Document Type



Doctor of Philosophy (PhD)


Dietetics and Nutrition

First Advisor's Name

Adriana Campa

First Advisor's Committee Title

Committee Chair

Second Advisor's Name

Fatma G. Huffman

Second Advisor's Committee Title

committee member

Third Advisor's Name

Marianna Baum

Third Advisor's Committee Title

committee member

Fourth Advisor's Name

Tan Li

Fourth Advisor's Committee Title

committee member


HIV; barriers to healthcare; nutrition counseling; alternate healthy eating index; cardiovascular disease

Date of Defense



The relationship between nutrition and HIV is multifactorial. Nutrition counseling provided by a Registered Dietitian (RD) has the potential for improving disease risk outcomes for PLWH. To determine barriers to access nutritional counseling with an RD in PLWH, and evaluate the relationship of this counseling on dietary intake, nutritional status, cardiovascular disease (CVD), and HIV-disease outcomes.

This is a cross-sectional study of a consecutive convenience sample of 130 PLWH on stable ART from the MASH cohort. After consenting, participants completed a survey on types and frequency of nutritional services received in the last 12 months, and on barriers to access these services. Participants were assigned to groups according to their responses. Demographics, anthropometries, dietary intake, medical history and laboratory information were obtained. The Alternative Healthy Eating Index (AHEI) scores were calculated after obtaining two 24-hour dietary recalls, and Nutribase and SPSS 20 were used for analyses.

Mean age was 47.7 years, 62.0% were male and 77.0% were Black; 48% percent were seeing an RD, with 48.3% of those visiting an RD³4 times within the year. Frequently identified barriers to nutritional services were difficulty in keeping appointments (33.8%) location (24.6%) and lack of referrals (23.8%) by medical personnel. Lack of referral was associated with lower CD4 cell count (r=-0.2, P=0.029). Compared to those who did not visit an RD, participants who did had higher AHEI scores (34.7 vs. 29.2, P < 0.001), lower waist circumference (35.5 vs. 38.5 in., P=0.003), and BMI (26.0 vs. 28.8 kg/m2, P=0.019), with higher proportion of participants within the normal range of BMI (48% vs. 25%, P=0.017). The group consulting an RD had significantly lower risk factors for CVD, with better lipid profiles for all biomarkers, and lower waist circumference (35.5 vs. 38.5 inches, P = 0.003) and systolic blood pressure (114.8 vs. 127.9 mmHg, P < 0.001). Other CVD risk factors such as ART and substance abuse, common in this population, were not significantly different between the groups. Our findings suggest that consulting with an RD is associated with better nutritional status, dietary intake and lower risk factors for CVD.





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