Diet Quality, Food Insecurity and Risk of Cardiovascular Diseases Among Adults Living with Hiv/Aids: A Scoping Review

Diet Quality, Food Insecurity and Risk of Cardiovascular Diseases Among Adults Living with Hiv/Aids: A Scoping Review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review Diet Quality, Food Insecurity and Risk of Cardiovascular Diseases Among Adults Living with Hiv/Aids: A Scoping Review Iyanuoluwa Oyedeji Oyetunji, Yetunde Wasilat Fadipe, Alastair Duncan, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7463524/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 22 Feb, 2026 Read the published version in Discover Public Health → Version 1 posted 4 You are reading this latest preprint version Abstract The introduction of antiretroviral therapy reduced HIV mortality, but was followed by increased comorbidities, including hypertension and dyslipidemia. A higher quality diet can delay the onset of comorbidities related to HIV infection. Diet quality measures are not established among People Living with HIV (PLWH). This review identified the diet quality and food insecurity indices used among PLWH and their associations with risk of cardiovascular diseases (CVD). We used recommendations from Arksey and O’Malley, the Joanna Briggs Institute’s manual, and the Preferred Reporting Items for Systematic review and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. A preliminary search was conducted on MEDLINE to develop a comprehensive search strategy. The final search was conducted on PubMed, EbscoHost, Scopus, Web of Science and COCHRANE library databases, and review conducted by two independent reviewers. Of 1094 retrieved records, 46 passed full text screening. Forty-two were cross-sectional, thirteen in the United States. Seven studies assessed food security; all indicated a high level of food insecurity. One study used the Healthy Eating Index, and six used Mediterranean Diet Score to assess diet quality with varying outcomes. Other studies compared dietary intake with various dietary guidelines. Hypertension, diabetes, obesity, and dyslipidemia were the most reported risk for CVD, with varying degrees of association with diet. Diet quality is not widely explored among PLWH, studies assessing this use heterogenous methods making it difficult to compare and summarize findings. There is evidence of association between diet and CVD among PLWH, but we need standardized methods to study this association. HIV infections diet quality food insecurity cardiovascular diseases Figures Figure 1 Figure 2 KEY MESSAGES What is already known on this topic: The introduction and scale-up of antiretroviral therapy was followed by an increased risk of cardiovascular disease (CVD) among people living with HIV (PLWH). Diet quality is a better measure of dietary adequacy and is associated with risks of CVD. We do not know what is available about diet quality and its measures among PLWH. What this study adds: Few studies conducted among PLWH measure diet quality, and they use varying methods of assessment. This makes it difficult to compare and summarize findings. How this study might affect research, practice and policy: The findings of this review emphasize the need for a standardized method of assessing diet quality among PLWH this will facilitate easier summary of the association between diet and risk of CVD and inform more effective dietary interventions. INTRODUCTION Globally, cardiovascular diseases (CVD) are the leading cause of death, [ 1 , 2 ] with hypertension, diabetes, and dyslipidemia identified as principal risk factors for the development of CVD [ 3 ] . In people living with HIV (PLWH), a three-fold increase in the global burden of HIV-related CVD has been reported over the last two decades. A systematic review concluded that PLWH are twice as likely to develop CVD compared to their HIV-negative counterparts [ 4 ] . This finding could be explained by several contributing factors including the infection itself and its treatment. It is known that the successful introduction and scale-up of effective Highly Active Antiretroviral Therapy (HAART) brought about a reduction in HIV mortality rates, and an ageing cohort of PLWH [ 5 ] . This, however, has been followed by a higher risk of morbidity, and increased prevalence of comorbidities including obesity, hyperglycemia dyslipidemia, hypertension, and other cardiovascular diseases among PLWH [ 6 , 7 ] . Furthermore, certain CVD risk factors such as lipodystrophy, increased central adiposity, insulin resistance, and diabetes have also directly been linked with the use of HAART [ 8 , 9 ] . HIV infection and HAART use have, therefore, been reported to significantly increase the risk for CVD [ 10 , 11 ] . Cardiovascular risks are also affected by other lifestyle factors such as dietary intake, smoking and physical activity [ 12 ] . Similarly, to the general population, lifestyle modification is an essential first step in the management of CVD among PLWH. Dietary interventions have been demonstrated to reduce the risk of CVD among the HIV-uninfected population [ 13 – 16 ] and PLWH [ 14 , 17 ] . However, there is an absence of HIV-specific dietary recommendations for the reduction of CVD risks among PLWH [ 18 ] . Diet Quality Diet quality is a concept that is not clearly defined; no consensus has been reached to have a specific meaning that can be applied in all contexts [ 19 ] . Diet quality indices are generally developed to reflect how much an individual or population’s food consumption conforms to dietary guidelines and recommendations within a context [ 19 ] . Diet quality is being increasingly adopted in nutritional epidemiology surveys to assess dietary patterns and evaluate the effectiveness of a specific dietary intervention. Since a relationship has been established and understood between food and human physiological function, diet quality has also been used as a proxy to predict mortality and risk of chronic diseases [ 20 , 21 ] . Several diet quality indices have been developed and used over the years. Some have been used to evaluate adherence to dietary guidelines while others monitor changes in dietary patterns over time [ 22 ] . Examples of diet quality indices include: Healthy Eating Index (HEI) [ 23 – 25 ] . Mediterranean Diet Score (MDS) [ 26 ] . Diet Quality Index (DQI) [ 27 ] , updated and renamed as Diet Quality Index-International (DQI-I) [ 28 ] . Recommended Food Score (RFS) [ 29 ] . Dietary Diversity Score (DDS), [ 30 ] and Food Variety Score (FVS), [ 31 ] . Dietary Approaches to Stop Hypertension (DASH) [ 32 ] . Dietary Inflammatory Index (DII) [ 33 ] . Poor diet quality increases the risk of mortality and morbidity in the HIV-uninfected population [ 34 ] , Some studies have also evaluated diet quality among PLWH (Weiss et al, 2019, Duran and Jaime, 2009, Henderson, 2013, Kadiyala and Rawat, 2013, Palermo et al, 2013, Sackey et al, 2019, Sackey et al, 2018, Stanner et al, 2019). Researchers from Boston in the United States conducted a cross-sectional study using the HEI tool, and reported that diet quality was lower among PLWH and significantly lower among women living with HIV when compared to HIV-negative controls [ 6 ] . This study did not link results with risk of CVD. Food insecurity Food insecurity is defined as limited availability of and access to sufficient, safe, and nutritious food to support healthy living [ 35 , 36 ] . The Food and Agriculture Organization (FAO), in the most recent report on the state of global food security and nutrition, estimated that 690 million people are hungry, equivalent to 8.9 percent of the world population. The FAO projects that the Covid-19 pandemic will exacerbate global food insecurity through disrupting social and economic systems, potentially resulting in up to an additional 132 million people experiencing undernutrition in 2020 [ 37 ] . Socioeconomic factors such as food insecurity can influence diet quality. Muhammad et al. [ 38 ] reported that 55% of their sample of PLWH in the USA (aged 50 years and older) are food insecure, and that food insecurity