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Diet Quality Is Suboptimal or Poor in Large Proportion of Global Population With HIV

Key findings

  • This study analyzed data from the Randomized Trial to Prevent Vascular Events in HIV on 7,736 people with HIV on antiretroviral therapy at low-to-moderate risk of atherosclerotic cardiovascular disease
  • The participants completed a questionnaire about their diet at baseline, and 42% of participants reported suboptimal or poor diet quality
  • There were notable variations in diet quality by region of the world, with poor or suboptimal diets more commonly reported in sub-Saharan Africa
  • Established risk factors for cardiovascular disease—atherosclerotic cardiovascular disease risk scores, body mass index, and waist circumference—increased with worsening category of diet quality
  • These data suggest the need to focus on diet quality as a potential modifiable risk for cardiovascular disease in people with HIV

Diet quality is acknowledged to be an important factor related to the development of chronic comorbid diseases in people with HIV (PWH). However, it's not often considered as part of assessing this population's risk of cardiometabolic disease.

Kathleen V. Fitch, MSN, a principal associate in medicine at Massachusetts General Hospital, Steven K. Grinspoon, MD, chief of the Metabolism Unit, and colleagues recently conducted the first analysis of diet quality across a multinational cohort of PWH. In the journal AIDS, they report that diet quality was poor or suboptimal in 42% of individuals.


The researchers analyzed data from the Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE), an ongoing randomized phase 3 trial assessing the effects of a statin to prevent major adverse cardiovascular events in PWH.

From 2015 to 2019, on five continents, the trial enrolled individuals without known atherosclerotic cardiovascular disease (ASCVD), 40 to 75 years of age, who were receiving antiretroviral therapy and were judged to be at low-to-moderate traditional risk of ASCVD at baseline, with an average ASCVD risk score of approximately 5%.

The current analysis examined data on 7,736 REPRIEVE participants who completed the Rapid Eating Assessment for Participants (REAP), a 31-item questionnaire developed to assess diet quality in primary care settings. REAP scores were analyzed on a continuous scale from 1 (worst) to 30 (best) and grouped into four categories: optimal, good, suboptimal, or poor.

Diet Quality Scores

The median diet quality score for the cohort was 17. Diet quality was optimal in 13% of participants, good in 45%, suboptimal in 38%, and poor in 4%.

Substantial percentages of participants had diet component scores categorized as suboptimal or poor:

  • Fiber—66% of participants
  • Saturated fat—47%
  • Added sugar—41%
  • Sodium—36%

Diet Quality by Region

The REPRIEVE sites were grouped into five of the Global Burden of Disease (GBD) super-region subgroups using classifications developed by the World Health Organization. Diet quality differed across GBD regions, with the best scores reported in South Asia (median of 23) and the worst in sub-Saharan Africa (median of 15). Likewise, 61% of participants in South Asia reported optimal diet quality versus only 6% in sub-Saharan Africa.

Diet Quality and Cardiometabolic Characteristics

ASCVD risk scores, body mass index, and waist circumference increased with the worsening category of diet quality score. Interestingly, though, there were no clinical differences in glucose or total cholesterol across categories. Participants with poor diet quality were the most likely to have hypertension.

Opportunities to Improve Care

Diet quality may be an important modifiable factor for cardiometabolic diseases in the large global population of PWH. These results are particularly important because a recent systematic review concluded the highest HIV-associated burden of cardiovascular disease is in sub-Saharan Africa. In this region, it is essential to develop and sustain care models that incorporate nutrition assessment and counseling for PWH, as well as improve the availability of and access to affordable, healthy foods.

of a global population of people with HIV reported suboptimal or poor diet quality

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