People with HIV (PWH) experience aging-associated comorbidities, including cardiovascular disease (CVD), at rates higher than the general population. Optimizing modifiable factors, such as diet, may delay onset or improve aging-associated comorbidities. However, diet quality across a global cohort of PWH has not been previously characterized.
REPRIEVE (Randomized Trial to Prevent Vascular Events in HIV) enrolled 7770 PWH, aged 40-75 years, at low-to-moderate traditional CVD risk, receiving ART. A cross-sectional analysis of the 7736 participants who completed the Rapid Eating Assessment for Participants (REAP) questionnaire at study entry was conducted. The overall REAP Score and scores for specific diet components were generated. Higher scores indicate better diet quality. Findings were summarized by Global Burden of Disease (GBD) super-region. Adjusted linear regression analyses were performed to examine differences in diet by key covariates.
Among 7736 participants, median age was 50 years (Q1-Q3: 45-55), 31% were natal female, 43% were Black or African American, median BMI was 25.8 kg/m2 (22.7-29.4), 48% has used ART for >10 years. Overall REAP Score was optimal in 13% of participants, but suboptimal or poor in 38% and 4% of participants, respectively. Participants residing in South Asia had the highest overall REAP Score, median 23 (21-25) (range 0-30), with 61% of participants’ diet classified as optimal. Participants in South Asia consistently had the highest score for specific diet components (see Table). In the adjusted analysis, older age, less frequent alcohol use, and South East/East Asia and South Asia GBD regions were associated with higher REAP Score, while Black or African American race (in High Income and Sub-Saharan Africa GBD regions) were associated with lower REAP Score. In adjusted analyses restricted to each GBD region, older age (60+ years) was consistently associated with higher REAP Score, as was less frequent alcohol use, in all GBD regions except South East/East Asia.
Among PWH eligible for primary cardiovascular prevention, there were substantial variations in diet quality reported by GBD region. Diet was suboptimal or poor for 42% of trial participants. Important factors associated with poorer diet quality were age less than 60 years and more frequent alcohol use. Poor diet is an important, common modifiable risk factor which may be optimized to reduce CVD risk among PWH.