was linked to lower diet quality, irrespective of income [ 38 ] . This finding is supported by evidence in the general population, [ 39 ] , and corroborated by the FAO report [ 40 ] . Given the current food security situation and the link with diet quality, we will include studies that assess food security status in our review. Food security has been assessed by several indicators at national, household, and individual levels. Some indicators measure food consumption adequacy while others gather additional information on experiences and behavioural responses [ 41 ] . Food security indicators may include: Food Consumption Score (FCS) [ 42 ] . Household Dietary Diversity Score (HDDS) [ 43 ] . Household Food Security Survey Module (HFSSM) [ 44 ] . Household Food Insecurity Access Scale, [ 35 ] used by the Food and Nutrition Technical Assistance-II (FANTA-II) initiative [ 41 ] . Food Insecurity Experience Scale (FIES) developed by FAO [ 45 ] . The extent to which diet quality and food security status have been assessed in the context of HIV is not known. This scoping review is necessary to aggregate information on the depth of research on diet quality and HIV. Aims The aims of this review include: To determine the diet quality and food security status of PLWH with or at risk of CVD. To identify the range and utility of diet quality and food security indices among PLWH with or at risk of CVD. This introductory section has been previously published in the review protocol [ 46 ] . METHODS AND ANALYSIS The methodology proposed by Arksey and O’Malley, [ 47 ] formed the bedrock for this scoping review. Input from other guidelines [ 48 , 49 ] was also incorporated. The Joanna Briggs Institute (JBI) manual recommends that a protocol stating a stepwise approach to the scoping review be designed and that a set of criteria for including or excluding studies should be determined a priori. These criteria must reflect the aim as well as the questions of the review [ 50 ] . The framework proposed by Arksey and O’Malley consists of six stages of which five are mandatory. The stages are: Identifying a research question Identifying relevant studies Study selection Charting the data Collating, summarizing and reporting the results Consultation exercise (optional). Stage six was omitted as this scoping review was not intended to provide evidence to inform clinical decisions. It however provides an overview of the literature on dietary components related to risks of CVD in PLWH and gives an indication whether the type of data is appropriate for meta-analyses. Given the increased risk of CVD in PLWH, this review also informs how best to assess dietary intake in this cohort. Stage 1: Identifying the review question This review was carried out to map the breadth of research on diet quality, food security, and risk of CVD among PLWH. The primary review question is: What is the current diet quality and food insecurity status of PLWH with or at risk of CVD? The introduction of highly active antiretroviral therapy (HAART) in the late 1990s, [ 51 ] brought a significant change to the health outcomes of PLWH [ 52 ] . The word “current” was included as studies published since 1998 will be considered for the purpose of this scoping review. This time-period has been selected based on the recorded time for the global scale-up of HAART. In addition to the main question this scoping review also sought to answer the following secondary questions: What methodologies have been used to assess the dietary quality and food security of PLWH with or at risk of CVD? Stage 2: Identifying relevant studies We searched the following databases: PubMed, Africa wide, CINAHL, APA Psyc info (via EBSCOhost), Scopus, Web of Science, COCHRANE library, and databases for grey literature such as ProQuest and AHRQ Agency for Healthcare Research and Quality. The inclusion criteria and a table of the preliminary full search strategy had been published [ 46 ] . Stage 3: Study selection After the search, the identified and collated citations were exported into EndNote X9 (Clarivate, Analytics, PA, USA) to remove duplicates. Titles and abstracts were screened independently against the inclusion criteria by two members of the research team on Rayyan QCRI (Copenhagen: The Nordic Cochrane Centre, Cochrane), [ 53 ] . Disagreements were discussed and resolved by consensus. Full text reports of studies were retrieved and screened to verify their conformance with the inclusion criteria. Articles that fail to meet the inclusion criteria here were excluded, and reasons are specified in the results using a Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Review (PRISMA-ScR) flow chart (Fig. 1 ). Stage 4: Charting the data A pre-designed tabulated data extraction tool template was piloted on ten included studies [ 49 ] . Extracted data can be found in the published protocol [ 46 ] . Stage 5: Collating, summarizing and reporting the results Extracted data were thematically described as relevant to the review questions. Meta-analysis of data or qualitative evaluation of included studies was not conducted for this review. This review is intended to give a descriptive overview of diet quality, food insecurity status and risk of CVD of adults living with HIV. A detailed description of the methods was published in the review protocol [ 46 ] . An updated search was conducted up to July 29th, 2025. RESULTS Search results As shown in Figure 1, a total of 1,094 studies were retrieved using the search strategy defined. A search for duplicates, conducted on EndNote, identified 201 duplicate articles, which were subsequently removed. Screening of title and abstract was conducted on Rayyan and COVIDENCE by three independent reviewers – IO, JH, and YWF; 826 articles were excluded based on the defined criteria, yielding 62 articles eligible for full-text review. A total of 46 studies passed the full-text screening. Reasons for excluding 16 studies at the level of full-text screening are a non-dietary method of assessing nutrient levels (eight studies), a prospective study design that compared dietary changes over time (three studies), on-going study (three studies), unavailable full texts (three studies), not published in English language (one study), and unpublished (one study). Characteristics of included studies Study design: Studies included were cross-sectional except for two cohort studies [ 54 , 55 ] , and two trials [ 17 , 56 ] . These studies were, however, included because they reported baseline dietary cross-sectional data. Five studies employed mixed-methods [ 57-61 ] , and seven studies included uninfected controls [ 62-68 ] , other articles included only PLWH. Country of origin: Thirteen of these were from the USA [ 54 , 59 , 62 , 66 , 69-77 ] ; five from Brazil [ 64 , 78-81 ] ; three from each of Croatia [ 65 , 82 , 83 ] and the UK [ 17 , 57 , 84 ] ; two from each of Cambodia [ 85 , 86 ] , Eswatini [ 58 , 87 ] , Nepal [ 60 , 88 ] , and Thailand [ 89 , 90 ] ; and one from each of Australia [ 91 ] , Canada [ 92 ] , Iran [ 93 ] , Ireland [ 67 ] , Kenya [ 68 ] , Malawi [ 94 ] , Malaysia [ 95 ] , Mexico [ 55 ] , Poland [ 96 ] , Portugal [ 63 ] , South Africa [ 97 ] , Spain [ 56 ] , and Uganda [ 98 ] . The final article was from a multinational study, but the first author is from the USA [ 99 ] . Sample: Fourteen studies included both ART-naïve and ART-experienced participants [ 54 , 60 , 63 , 64 , 70 , 71 , 80 , 84-86 , 88 , 89 , 92 , 93 ] . The authors of three studies did not indicate ART usage among the participants [ 73 , 76 , 97 ] . The remaining studies included only ART-experienced participants. The authors of most studies reported age range either as part of the inclusion criteria or results. While some provided only lower limits, generally the reported age ranges were between 15 to 70 years. Eight studies did not have an age range, but only the mean (SD) or median age was shown in their results [ 56 , 59 , 71-73 , 77 , 92 , 99 ] . Quality of Included Studies: Scoping reviews do not require quality appraisal; thus, we did not appraise the quality of included