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K. Berner1, H. Strijdom2, I. Webster2, M.F. Essop3,2, Q. Louw1
1Stellenbosch University, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Cape Town, South Africa, 2Stellenbosch University, Centre for Cardiometabolic Research in Africa, Division of Medical Physiology, Faculty of Medicine and Health Sciences, Cape Town, South Africa, 3Stellenbosch University, Department of Physiological Sciences, Faculty of Science, Stellenbosch, South Africa
Background: Obesity, multimorbidity and functional impairments are becoming apparent in people living with chronic HIV (PLHIV). Evidence from high-income settings suggests that obesity and multimorbidity may contribute to functional decline, poor mental health and reduced quality of life in PLHIV. Understanding functional consequences and patients’ experiences is crucial to inform personalised care. Unfortunately, the person-centred sequelae of obesity and multimorbidity in interaction with HIV remain poorly characterised; and for South Africa, where HIV may affect younger adults who may live well into old age, longitudinal evidence is non-existent. This is the first study that will investigate feasibility and clinical outcomes of a prospective protocol to explore such relationships in a low-resource setting.
Purpose: To investigate if an obese body mass and/or multimorbidity influence person-centred outcomes and whether these observations differ by HIV status, and determine the feasibility of a nested longitudinal design to describe temporal trends.
Methods: This ongoing study compares adults differing in HIV status, multimorbid status and body mass using an non-interventional, prospective design with repeated measures. Eighteen-month follow-up will serve as an internal pilot to establish feasibility. A primary care community clinic in the Western Cape, South Africa, is the study setting. Preliminary baseline data have been extracted and analysed for 28 HIV+ and 17 HIV- participants out of a planned total of 150 (data collection placed on hold in March 2020 due to COVID-19). Person-centred outcomes include activity limitations (WHODAS 12-item), falls (1-year retrospective recall), depressive symptoms (CES-D-10), functional mobility (5x sit-to-stand time), functional fitness (STEP protocol-derived VO2 max) and handgrip strength (hydraulic dynamometer). Analyses included factorial ANOVA and chi-square test (background characteristics) and factorial ANCOVA including gender (person-centred outcomes).
Results: Mean sample age was 42.4 (1.31) years and similar between all comparison groups (p>0.05). When respectively defining multimorbidity as (i) having ≥2 of any chronic conditions, or (ii) among PLHIV, as HIV plus ≥2 additional conditions, multimorbidity was more (71.4%, p=0.019) or similarly (25.0%, p=0.460) prevalent in PLHIV than SNP (35.3%). 35.3% of SNP and 21.4% of PLHIV were obese (p=0.325). Differences in person-centred outcomes were variably associated with having HIV (slower chair rise time, p=0.024), multimorbidity (depressive symptoms, p=0.045), obesity (lower VO2 max, p=0.041), or an HIVxBMI interaction (depressive symptoms, p=0.032).
Conclusion(s): Preliminary results show that in this middle-aged South African sample, obesity seems as prevalent, and multimorbidity similar or more prevalent, in PLHIV relative to HIV-free peers. HIV, obesity and multimorbidity were variably and potentially synergystically associated with different dimensions of objective function and depressive symptoms. We will re-assess these results upon completion of baseline data collection, establish the feasibility of conducting a longitudinal study nested in an existing cohort and ultimately determine temporal trends in the study outcomes.
Implications: As the obesity, non-communicable disease and HIV epidemics collide, rehabilitation specialists should keep potential impacts (which may be synergistic) on mental health, functional fitness and functional mobility in mind. Such outcomes seem valuable to assess and may inform personalised care of young-to-middle-aged adults who may suffer any or a combination of these conditions.
Funding, acknowledgements: Subcommittee C of the Research Committee’s Early-career Research Fund, Faculty of Medicine and Health Sciences, Stellenbosch University.
Keywords: HIV, obesity, multimorbidity
Topic: Disability & rehabilitation
Did this work require ethics approval? Yes
Institution: Stellenbsoch University
Committee: Human Research Ethics Committee
Ethics number: N19/02/029
All authors, affiliations and abstracts have been published as submitted.
