1. Dietary patterns and cardiovascular disease-related risks among women living with HIV.
by Pedro A. Argueta

2. Contents Research Question Introduction Methods Analysis Results
Conclusion

3. HIV is a risk factor for CVDs in women
HIV+ women vs HIV- women
HIV+ Women have a higher prevalence of:
Low HDL
High Triglycerides
High Smoking
HIV infected women compared to non infected HIV women had a higher prevalence of low HDL cholesterol, elevated TGs, elevated smoking levels, and a lower prevalence of hypertension and obesity.
Had an increased risk of CVD.
May be due to side effects from HIV medication or poor nutrition patterns specific to this population.
CVD risk seems to be higher among women with HIV when compared to non HIV infected women, but literature currently lacks studies that have explored possible mechanisms especially among women.

4. HIV increases risks for CVDs for many reasons
HIV Status is related to Cardiovascular disease. Being HIV positive means higher risk for CVD. This is because of:
ARV Medications
Chronic Inflammation
Hypertriglyceridemia
Nutrition?
Manifestations from antiretroviral medication side effects: hyperlipidemia, increase CHOL, increased triglycerides, hypertension.
Chronic inflammation due to HIV infection that damages the vascular endothelium.
Hypertriglyceridemia- HIV increases production of interferon gamma, contributes to the development of hypertriglyceridemia.
Nutrition has not been fully explored as a possible risk factor among the HIV population.

5. Nutrition plays a role in connection of HIV & CVDs
HIV leads to poor eating habits because of:
reduced appetite
nausea
vomiting
diarrhea
HIV disease gives rise to clinical symptoms that interfere with food consumption5.
Having reduced appetite, nausea, vomiting, and some diarrhea5.
Compared to men, women were more likely to have inadequate nutrient intake.
So we know HIV women eat more poorly due to HIV medication side effects, but whether these dietary influences your risk for CVD risk factors is not completely known.

6. Conceptual Framework
HIV CVD

7. HIV CVD ARV Medications Chronic Inflammation Hypertriglyceridemia
Nutrition?

8. HIV CVD ARV Medications Chronic Inflammation Hypertriglyceridemia
Nutrition?

9. Income, Age, Education, Race, Alcohol, Smoker, BP Medication
HIV CVD
Confounders
ARV Medications
Chronic Inflammation
Hypertriglyceridemia
Nutrition?
Income, Age, Education, Race, Alcohol, Smoker, BP Medication

10. Research Question & Hypothesis
Question: What role do dietary factors play in HIV+ women in increasing risk factors for CVD?
Hypothesis: Poor dietary patterns increase risk factors for CVD among HIV+ women.
if they do, are they related to dietary factors?
HIV positive women will have higher risk factors for CVD due to poor dietary intake.

11. Methods Women’s Interagency HIV Study (WIHS).
1994 Prospective Cohort study
Women with or at risk for HIV
Five-Factor Screener.
18 questions on food frequency intake
This paper will seek to answer the above question using a population of women from the Women’s Interagency HIV Study (WIHS). WIHS is a large multicenter, prospective cohort study that began in 1994 to investigate the effect of HIV infection on women.
Five Factor screener was used to capture intake, developed from National Cáncer Institute.

12. Independent variable: Dietary Intake
Participants reported the different kinds of foods they usually ate or drank in the last 30 days.
In this factor analysis, we grouped the participants responses to identify the most common dietary patterns in this group.

13. Factor 1
Factor 2
Factor 3
In this factor analysis, we grouped the participants responses to identify the most common dietary patterns in this group.

14. Dietary Pattern #1- Dairy
Yogurt, cheese, liquid milk.

15. Dietary Pattern #2- Sweetened Beverages
Non-diet sodas or fruit drinks such as Sunny Delight or Tang. Does not include 100% fruit juices.

16. Dietary Pattern #3 Protein, Grains, & Fat
Fat: butter, margarine, full-fat salad dressing, mayonnaise.
Grains: cereal, rice, pasta, breads, tortillas.
Protein: (meat, chicken, seafood) Seafood, chicken, turkey, duck, pork, burgers, meatloaf, hot dogs, sausage.

17. Dependent Variable: CVD Risk Factors
BMI
Hypertension
High LDL
Low HDL
High Triglycerides
Waist circumference

18. Analysis Regression Analysis for continuous outcomes
BMI, Waist Circumference
Logistic Regression Analysis for binary outcomes
Hypertension, High LDL, Low HDL, High Triglycerides

19. Confounders Income Age Education Race Alcohol Smoking Status
Blood Pressure Medication
I controlled for all measured confounders in my dataset.
Blood Pressure Medication and Smoking alters your taste receptors and therefore the types of food you find tolerable to eat.

20. Higher BMI, Hypertension, & Higher Waist Circumference
Summary of Results
Sweetened Beverage consumption was associated with more CVD risk factors, before adjusting.
Higher BMI, Hypertension, & Higher Waist Circumference

21. Higher BMI, Hypertension, & Higher Waist Circumference
Summary of Results
Sweetened Beverage consumption was associated with more CVD risk factors, before adjusting.
Higher BMI, Hypertension, & Higher Waist Circumference
After adjusting, Sweetened Beverage consumption was no longer associated with CVD risk factors.

22. Conclusions and Next Steps
There was no observed increased risk factors for CVD from poor dietary patterns among HIV+ women.
There was no observed increased risk factors for CVD from dietary intake among HIV+ women.
Next Steps:
Explore this question using other methods for capturing dietary intake (e.g. 24-hr recall, FFQ).
More studies among women when assessing the relationship between HIV and CVD.

23. Conclusions and Next Steps
There was no observed increased risk factors for CVD from poor dietary patterns among HIV+ women.
Explore this question using other methods for capturing dietary intake (e.g. 24-hr recall, FFQ).
Further studies needed to assess the increased risk for CVD, especially among HIV+ women.
There was no observed increased risk factors for CVD from dietary intake among HIV+ women.
Next Steps:
Explore this question using other methods for capturing dietary intake (e.g. 24-hr recall, FFQ).
More studies among women when assessing the relationship between HIV and CVD.

24. Acknowledgements
Barbara Laraia PhD, MPH, RD Lia C. Haskin Fernald PhD, MBA
Lila A. Sheira, MPH Sheri Weiser, MD
I would like to end my presentation by thanking the people that supported and mentored me throughout this project.