studies. However, the following points may be important to note: the authors of the five studies did not mention obtaining ethical approval from an ethics committee. However, four of these studies referred to a parent study [ 65 , 66 , 71 , 99 ] , while the authors of the fifth study mentioned obtaining informed consent from the participants [ 96 ] . All other studies were approved by an ethics review committee. Findings Diet Quality / Food Security methods used: As shown in Table I, seven studies included a measure of food security [ 59 , 73 , 76 , 77 , 84 , 93 , 97 ] . Of these, two assessed both diet adequacy and food security [ 59 , 97 ] , while the other studies only assessed food security in the context of HIV and NCDs. Food Security: The measures used to assess food security status included the USDA household food security survey (HFSS) [ 59 , 73 ] , a validated household food insecurity access scale [ 93 , 97 ] , 2-item tool derived from the USDA HFSS [ 77 ] , a one-item questionnaire that is not validated [ 76 ] , and an undefined tool [ 84 ] . Dietary Intake Assessment Methods: Dietary intake was measured using a 24-hour recall in 12 studies [ 54 , 57 , 59 , 66 , 75 , 80 , 81 , 88-90 , 95 , 96 ] , FFQ in 11 studies [ 60 , 64 , 65 , 67 , 69 , 74 , 79 , 80 , 82 , 91 , 97 ] , and other studies used food records, nutritional diaries, food protocol in five studies, diet history, WHO STEPwise approach to surveillance, or unvalidated tools. While some studies included repeated 24-hour recall, some only conducted a single measure, and others did not specify. Similarly, some studies used previously validated FFQ while others did not provide this information (Table I). The FFQs consisted of a list of food items ranging from 10 to 150. Food records/nutritional diaries/food protocol were recorded for a range of 3-7 days. Diet history was recorded for the past month. The data from the dietary intake methods were then used to calculate diet quality indices or compared to established standards to report adequacy of dietary intake in most (n=30) studies. Diet Quality Index: One study each assessed diet quality using the Healthy Eating Index (HEI) score [ 75 ] and Healthy Food Diversity Index (HFDI) [ 67 ] , and five studies used the Mediterranean Diet Score (MDS) [ 17 , 56 , 63 , 65 , 74 , 82 , 83 ] . An intervention study did not compute a diet quality score, but included dietary goals based on the Mediterranean and DASH guidelines [ 57 ] . Dietary Adequacy: Macro- and micronutrient intakes were compared with various dietary guidelines in different studies such as country-specific DRIs and EARs. Some studies included questions that assessed intakes of fruits and vegetables, dietary behavior/ habits, animal protein consumption, and the type of cooking oil used, and compared them with the standard. Outcome Food security: The studies that assessed food security status indicated a high level of food insecurity among the participants. However, there was a wide range of prevalence reported, ranging from 22.3% [ 84 ] , 31% [ 73 ] , 36.3% [ 77 ] , 46% [ 76 ] , and 54% [ 59 ] , and 70% [ 97 ] . The final study assessing food security did not report a prevalence [ 93 ] . All included studies reported an association between food insecurity and adverse outcomes. Food insecurity significantly predicted nutrition risk [ 76 ] , was associated with high prevalence of comorbidities [ 73 , 77 , 84 , 97 ] , adversely affected quality of life [ 93 ] . Diet quality: Overall, diet quality was similar among PLWH and uninfected controls, in studies that included controls. Diet quality was associated with reduced risk of comorbidities in some studies. Diet quality, assessed using the Healthy Food Diversity index, was associated with microbiome changes relevant to CVD risk but did not differ among PLWH and un-infected control [ 67 ] . Only 8% of treatment group had a high adherence to mediterranean diet at baseline, adherence improved metabolic parameters [ 56 ] , but this was only sustained for a short-term in an intervention study [ 17 ] . Policarpo and colleagues [ 63 ] also assessed diet quality using the MDS. The authors used tertiles of the score to group participants into low adherence (30 points) out of a total of 55 points. Although the mean score indicated moderate adherence (27.5 ± 5.5 points), most of the recommendations for the individual food items that make up the score were followed by a very small percentage of the participants. The authors identified that increased adherence to MD was associated with some cardiometabolic risk and suspected that participants may have adopted the diet after the onset of comorbidities. Three studies in Croatia [ 83 , 100 , 101 ] also used the MDS to assess the diet quality. The scores were dichotomized to give a range of 0-9 and classified as low adherence if scores <4 or scores 4 and above as moderate to high adherence. A study reported that 67% of the participants had moderate to high adherence to the Mediterranean diet [ 101 ] while another found that PLWH had higher adherence to MDS than the uninfected population with median (range) scores of 5 (3 – 7) and 3 (2 -5) respectively [ 83 ] . No further information concerning adherence to the diet score was reported. Webel and colleagues assessed 105 PLWH and 86 uninfected controls in the US. They assessed diet quality using the HEI which has a maximum score of 100 [ 61 ] . The overall mean (SD) HEI score for all participants was 45.4 (11), this score and the individual diet component score did not significantly differ between groups. Others: Studies that either did not use a pre-defined diet quality index or assess food security status compared intakes of the participants with standards such as Dietary Reference Intakes (DRIs) and NCEP guidelines, while some did not specify this. Most of these studies have similar findings. The most prominent themes emerging from the findings of these studies are high fat and energy intake, low consumption of fruits, vegetables, dietary fiber, and sources of micronutrients. The authors of one of the studies described this as “…a typical high fat, low fiber Western diet with suboptimal intake of many micronutrients…” [ 92 ] . Joy et al., [ 54 ] compared intakes of PLWH with uninfected controls, this study showed that fat consumption was higher, and fiber lower among PLWH compared to the controls. Some studies also compared intakes by gender; the authors of two studies reported that energy intake was higher among men than women. Fat: Generally, high consumption of total fat, energy from fat, cholesterol, saturated, and trans-fat was reported [ 62 , 64 , 69 , 71 , 72 , 92 , 96 ] . While consumption of essential fat was reported low. Overall, almost all the studies assessing dietary intake showed that fat recommendations were not met by the participants. Proteins: Some studies had protein intake in their results. Jackiewicz et al [ 96 ] reported that PLWH in Poland consumed more meat than fish which consequently increased their saturated fat intake. Leite and Sampaio [ 80 ] assessed dietary calcium and dairy food intake among PLWH in Brazil. Although they reported that milk was the most important dairy product consumed, only 56% consumed up to 1-2 servings per day. Tsiodras et al [ 74 ] compared protein intakes of PLWH and fat redistribution (FR) with PLWH without FR. They reported that the group with FR consumed more protein and red meat products than the group without. They, however, did not report the quantity of intake for any group. Upreti [ 60 ] reported contrary finding in their Nepali study; they reported that the participants typically eat a plant-based diet and have low intakes of animal products. Micronutrients: Authors of all studies with micronutrient intake information reported low intakes, except for Sodium [ 64 ] and vitamin C [ 60 ] . Specific nutrients mentioned having low intake levels were Calcium [ 80 ] , B-vitamins [ 88 ] , Iron [ 60 ] , Magnesium, Vitamins A and E [ 92 ] . A study showed that Vitamin C intake was satisfactory [ 60 ] , while two studies revealed