Higher steps per day and better diet quality associated with lower symptom burden in adults with HIV: results from the PROSPER-HIV study

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Abstract Background and aims People with HIV (PWH) experience a persistent symptom burden that negatively affects quality of life and daily functioning. Evidence examining modifiable lifestyle behaviors that may mitigate symptoms is limited. We examined longitudinal associations between objectively measured physical activity, diet quality, and symptom burden in PWH. Methods PROSPER-HIV enrolled adults with well-controlled HIV receiving care at four Centers for AIDS Research Network of Integrated Clinical Systems sites in the United States. Participants completed annual assessments, including physical activity levels using actigraphy, dietary intake measured with three 24-h recalls generating the Healthy Eating Index-2015 (HEI-2015), and symptom burden with the HIV Symptom Index. Linear mixed models evaluated associations adjusting for age, sex at birth, race/ethnicity, and site. Results Among 704 participants (mean age, 52.7 years; 78% male; 52% non-Hispanic Black), symptom burden remained stable over follow-up. Participants averaged 5426 ± 3149 steps/day, 164 (IQR, 67–311) minutes/week of moderate-to-vigorous physical activity (MVPA), and an HEI-2015 score of 48.1 ± 14.6. The most prevalent bothersome symptoms were muscle aches/joint pain, fatigue, sleep disturbance, anxiety, and trouble remembering. More steps/day were associated with fewer bothersome symptoms (β = −0.59 steps; P < .01), whereas more sedentary time was associated with higher symptom burden (β = 0.64; P < .01). Higher diet quality was associated with lower symptom burden (β = −0.20; P = .01). Duration of MVPA and light physical activity were not associated with symptom burden. Conclusions Among adults with well-controlled HIV, a higher daily step count, less sedentary time, and better diet quality were associated with lower symptom burden, highlighting critical lifestyle behaviors to support symptom management in HIV care. Learning points Among adults with well - controlled HIV, objectively measured higher daily steps and better diet quality, but not weekly moderate - to - vigorous physical activity, were associated with lower symptom burden over three years. Achievable targets to improve persistent, clinically meaningful symptoms in HIV care were identified. Clinical trial registration number ClinicalTrials.gov [NCT03790501].

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