases. J Gerontol A Biol Sci Med Sci. 2014;69(Suppl 1):S4-9.
pubmed: 24833586
Nasi M, De Biasi S, Gibellini L, Bianchini E, Pecorini S, Bacca V, et al. Ageing and inflammation in patients with HIV infection. Clin Exp Immunol. 2017;187(1):44–52.
pubmed: 27198731
Gbadamosi SO, Trepka MJ, Dawit R, Jebai R, Sheehan DM. A systematic review and meta-analysis to estimate the time from HIV infection to diagnosis for people with HIV. AIDS Rev. 2022;24(1):32–40.
pubmed: 34077404
pmcid: 8636511
Deeks SG. HIV infection, inflammation, immunosenescence, and aging. Annu Rev Med. 2011;62:141–55.
pubmed: 21090961
pmcid: 3759035
Sehl ME, Breen EC, Shih R, Chen L, Wang R, Horvath S, et al. Increased rate of epigenetic aging in men living with HIV prior to treatment. Front Genet. 2021;12: 796547.
pubmed: 35295196
Sehl ME, Rickabaugh TM, Shih R, Martinez-Maza O, Horvath S, Ramirez CM, et al. The effects of anti-retroviral therapy on epigenetic age acceleration observed in HIV-1-infected adults. Pathog Immun. 2020;5(1):291–311.
pubmed: 33501399
pmcid: 7815056
Grinspoon SK, Fitch KV, Zanni MV, Fichtenbaum CJ, Umbleja T, Aberg JA, et al. Pitavastatin to prevent cardiovascular disease in HIV infection. N Engl J Med. 2023;389(8):687–99.
pubmed: 37486775
Thomas A, Belsky DW, Gu Y. Healthy lifestyle behaviors and biological aging in the US National Health and Nutrition Examination Surveys 1999–2018. J Gerontol A Biol Sci Med Sci. Series A. 2023; 78(9):1535–42.
Sabia S, Singh-Manoux A, Hagger-Johnson G, Cambois E, Brunner EJ, Kivimaki M. Influence of individual and combined healthy behaviours on successful aging. CMAJ. 2012;184(18):1985–92.
pubmed: 23091184
pmcid: 3519184
Botros D, Somarriba G, Neri D, Miller TL. Interventions to address chronic disease and HIV: strategies to promote exercise and nutrition among HIV-infected individuals. Curr HIV/AIDS Rep. 2012;9(4):351–63.
pubmed: 22933247
pmcid: 3492509
Cade WT, Reeds DN, Mondy KE, Overton ET, Grassino J, Tucker S, et al. Yoga lifestyle intervention reduces blood pressure in HIV-infected adults with cardiovascular disease risk factors. HIV Med. 2010;11(6):379–88.
pubmed: 20059570
pmcid: 2889007
Dempsey PC, Musicha C, Rowlands AV, Davies M, Khunti K, Razieh C, et al. Investigation of a UK biobank cohort reveals causal associations of self-reported walking pace with telomere length. Commun Biol. 2022;5(1):381.
pubmed: 35444173
pmcid: 9021230
Dalene KE, Tarp J, Selmer RM, Ariansen IKH, Nystad W, Coenen P, et al. Occupational physical activity and longevity in working men and women in Norway: a prospective cohort study. Lancet Public Health. 2021;6(6):e386–95.
pubmed: 33932334
Shim MS, Noh D. Effects of physical activity interventions on health outcomes among older adults living with HIV: a systematic review and meta-analysis. Int J Environ Res Public Health. 2022;19(14):8439.
pubmed: 35886293
pmcid: 9317429
Simpson RJ, Campbell JP, Gleeson M, Krüger K, Nieman DC, Pyne DB, et al. Can exercise affect immune function to increase susceptibility to infection? Exerc Immunol Rev. 2020;26:8–22.