a high intake of sodium among the participants [ 64 , 92 ] . Arendt and colleagues [ 92 ] specifically reported that diet alone did not meet the micronutrient requirement of PLWH. Others: Other dietary components mentioned are fiber; fruits and vegetables; alcohol; sweet drinks, snacks, and added sugars. All the studies that assessed fiber [ 62 , 70 , 72 , 92 ] , fruits, and vegetables [ 86 , 94 ] recorded a low intake among the participants. One study showed a lower intake of alcohol by PLWH than in control but did not quantify the intake [ 54 ] . Finally, some studies included the intake of sweet drinks, snacks, and added sugars [ 78 , 96 ] . Jackiewicz and colleagues reported a high intake of this among their study participants. Risk of CVD reported: Thirty-seven studies included one or more risks of CVD in their report. As shown in Table II, the risks of CVD reported are lipodystrophy/fat redistribution (five studies), obesity/overweight (10 studies), central obesity (five studies), hypertension (15 studies), dyslipidemia (10 studies), insulin resistance/hyperglycemia/diabetes (11 studies), metabolic syndrome (six studies), 10-year risk estimation using the Framingham scale (three studies), and 1 study for established CVD. A study [ 94 ] highlighted that CVD risks were more common among PLWH on long-term ART while Turcinov and Begovac [82] showed that metabolic syndrome was more frequent in females than in males. It is important to note that nine studies recruited the participants based on the presence of the risk of CVD of their interest [ 54 , 62 , 70 , 91 , 92 , 102 ] . The findings of these studies might not be representative, so the CVD data were not included in the summary. However, we included these studies in our review because of our primary outcome of interest – diet quality. Similarly, as mentioned above, some studies recruited some HIV uninfected participants [ 54 , 73 , 75 , 83 ] . Notably, two studies assessed gut microbiome/microbiota [ 56 , 67 ] . Table II shows the ranges of the prevalence of each risk, the number of studies from which the ranges were generated, and the reported association with diet. Lipodystrophy: Studies reporting all forms of fat redistribution among PLWH were included. Obesity/overweight: Studies estimating BMI categories were included. One study reported a prevalence of underweight at 29% [ 60 ] . Central obesity: Studies estimating Waist or abdominal circumference, as well as waist-to-hip ratio, were included Hypertension: Studies reporting high values of systolic, diastolic, or both pressures. DISCUSSION This scoping review aimed to determine the diet quality and food security status of PLWH with or at risk of CVD and to identify the range and utility of diet quality and food security indices among PLWH with or at risk of CVD. Generally, the diet quality of PLWH is suboptimal, there is a high prevalence of CVD risk among the population, and there is evidence of an association between diet and the risk of CVD. The higher risk of CVD among PLWH [ 4 ] , and the possibility of dietary intervention reducing this risk [ 15 ] emphasize the need for research evidence among PLWH. The use of a wide range of methodologies to assess dietary adequacy and food insecurity made it very difficult to aggregate the findings of the included studies. Dietary intake was assessed using several methods and compared with different quality standards based on the objectives of each study. Some authors failed to adequately describe their method of dietary assessment in a replicable manner. This is a challenge frequently encountered in studies involving dietary assessment among uninfected population [ 103 ] , thus our findings emphasize the need for authors to use validated tools for dietary assessment and include a comprehensive description of how the tool was used in their study [ 104 ] . Despite the high level of heterogeneity in the included studies, similar themes regarding food insecurity and dietary intake were reported. Food insecurity level was high and dietary quality ranged from low to medium adherence to quality standards. Notably, the South African study reported household food insecurity as high as 70% among their adolescent participants [ 97 ] . Even when diet quality had overall medium adherence to quality standards, adherence to the recommendation of individual food items was generally low. Few studies compared the diet adequacy of PLWH with uninfected controls, and mixed findings emerged. While some studies reported no significant differences in the diet of the two groups, others reported a lower diet quality for PLWH. Overall, results from included study reflect poor food security, moderate adherence to diet quality indices recommendations (MDS, HEI, and HFDI), and poor adherence to DRIs and other guidelines. This finding underscores the importance of continued nutritional screening and intervention among PLWH. We recommend that this be integrated into primary health care systems that are in contact with PLWH. Diet quality assessment using a predefined diet quality index, which is the primary outcome of this review, was reported in eight studies, representing only about 17% of included studies. In contrast, studies among the general population have shifted more from nutrient assessment towards assessing overall dietary pattern [ 105 ] . Overall dietary pattern or consumption of food groups better reflects the dietary quality and is a more efficient way of assessing the association that may exist between diet and chronic diseases [ 27 , 106 ] . We recommend that researchers employ the use of these diet quality indices to assess the dietary adequacy of PLWH when possible. This will also facilitate easy comparison between studies and highlight the need for nutritional intervention in a specific population. Globally, CVD has been identified as the leading cause of mortality [ 2 ] . The most reported comorbidity, and risk for CVD, in the included studies were hypertension and diabetes, followed by obesity and dyslipidemia. Similar findings have been reported in studies among PLWH [ 107 , 108 ] , and the general population [ 109 ] . As the global prevalence of hypertension and other risks of CVD continues to rise, [ 110 ] there is need for continued screening and monitoring, especially among PLWH as they continue to live longer and potentially face a higher risk [ 111 ] . The association between diet and the risks of CVD reported in the included studies is complex. Most studies had findings suggesting that a diet that adheres to the quality standard used in the study may reduce the risk of CVD [ 69 , 71 , 74 , 78 , 80 , 83 , 85 , 90 , 95 ] . While a few had findings that suggested no association between diet and risk of CVD [ 63 , 82 ] , others did not report any association between diet and the risk of CVD. We opine that this variation in the association between the risk of CVD and diet may be largely due to the heterogeneity in methodology and possibly in the study population. Additionally, this may be because the articles included in this scoping review were cross-sectional, observational study which is prone to confounding. This is especially true as previous dietary interventions have been shown to reduce the risk of CVD among PLWH (Lazzaretti et al., 2012, Stradling et al., 2021). Again, we recommend that researchers use a standardized method of dietary assessment within their context, and report overall dietary patterns with reference to the risk of CVD when possible. CONCLUSIONS PLWH continue to be at nutritional risk and complication which necessitates nutritional screening and intervention [ 76 ] . While being affected by food insecurity, the diet quality of PLWH has medium adherence to recommendations. More standardized methods of dietary assessment should be employed by researchers to facilitate easy comparison. The treatment outcome of PLWH may be strongly affected by the dietary intervention [ 96 ] . Therefore, it is important to include a dietitian in the treatment continuum of PLWH, especially at the PHC level. Declarations Ethics