Diet, exercise and cancer screening boosted by 'highly feasible' intervention targeted at HIV serodiscordant couples

Fruit and vegetable consumption and exercise frequency can be increased by participation in a health promotion intervention designed to reduce the risk of chronic diseases, investigators report in the April 25^th edition of the Archives of Internal Medicine.

The research involved African-American HIV-serodiscordant heterosexual couples who were randomised to receive either information and motivation about the benefits of good diet and exercise, or a general HIV/sexual health promotion intervention.

Up to a year after completing the programme, couples participating in the healthy living intervention were significantly more likely to report eating a diet rich in fresh fruit and vegetables and regular exercise.

Moreover, participation in the enhanced health promotion information was associated with the consumption of less fatty food, and increased rates of screening for prostate and breast cancer.

“The present results demonstrate that a health promotion intervention had significant effects on multiple health behaviors in African-American HIV-positive and HIV-negative individuals,” comment the investigators. The author of an accompanying editorial was “particularly impressed with the intervention.”

Chronic conditions such as cardiovascular disease are now an important cause of illness and death in people with HIV. Therefore, addressing modifiable risk factors for such illnesses is now an important priority of HIV care.

African-Americans represent 48% of all HIV-positive patients in the US, and African-Americans generally eat fewer fruit and vegetables, exercise less frequently, and have poorer survival rates for prostate and breast cancer than white Americans.

Investigators therefore wished to see if an intervention could improve a range of health behaviours in HIV-serodiscordant African-American couples enrolled in an HIV/sexual health promotion study.

The study was conducted between 2003 and 2007. The intervention consisted of eight two-hour weekly sessions and was designed to build skills and knowledge about eating lots of fruit and vegetables, exercise, the reduction of fat in diet, screening for prostate and breast cancer, and alcohol use.

A total of 550 individuals were randomised to receive the intervention, and 520 individuals were randomised into a control arm, and received HIV/sexual health information. Outcomes were monitored six and twelve months after completion of the trial.  

At baseline, only 21% of participants overall reported eating five or more portions of fruit and vegetables a day, and fewer than 20% exercised regularly.

Six and twelve months after completing the study, individuals in the intervention arm were 38% more likely than those in the control arm to report having a diet that incorporated large amounts of fruit and vegetables (odds ratio [OR] = 1.38; 95% CI, 1.18-1.62, p < 0.001). Patients in the intervention arm were also significantly less likely to report the consumption of fatty foods (p = 0.003).

They were also 39% more likely to report regular exercise (OR = 1.39; 95% CI, 1.22-1.59, p < 0.001).

Rates of prostate and breast cancer screening were also significantly higher in the intervention arm (p < 0.001 and p = 0.009 respectively).

However, alcohol consumption was comparable in the two arms of the study. The investigators speculate that this was because individuals in the control arm received information about the role of alcohol in HIV risk behaviour.

“We are optimistic that the present study offers an approach that may help reduce the disproportionately high morbidity and mortality rates from chronic diseases in African-Americans,” conclude the authors.

In his accompanying editorial, Dr Mitchell H. Katz of the Los Angeles Department of Health described the intervention as “highly feasible”, adding that although it was conducted in serodiscordant couples, “there is no reason to believe that [the] intervention would not work among HIV-infected persons.”