pubmed: 32139352
Fitzgerald KN, Hodges R, Hanes D, Stack E, Cheishvili D, Szyf M, et al. Potential reversal of epigenetic age using a diet and lifestyle intervention: a pilot randomized clinical trial. Aging (Albany NY). 2021;13(7):9419–32.
pubmed: 33844651
Kim Y, Huan T, Joehanes R, McKeown NM, Horvath S, Levy D, et al. Higher diet quality relates to decelerated epigenetic aging. Am J Clin Nutr. 2022;115(1):163–70.
pubmed: 34134146
Kresovich JK, Park YM, Keller JA, Sandler DP, Taylor JA. Healthy eating patterns and epigenetic measures of biological age. Am J Clin Nutr. 2022;115(1):171–9.
pubmed: 34637497
Gensous N, Garagnani P, Santoro A, Giuliani C, Ostan R, Fabbri C, et al. One-year Mediterranean diet promotes epigenetic rejuvenation with country- and sex-specific effects: a pilot study from the NU-AGE project. Geroscience. 2020;42(2):687–701.
pubmed: 31981007
pmcid: 7205853
Fiorito G, Caini S, Palli D, Bendinelli B, Saieva C, Ermini I, et al. DNA methylation-based biomarkers of aging were slowed down in a two-year diet and physical activity intervention trial: the DAMA study. Aging Cell. 2021;20(10): e13439.
pubmed: 34535961
pmcid: 8520727
Martínez de Toda I, Maté I, Vida C, Cruces J, De la Fuente M. Immune function parameters as markers of biological age and predictors of longevity. Aging. 2016;8(11):3110–9.
pubmed: 27899767
Raiten DJ. Nutrition and pharmacology: general principles and implications for HIV. Am J Clin Nutr. 2011;94(6):1697S-S1702.
pubmed: 22089445
pmcid: 3225603
Bassett IV, Sax PE. Untreated HIV: harmful even at high CD4 cell counts. Lancet. 2010;376(9738):306–8.
pubmed: 20638117
pmcid: 3523325
Rawat R, McCoy SI, Kadiyala S. Poor diet quality is associated with low CD4 count and anemia and predicts mortality among antiretroviral therapy-naive HIV-positive adults in Uganda. J Acquir Immune Defic Syndr. 2013;62(2):246–53.
pubmed: 23117502
Keshani P, Sarihi S, Parsaie N, Joulaei H. Dietary pattern association with CD4 cells count in patients living with human immunodeficiency virus: a cross-sectional study. J Public Health Res. 2023;12(2):22799036231181200.
pubmed: 37434871
pmcid: 10331780
Somarriba G, Neri D, Schaefer N, Miller TL. The effect of aging, nutrition, and exercise during HIV infection. HIV AIDS (Auckl). 2010;2:191–201.
pubmed: 22096398
Riediger ND, Bombak AE, Mudryj AN. Health-related behaviours and their relationship with self-rated health among Canadian adults. BMC Public Health. 2019;19(1):960.
pubmed: 31319817
pmcid: 6637547
Tran N, Nishi A, Young LE, Endo A, Cumberland WG, Young SD. The role of perceived health in retention disparity: a HIV-testing-related behavioral intervention among African American and Latinx men who have sex with men in the United States. Prev Med Rep. 2023;33: 102195.
pubmed: 37223563
pmcid: 10201871
Fuente-Soro L, López-Varela E, Augusto O, Bernardo EL, Sacoor C, Nhacolo A, et al. Loss to follow-up and opportunities for reengagement in HIV care in rural Mozambique: a prospective cohort study. Medicine (Baltimore). 2020;99(20): e20236.
pubmed: 32443358
Schoepf IC, Esteban-Cantos A, Thorball CW, Rodes B, Reiss P, Rodriguez-Centeno J, et al. Epigenetic ageing accelerates before antiretroviral therapy and decelerates after viral suppression in people with HIV in Switzerland: a longitudinal study over 17 years. Lancet Healthy Longev. 2023;4(5):e211–8.
pubmed: 37148893