Approval and Consent to Participate: The review did not require any generation of primary data; all documents will be retrieved from the public domain. This review, therefore, did not require ethical approval. It forms part of a dissertation towards a Master of Medical Science in Nutrition (MMedSci Nutrition), which was completed in 2022. This protocol is registered on Open Science Framework (OSF) with registration number: https://osf.io/7k3ja and published in Oyetunji et al., (2021) Consent for Publication: NA Funding: The Mastercard Foundation Scholars Program funded the degree of IOO. This work does not reflect the views of the funder, but the views of the authors based on research findings. Author Contribution IOO, JH, and AD were involved in the conceptualization of the scoping review protocol. YWF was involved in additional screening of studies, review, and extraction of data. IOO led the process and wrote the manuscript under the supervision of JH and AD. All authors reviewed and approved the publication of the scoping review findings. Acknowledgement The authors acknowledge and appreciate the effort of Namhla Madini of the Bongani Mayosi Health Sciences Library, University of Cape Town, for the assistance she provided with the preliminary search and development of the search strategy. Availability of Data and Materials: NA Contribution : IOO, JH, and AD were involved in the conceptualization of the scoping review protocol. YWF was involved in additional screening of studies, review, and extraction of data. IOO led the process and wrote the manuscript under the supervision of JH and AD. All authors reviewed and approved the publication of the scoping review findings. Competing Interest : The authors have no competing interests to declare that are relevant to the content of this article. Clinical Trial Number : NA References World Health Organization. Hypertension. 2020/06/10, 2020. Accessed 2020/06/10, 2020. https://www.who.int/news-room/fact-sheets/detail/hypertension Naghavi M, Abajobir AA, Abbafati C, et al. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet . 2017;390(10100):1151-1210. doi:10.1016/S0140-6736(17)32152-9 World Health Organization. Cardiovascular diseases. 2020/06/10, 2020. Accessed 2020/06/10, 2020. https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds) Shah AS, Stelzle D, Lee KK, et al. Global burden of atherosclerotic cardiovascular disease in people living with HIV: systematic review and meta-analysis. Circulation . 2018;138(11):1100-1112. Mutevedzi PC, Newell M-L. The changing face of the HIV epidemic in sub-Saharan Africa.(Report). Tropical Medicine and International Health . 2014;19(9):1015. doi:10.1111/tmi.12344 Weiss JJ, Sanchez L, Hubbard J, Lo J, Grinspoon SK, Fitch KV. Diet quality is low and differs by sex in people with HIV. The Journal of nutrition . 2019;149(1):78-87. Rasmussen LD, May MT, Kronborg G, et al. Time trends for risk of severe age-related diseases in individuals with and without HIV infection in Denmark: a nationwide population-based cohort study. The Lancet HIV . 2015;2(7):e288-e298. doi:10.1016/S2352-3018(15)00077-6 Bozkurt B. Cardiovascular toxicity with highly active antiretroviral therapy. Cardiovascular Toxicology . 2004;4(3):243-60. doi:10.1385/CT:4:3:243 Rawdanowicz J, Pikto-Pietkiewicz W, Marczynska M. Cardiovascular diseases associated with HIV infection and their management. Kardiologia Polska . 2013;71(11):1183-1187. doi:10.5603/KP.2013.0301 Nou KE, Lo KJ, Grinspoon KS. Inflammation, immune activation, and cardiovascular disease in HIV. AIDS . 2016;30(10)doi:10.1097/QAD.0000000000001109 Nduka C, Sarki A, Uthman O, Stranges S. Impact of antiretroviral therapy on serum lipoprotein levels and dyslipidemias: A systematic review and meta-analysis. Article. Int J Cardiol . 2015;199:307-318. doi:10.1016/j.ijcard.2015.07.052 Claudia Daniele Tavares D, Anny Karulinny Mesquita M, Daniele Almeida S, et al. RISK FACTORS FOR CARDIOVASCULAR DISEASES IN PATIENTS WITH HIV LIPODYSTROPHIC SYNDROME. Revista Gestão & saúde (Brasília) . 2012;3(3):836-851. Estruch R, Ros E, Salas-Salvadó J, et al. Primary Prevention of Cardiovascular Disease with a Mediterranean Diet Supplemented with Extra-Virgin Olive Oil or Nuts. New England Journal of Medicine . 2018;378(25):e34. doi:10.1056/NEJMoa1800389 Lazzaretti RK, Kuhmmer R, Sprinz E, Polanczyk CA, Ribeiro JP. Dietary intervention prevents dyslipidemia associated with highly active antiretroviral therapy in human immunodeficiency virus type 1–infected individuals: a randomized trial. Journal of the American College of Cardiology . 2012;59(11):979-988. Stradling C, Thomas G, Hemming K, et al. The Mediterranean portfolio diet in HIV dyslipidaemia: a randomized controlled trial. Topics in Antiviral Medicine . 2018;26:306s. Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology . 2019;73(24):3168-3209. Stradling C, Thomas GN, Hemming K, Taylor S, Taheri S. Randomized parallel-group pilot trial (Best foods for your heart) comparing the effects of a Mediterranean Portfolio diet with a low saturated fat diet on HIV dyslipidemia. Clinical Nutrition . 2021;40(3):860-869. Feinstein MJ, Hsue PY, Benjamin LA, et al. Characteristics, Prevention, and Management of Cardiovascular Disease in People Living With HIV: A Scientific Statement From the American Heart Association. Circulation (New York, NY) . 2019;140(2):e98-e124. doi:10.1161/cir.0000000000000695 Drewnowski A, Henderson SA, Shore A, Fischler C, Preziosi P, Hercberg S. Diet Quality and Dietary Diversity in France: Implications for the French Paradox. Journal of the American Dietetic Association . 1996;96(7):663-669. doi:10.1016/S0002-8223(96)00185-X Alkerwi Aa. Diet quality concept. Nutrition . 2014/06/01/ 2013;30(6):613-618. doi:https://doi.org/10.1016/j.nut.2013.10.001 Miller V, Webb P, Micha R, Mozaffarian D. Defining diet quality: a synthesis of dietary quality metrics and their validity for the double burden of malnutrition. The Lancet Planetary Health . 2020/08/01/ 2020;4(8):e352-e370. doi:https://doi.org/10.1016/S2542-5196(20)30162-5 Fransen PH, Ocké CM. Indices of diet quality. Current Opinion in Clinical Nutrition and Metabolic Care . 2008;11(5):559-565. doi:10.1097/MCO.0b013e32830a49db Reedy J, Lerman JL, Krebs-Smith SM, et al. Evaluation of the Healthy Eating Index-2015. Journal of the Academy of Nutrition and Dietetics . 2018;118(9):1622-1633. doi:10.1016/j.jand.2018.05.019 Guenther P, Kirkpatrick S, Reedy J, et al. The Healthy Eating Index-2010 Is a Valid and Reliable Measure of Diet Quality According to the 2010 Dietary Guidelines for Americans1-3. The Journal of Nutrition . 2014;144(3):399-407. doi:10.3945/jn.113.183079 Krebs-Smith SM, Pannucci TE, Subar AF, et al. Update of the Healthy Eating Index: HEI-2015. Journal of the Academy of Nutrition and Dietetics . 2018;118(9):1591-1602. doi:10.1016/j.jand.2018.05.021 Trichopoulou A, Kouris-Blazos A, Wahlqvist ML, et al. Diet And Overall Survival In Elderly People. BMJ: British Medical Journal . 1995;311(7018):1457-1460. Patterson RE, Haines PS, Popkin BM. Diet quality index: Capturing a multidimensional behavior. Journal of the American Dietetic Association . 1994;94(1):57-64. doi:10.1016/0002-8223(94)92042-7 Kim S, Haines PS, Siega-Riz AM, Popkin BM. The Diet Quality Index-International (DQI-I) provides an effective tool for cross-national comparison of diet quality as illustrated by China and the United States. The Journal of nutrition . 2003;133(11):3476-3484. Bhattacharjee NV, Schumacher AE, Aali A, et al. Global fertility in 204 countries and territories, 1950–2021, with forecasts to 2100: a comprehensive demographic analysis for the Global Burden of Disease Study 2021. Article. The Lancet . 2024;403(10440):2057-2099. doi:10.1016/S0140-6736(24)00550-6 Jayawardena R, Byrne N, Soares M, Katulanda P, Yadav B, Hills AP. High dietary diversity is associated with obesity in Sri Lankan adults: an evaluation of three dietary scores. Bmc Public Health . 2013;13doi:10.1186/1471-2458-13-314 Hatløy A, Torheim LE, Oshaug A. Food variety--a good indicator of nutritional adequacy of the diet? A case study from an urban area in Mali, West Africa. European journal of clinical nutrition . 