The following is a video and transcript excerpt from an interview conducted with David Alain Wohl, M.D., discussing highlights and clinical takeaway messages from the 2021 Conference on Retroviruses and Opportunistic Infections (CROI 2021), which took place in March. In this video, Wohl talks through new findings that help us better understand the connections between sleep, diet, and quality of life among people living with HIV.
There were two other studies that I really liked a lot, and they have to do with two of the things that I think I enjoy the most. And that has to do with sleep and food.
Sleep Quality Is Lower Among People Living With HIV
There was a really nice study looking at sleep quality in people living with HIV. Not too surprisingly, sleep wasn’t all that great. And importantly, if you got less than seven hours a night of sleep, the data indicated that you were more likely to not be healthy.
I think, for me, sleep is one of these things that people don’t pay enough attention to, and is something that could be changed with the right training. In their particular analysis, they didn’t look at outcomes, but they looked at inflammation of endothelium-dependent vasodilation—a marker, eventually, of cardiovascular disease and inflammation.
It really strikes home to me that many of us don’t get enough sleep: people without HIV, people with HIV. But maybe, for people living with HIV with their other stressors—whether it be the retrovirus causing some inflammation and the other factors that we’re talking about chronically—that maybe sleep plays a more important role.
We’ve known for years that when you look at smokers—again, people living with HIV and without HIV—for the same amount of smoking, people with HIV seem to suffer more as far as loss of lung function and maybe even rates of cancer. And so, I think this might be the same sort of thing: that for people who are already living with a bit of stress, shorter nightly sleep duration may also be associated with not such good things.
Global Eating Assessment Yields Factors Associated With Poorer Diet in HIV
I’m a big harper on “Let’s get your hypertension under control,” and, “Let’s try to get you not to drink any more Mountain Dew. I know it’s Diet Mountain Dew. Good for you, but let’s stop the Mountain Dew.” Which leads us to diet.
REPRIEVE is a really impressive study that’s looking at whether or not statins have magical properties that prevent not only cardiovascular disease, but all sorts of other things. It’s collecting lots of data now, COVID-related data. But they also looked, across the [parts of the] world that the study is participating in, [at] dietary quality.
There’s a score; there’s a rapid eating assessment for participants that’s not about eating rapidly—it’s a rapid assessment [called REAP, short for Rapid Eating Assessment for Participants] that could be done to understand how people eat and what they eat.
I thought it was pretty fascinating, because there’s differences across demographics, and there’s differences by age, and there’s differences by geography. And it was interesting that according to the REAP score, people living in Southeast Asia—people living with HIV—had the best scores. They had higher scores, which mean better food quality, and especially for specific components that we value in good diet.
Well, here in the United States, we didn’t do as well. And Black or African-American race in high-income areas like ours was associated with a lower REAP score. And, of course, that brings up a whole bunch of issues about access to good food.
In addition, older age was consistently associated with better diet scores; with better quality diet. And interestingly as well, the more alcohol you drank, the lower quality of your diet.
So, you can just read into this—there’s a whole bunch of things: In certain parts of the world, diets are better than they are here. In certain demographic groups, access to good food is part and parcel of what happens in our society, and who has access to nutrition and who doesn’t. And as we get older, we generally get wiser in our decision-making regarding food, and our quality improves. And if we drink less alcohol, we’re likely to eat better.
Putting this all together, I think we see—triangulating between these different studies, which have completely different methods—that controlling the things we need to control that we know helps people without HIV, like keeping your blood pressure from bursting your blood vessels, is really important. We know that if we get better sleep, we probably are going to be healthier, and maybe more so for people living with HIV, who may have more of an inflammatory burden.
And we can always improve our diets, and we do have to do that as well. I think REPRIEVE is making that pretty clear. I wouldn’t be surprised if this comes out to be a major confounder for some of the outcomes that we’re looking at in REPRIEVE, is that diet is going to matter when we start thinking about longer-term outcomes.
So, putting this all together, it’s pretty pragmatic, but I think you have data now where we can really back it up. What we need next is: What’s the interventions that can help people and help providers get people’s blood pressure better? What are the things we need to do to help people have better sleep quality? Kick caffeine and bad sleep habits, especially during COVID. And what about eating, especially during COVID? But even afterwards, how do we make sure that we can help people?
There’s lots of interventions that are out there, but I think we need something a little bit more specific, probably, for people living with HIV.