1998;52(12):891. doi:10.1038/sj.ejcn.1600662 Fung T, Chiuve S, McCullough M, Rexrode K, Logroscino G, Hu F. Adherence to a DASH-Style diet and risk of coronary heart disease and stroke in women. Archives Of Internal Medicine . 2008;168(7):713-720. Shivappa N, Steck SE, Hurley TG, et al. A population-based dietary inflammatory index predicts levels of C-reactive protein in the Seasonal Variation of Blood Cholesterol Study (SEASONS). 2014;17(8):1825-1833. doi:10.1017/S1368980013002565 Olstad D, Campbell N, Raine K. Diet quality in Canada: policy solutions for equity. Canadian Medical Association Journal . 2019;191(4):E100-E102. doi:10.1503/cmaj.180938 Eaton LA, Cain DN, Pitpitan EV, et al. Exploring the relationships among food insecurity, alcohol use, and sexual risk taking among men and women living in South African townships. The Journal of Primary Prevention . 2014;35(4):255-265. doi:10.1007/s10935-014-0346-3 Goosen A, Venter D, Beeforth M, et al. Food insecurity among students living with HIV: Strengthening safety nets at the Nelson Mandela Metropolitan University, South Africa. Sahara Journal of the Social Aspects of HIV/AIDS . 01/01/ 2016;13(1):106-111. FAO, IFAD, UNICEF, WFP, WHO. The State of Food Security and NUtrition in the World 2020 . The State of Food Security and NUtrition in the World (SOFI). FAO, IFAD, UNICEF, WFP, WHO; 2020:320. Muhammad J, Fernandez J, Clay O, Saag M, Overton E, Willig A. Associations of food insecurity and psychosocial measures with diet quality in adults aging with HIV. AIDS care . 2019;31(5):554-562. Hanson K, Connor L. Food insecurity and dietary quality in US adults and children: a systematic review. American Journal Of Clinical Nutrition . 2014;100(2):684-692. doi:10.3945/ajcn.114.084525 Henderson C. Study Results from International Food Policy Research Institute Provide New Insights into Public Health (Food access and diet quality independently predict nutritional status among people living with HIV in Uganda). AIDS Weekly . 2013:a70. Cafiero C, Melgar‐Quiñonez HR, Ballard TJ, Kepple AW. Validity and reliability of food security measures. Annals of the New York Academy of Sciences . 2014;1331(1):230-248. doi:10.1111/nyas.12594 Programme WF. Food consumption analysis: Calculation and use of the food consumption score in food security analysis. World Food Programme Rome, Italy; 2008. Swindale A, Bilinsky P. Household dietary diversity score (HDDS) for measurement of household food access: indicator guide. Washington, DC: Food and Nutrition Technical Assistance Project, Academy for Educational Development . 2006; Bickel G, Nord M, Price C, Hamilton W, Cook J. Guide to measuring household food security. Revised; 2000. Ahmadi D, Melgar-Quiñonez H. Use of the Food Insecurity Experience Scale to assess food security status in Ireland, 2014–17: a cross-sectional analysis. The Lancet . 2018;392:S16-S16. doi:10.1016/S0140-6736(18)32868-X Oyetunji IO, Duncan A, Booley S, Harbron J. Diet quality, food insecurity and risk of cardiovascular diseases among adults living with HIV/AIDS: a scoping review protocol. BMJ Open . Oct 12 2021;11(10):e047314. doi:10.1136/bmjopen-2020-047314 Arksey H, O'Malley L. Scoping studies: towards a methodological framework. International Journal of Social Research Methodology . 2005;8(1):19-32. doi:10.1080/1364557032000119616 Levac D, Colquhoun H, O'Brien KK. Scoping studies: advancing the methodology. Implementation science . 2010;5(1):69. Peters MD, Godfrey C, McInerney P, Baldini Soares C, Khalil H, Parker D. Chapter 11: scoping reviews. Joanna Briggs Institute Reviewer's Manual The Joanna Briggs Institute . 2017; Oduwole EO, Pienaar ED, Mahomed H, Wiysonge CS. Current tools available for investigating vaccine hesitancy: a scoping review protocol. BMJ Open . 2019;9(12)doi:10.1136/bmjopen-2019-033245 Pau AK, George JM. Antiretroviral Therapy. Infectious Disease Clinics of North America . 2014;28(3):371-402. doi:10.1016/j.idc.2014.06.001 Weldehaweria NB, Abreha EH, Weldu MG, Misgina KH. Psychosocial correlates of nutritional status among people living with HIV on antiretroviral therapy: A matched case-control study in Central zone of Tigray, Northern Ethiopia. Article. PLoS ONE . 2017;12(3)e0174082. doi:10.1371/journal.pone.0174082 Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan — a web and mobile app for systematic reviews. Systematic Reviews . 2016;(5):210. doi:10.1186/s13643-016-0384-4 Joy T, Keogh HM, Hadigan C, et al. Dietary fat intake and relationship to serum lipid levels in HIV-infected patients with metabolic abnormalities in the HAART era. Aids . Jul-31 2007;21(12):1591-600. Osuna-Padilla IA, Briceño O, Aguilar-Vargas A, et al. Zinc and selenium indicators and their relation to immunologic and metabolic parameters in male patients with human immunodeficiency virus. Nutrition . 2020/02/01/ 2020;70:110585. doi:https://doi.org/10.1016/j.nut.2019.110585 Pastor-Ibáñez R, Blanco-Heredia J, Etcheverry F, et al. Adherence to a Supplemented Mediterranean Diet Drives Changes in the Gut Microbiota of HIV-1-Infected Individuals. Nutrients . Mar 30 2021;13(4)doi:10.3390/nu13041141 Duncan AD, Peters BS, Rivas C, Goff L. Reducing risk of type 2 diabetes in HIV: a mixed‐methods investigation of the STOP‐diabetes diet and physical activity intervention. Diabetic Medicine . 2020;37(10):1705-1714. Harris TG, Flören S, Mantell JE, et al. HIV and aging among adults aged 50 years and older on antiretroviral therapy in Eswatini. Afr J AIDS Res . Mar 2021;20(1):107-115. doi:10.2989/16085906.2021.1887301 Noble CA. Least of My Worries: Food Security, Diet Quality, and Antiretroviral Adherence among People Living with HIV . University of South Florida; 2019. Upreti D. Diet and nutritional assessment of people living with HIV/AIDS in Nepal (Kathmandu Valley and Terai Highway) . University of Aberdeen; 2014. Webel A, Davey CH, Schexnayder J, et al. Impact of perceived cardiovascular risk on cardiovascular disease prevention behaviors in people with and without HIV infection. JAIDS Journal of Acquired Immune Deficiency Syndromes . 2020;83(5):513-521. Capili B, Anastasi JK. Body mass index and nutritional intake in patients with HIV and chronic diarrhea: A secondary analysis. Journal of the American Academy of Nurse Practitioners . 2008 2008;20(9):463-470. Policarpo S, Rodrigues T, Moreira AC, Valadas E. Adherence to Mediterranean diet in HIV infected patients: Relation with nutritional status and cardiovascular risk. Clin Nutr ESPEN . Apr 2017;18:31-36. Silva EF, Lewi DS, Vedovato GM, Garcia VR, Tenore SB, Bassichetto KC. Nutritional and clinical status, and dietary patterns of people living with HIV/AIDS in ambulatory care in Sao Paulo, Brazil. Rev Bras Epidemiol . Dec 2010;13(4):677-88. Turcinov D, Stanley C, Canchola JA, Rutherford GW, Novotny TE, Begovac J. Dyslipidemia and adherence to the Mediterranean diet in Croatian HIV-infected patients during the first year of highly active antiretroviral therapy. Coll Antropol . Jun 2009;33(2):423-30. Fletcher AA, Durieux JC, Bederman I, et al. Associations of Plasma Erythritol with Dietary Factors, Cardiometabolic, Inflammatory, and Gut Health Markers in People with and without HIV: A Cross-Sectional Study. Nutrients . 2024;16(20):3449. MacCann R, Li J, Leon AAG, et al. Associations between the gut microbiome, inflammation, and cardiovascular profiles in people with human immunodeficiency virus. The Journal of Infectious Diseases . 2025;231(4):e781-e791. Tilahun H, Masyuko SJ, Mogaka JN, et al. Prevalence and correlates of dyslipidemia in HIV positive and negative adults in Western Kenya: a cross-sectional study. Medicine . 2021;100(10):e24800. Gavrila A, Tsiodras S, Doweiko J, et al. Exercise and vitamin E intake are independently associated with metabolic abnormalities in human immunodeficiency virus-positive subjects: a cross-sectional study. Clin Infect Dis . Jun-15 2003;36(12):1593-601. Hadigan C, Jeste S, Anderson EJ, Tsay R, Cyr H, Grinspoon S. Modifiable dietary habits and their relation to metabolic abnormalities in men and women with human immunodeficiency virus infection and fat redistribution. Clin Infect Dis . Sep-1 2001;33(5):710-7. Hendricks KM, Jones CY, Hendricks KM, Houser R, Hendricks KM, Willis K. Obesity in HIV-Infection: Dietary Correlates. Journal of the American College of Nutrition . 2006 2006;25(4):321-331. Shah M, Tierney K, Adams-Huet B, et al. The role of diet, exercise and smoking in dyslipidaemia in HIV-infected patients with lipodystrophy. HIV Med . Jul 2005;6(4):291-8. Sirotin N, Hoover DR, Shi Q, Anastos K, Weiser SD. Food insecurity with hunger is associated with obesity among HIV-infected and at risk women in Bronx, NY. PLoS One . 2014 2014;9(8):e105957. Tsiodras S, Poulia KA, Yannakoulia M, et al. Adherence to Mediterranean diet is favorably associated with metabolic parameters in HIV-positive patients with the highly active antiretroviral therapy-induced metabolic syndrome and lipodystrophy. Metabolism . Jun 2009;58(6):854-9. Webel A, Horvat Davey C, Schexnayder J, et al. Impact of Perceived Cardiovascular Risk on Cardiovascular Disease Prevention Behaviors in People With and Without HIV Infection. Journal of acquired immune deficiency syndromes (1999) . 2020 2020;83(5):513-521. Wright L, Epps JB. Nutrition Risk and Complications in HIV/AIDS. Topics in Clinical Nutrition . 2014 2014;29(4):288-293. Valerio LA, Rzepka MC, Davy-Mendez T, et al. Food Insecurity Prevalence and Risk Factors among Persons with HIV in a Southeastern US Clinical Care Setting. AIDS and Behavior . 2025;29(1):45-54. da Cunha GH, Franco KB, Galvão MTG, et al. Diabetes mellitus in people living with HIV/AIDS: prevalence and associated risk factors. AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV . 2020 2020;32(5):600-607. da Silva TA, Barboza RR, de Andrade RD, et al. Relationship between dietary intake and use of protease inhibitors with anthropometric and biochemical parameters of lipodystrophy in people living with hiv. Nutr Hosp . Oct-1 2014;30(4):935-40. Leite LH, Sampaio AB. Dietary calcium, dairy food intake and metabolic abnormalities in HIV-infected individuals. J Hum Nutr Diet . Oct 2010;23(5):535-43. Vercesi BF, Moscardini IS, Esteves GP, Beraldo RA. Patients living with HIV have quantitatively inadequate food consumption. Archives of Endocrinology and Metabolism . 2023;67(5):e000623. Turcinov D, Begovac J. Predicted coronary heart disease risk in croatian HIV infected patients treated with combination antiretroviral therapy. Coll Antropol . Mar 2011;35(1):115-21. Višković K, Rutherford GW, Stemberger L, Brnić Z, Begovac J. Ultrasound measurements of carotid intima-media thickness and plaque in HIV-infected patients on the Mediterranean diet. Croatian medical journal . 2013;54(4):330-338. Dominguez-Dominguez L, Campbell L, Barbini B, et al. Associations between social determinants of health and comorbidity and multimorbidity in people of black ethnicities with HIV. AIDS . 2024;38(6) Chhoun P, Tuot S, Harries AD, et al. High prevalence of non-communicable diseases and associated risk factors amongst adults living with HIV in Cambodia. PLoS ONE . 2017 2017;12(11) ChhounPheak, Ngin C, Tuot S, et al. Non-communicable diseases and related risk behaviors among men and women living with HIV in Cambodia: findings from a cross-sectional study. International journal for equity in health . 01-01 2017;16(1):125-125. Dye CK, Wu H, Jackson GL, et al. Epigenetic aging in older people living with HIV in Eswatini: a pilot study of HIV and lifestyle factors and epigenetic aging. Clinical Epigenetics . 2024;16(1):32. Poudel-T, ukar K. Dietary B vitamins and depression in persons with human immunodeficiency virus infection: The positive living with HIV (POLH) study. Journal of Nutritional Science and Vitaminology . 2016 2016;62(6):388-396. Jantarapakde J, Phanuphak N, Chaturawit C, et al. Prevalence of metabolic syndrome among antiretroviral-naive and antiretroviral-experienced HIV-1 infected Thai adults. AIDS Patient Care STDS . Jul 2014;28(7):331-40. Pongthananikorn S, Jantarathaneewat K, Somnikha P, Jaturapullarp S, Meksawan K. Prevalence and Risk Factors of Metabolic Syndrome in HIV-Infected Patients Receiving the Highly Active Antiretroviral Therapy. Topics in Clinical Nutrition . Jan-Mar 2018;33(1):41-49. Samaras K, H, Law M, Emery S, Cooper DA, Carr A. Dietary intake in HIV-infected men with lipodystrophy: Relationships with body composition, visceral fat, lipid, glucose and adipokine metabolism. Current HIV Research . 2009 2009;7(4):456-461. Arendt BM, Aghdassi E, Mohammed SS, et al. Dietary intake and physical activity in a Canadian population sample of male patients with HIV infection and metabolic abnormalities. Curr HIV Res . Jan 2008;6(1):82-90. Foroozanfar Z, Hooshyar D, Joulaei H. Psychosocial predictors of quality of life among women living with HIV/AIDS: a cross-sectional study in a VCT centre in Shiraz, Iran. Quality of Life Research . 2024;33(4):1063-1073. Muronya W, Sanga E, Talama G, Kumwenda JJ, Van Oosterhout JJ. Cardiovascular risk factors in adult Malawians on long-term antiretroviral therapy. Transactions of the Royal Society of Tropical Medicine and Hygiene . 2011 2011;105(11):644-649. Hejazi N, Huang MS, Lin KG, Choong LC. Hypertension among HIV-infected adults receiving highly active antiretroviral therapy (HAART) in Malaysia. Glob J Health Sci . Dec-1 2013;6(2):58-71. Jackiewicz A, Czarnecki M, Przeliorz-Pyszczek A, Knysz B. Effect of fatty acid content in the diet on lipid profile in HIV-infected patients treated with antiretroviral drugs. Hiv & Aids Review . 2019 2019;18(1):25-32. Kamkuemah M, Gausi B, Oni T. High prevalence of multimorbidity and non-communicable disease risk factors in South African adolescents and youth living with HIV: Implications for integrated prevention. South African Medical Journal . 2022;112(4):259-267. Kazooba P, Kasamba I, Mayanja BN, et al. Cardiometabolic risk among HIV-POSITIVE Ugandan adults: prevalence, predictors and effect of long-term antiretroviral therapy. The Pan African medical journal . 01-01 2017;27(1):40-40. Fitch KV, McCallum SA, Erlandson KM, et al. Diet in a global cohort of adults with HIV at low-to-moderate traditional cardiovascular disease risk. Aids . 2022;36(14):1997-2003. Turčinov D, Begovac J. Predicted coronary heart disease risk in croatian HIV infected patients treated with combination antiretroviral therapy. Collegium antropologicum . 2011;35(1):115-121. Turčinov D, Stanley C, Canchola JA, Rutherford GW, Novotny TE, Begovac J. Dyslipidemia and adherence to the Mediterranean diet in Croatian HIV-infected patients during the first year of highly active antiretroviral therapy. Collegium antropologicum . 2009;33(2):423-430. Kassebaum NJ, Arora M, Barber RM, et al. Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Article. The Lancet . 2016;388(10053):1603-1658. doi:10.1016/S0140-6736(16)31460-X Hutchinson JM, Raffoul A, Pepetone A, et al. Advances in methods for characterising dietary patterns: a scoping review. British Journal of Nutrition . 2024:1-15. Clarke ED, Ferguson JJ, Stanford J, Collins CE. Dietary assessment and metabolomic methodologies in human feeding studies: a scoping review. Advances in Nutrition . 2023;14(6):1453-1465. Chan VWK, Gebretsadik GG, Panchal P, et al. Evolving Research Focus on Diet and Cardiovascular Disease: A Systematic Review of 298 Cohort Studies Published from 2019 to 2024. Nutrients . 2025;17(13):2126. Coulston AM. The search continues for a tool to evaluate dietary quality. The American journal of clinical nutrition . 2001;74(4):417. doi:10.1093/ajcn/74.4.417 Paudel M, Prajapati G, Buysman EK, et al. Comorbidity and comedication burden among people living with HIV in the United States. Curr Med Res Opin . Aug 2022;38(8):1443-1450. doi:10.1080/03007995.2022.2088714 Webel AR, Schexnayder J, Cioe PA, Zuñiga JA. A Review of Chronic Comorbidities in Adults Living With HIV: State of the Science. J Assoc Nurses AIDS Care . May-Jun 01 2021;32(3):322-346. doi:10.1097/jnc.0000000000000240 Chowdhury SR, Das DC, Sunna TC, Beyene J, Hossain A. Global and regional prevalence of multimorbidity in the adult population in community settings: a systematic review and meta-analysis. EClinicalMedicine . 2023;57 Mills KT, Bundy JD, Kelly TN, et al. Global Disparities of Hypertension Prevalence and Control: A Systematic Analysis of Population-Based Studies From 90 Countries. Circulation . Aug 9 2016;134(6):441-50. doi:10.1161/circulationaha.115.018912 Gutierrez J, Albuquerque ALA, Falzon L. HIV infection as vascular risk: a systematic review of the literature and meta-analysis. PloS one . 2017;12(5):e0176686. Tables Tables 1 and 2 are available in the Supplementary Files section. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7463524","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":508042386,"identity":"8d97c576-0e67-49a5-97cc-e10ff58edf39","order_by":0,"name":"Iyanuoluwa Oyedeji Oyetunji","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA70lEQVRIie2PsQrCMBCGTwKtQ7BriqCvEClEpOCzCAVd3ARxkkKhLn0BwZfwDRoCdgnOBR0UwclBF+loo51TR8F8kLsL3Af/ARgMP4hVdeQANFI1kerplXIVueG7A6lVoFKApt8qLTvpXR7x0fbyIOUFiKUbIn7AumBYepTHV8Ty8UhgEKQNVuBrFTJlhMcCMSmpgFLpAGbtGqVfKMVLJFXBSsV51ikMlELthKafYNjSK3g3I3IvEMni8hY6cdeR5Q02GqW7irb3xVwEToT4uVj4Dsmic37TKABNqmrw+agZadcV9knVYe2ewWAw/C8v7R5HfbjKnRwAAAAASUVORK5CYII=","orcid":"","institution":"University of Tennessee at Knoxville","correspondingAuthor":true,"prefix":"","firstName":"Iyanuoluwa","middleName":"Oyedeji","lastName":"Oyetunji","suffix":""},{"id":508042387,"identity":"8035bea0-60c4-4840-abd6-e316e57d7a8c","order_by":1,"name":"Yetunde Wasilat Fadipe","email":"","orcid":"","institution":"University of Tennessee Institute of Agriculture","correspondingAuthor":false,"prefix":"","firstName":"Yetunde","middleName":"Wasilat","lastName":"Fadipe","suffix":""},{"id":508042388,"identity":"f452fc97-2457-4aca-9b42-3250f9a64c37","order_by":2,"name":"Alastair Duncan","email":"","orcid":"","institution":"Guy's and St Thomas' NHS Foundation Trust","correspondingAuthor":false,"prefix":"","firstName":"Alastair","middleName":"","lastName":"Duncan","suffix":""},{"id":508042389,"identity":"07be9bdd-6b3c-4534-8a8e-6c75735484d4","order_by":3,"name":"Janetta Harbron","email":"","orcid":"","institution":"University of Cape Town","correspondingAuthor":false,"prefix":"","firstName":"Janetta","middleName":"","lastName":"Harbron","suffix":""}],"badges":[],"createdAt":"2025-08-26 13:38:28","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7463524/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7463524/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12982-026-01602-0","type":"published","date":"2026-02-22T15:57:00+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":90302214,"identity":"040e4abb-01dc-4671-8131-a51dcd2d6519","added_by":"auto","created_at":"2025-09-01 09:06:37","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":37072,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePRISMA flow chart for study selection\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7463524/v1/99dd72f84a6d206d2863adf3.png"},{"id":90304347,"identity":"91c56f12-7340-44d5-999d-7a2223b9aacf","added_by":"auto","created_at":"2025-09-01 09:14:36","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":16775,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eThe Risk of Cardiovascular Diseases (CVD) Reported and the Number of Studies\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7463524/v1/688320bee289967caee73cb2.png"},{"id":103251017,"identity":"f5ffde19-a1a1-4f2b-9076-3f06c4373a6d","added_by":"auto","created_at":"2026-02-23 16:01:00","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1044306,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7463524/v1/bc8ecda1-9a51-4329-9dea-9144c4fa3709.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eDiet Quality, Food Insecurity and Risk of Cardiovascular Diseases Among Adults Living with Hiv/Aids: A Scoping Review\u003c/p\u003e","fulltext":[{"header":"KEY MESSAGES","content":"\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eWhat is already known on this topic:\u003c/strong\u003e The introduction and scale-up of antiretroviral therapy was followed by an increased risk of cardiovascular disease (CVD) among people living with HIV (PLWH). Diet quality is a better measure of dietary adequacy and is associated with risks of CVD. We do not know what is available about diet quality and its measures among PLWH.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eWhat this study adds:\u003c/strong\u003e Few studies conducted among PLWH measure diet quality, and they use varying methods of assessment. This makes it difficult to compare and summarize findings.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eHow this study might affect research, practice and policy:\u003c/strong\u003e The findings of this review emphasize the need for a standardized method of assessing diet quality among PLWH this will facilitate easier summary of the association between diet and risk of CVD and inform more effective dietary interventions.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"INTRODUCTION","content":"\u003cp\u003eGlobally, cardiovascular diseases (CVD) are the leading cause of death,\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e with hypertension, diabetes, and dyslipidemia identified as principal risk factors for the development of CVD \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. In people living with HIV (PLWH), a three-fold increase in the global burden of HIV-related CVD has been reported over the last two decades. A systematic review concluded that PLWH are twice as likely to develop CVD compared to their HIV-negative counterparts \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. This finding could be explained by several contributing factors including the infection itself and its treatment.\u003c/p\u003e\u003cp\u003eIt is known that the successful introduction and scale-up of effective Highly Active Antiretroviral Therapy (HAART) brought about a reduction in HIV mortality rates, and an ageing cohort of PLWH \u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. This, however, has been followed by a higher risk of morbidity, and increased prevalence of comorbidities including obesity, hyperglycemia dyslipidemia, hypertension, and other cardiovascular diseases among PLWH \u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. Furthermore, certain CVD risk factors such as lipodystrophy, increased central adiposity, insulin resistance, and diabetes have also directly been linked with the use of HAART \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. HIV infection and HAART use have, therefore, been reported to significantly increase the risk for CVD \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. Cardiovascular risks are also affected by other lifestyle factors such as dietary intake, smoking and physical activity \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eSimilarly, to the general population, lifestyle modification is an essential first step in the management of CVD among PLWH. Dietary interventions have been demonstrated to reduce the risk of CVD among the HIV-uninfected population \u003csup\u003e[\u003cspan additionalcitationids=\"CR14 CR15\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e and PLWH \u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. However, there is an absence of HIV-specific dietary recommendations for the reduction of CVD risks among PLWH \u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n\u003ch3\u003eDiet Quality\u003c/h3\u003e\n\u003cp\u003eDiet quality is a concept that is not clearly defined; no consensus has been reached to have a specific meaning that can be applied in all contexts \u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e. Diet quality indices are generally developed to reflect how much an individual or population\u0026rsquo;s food consumption conforms to dietary guidelines and recommendations within a context \u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e. Diet quality is being increasingly adopted in nutritional epidemiology surveys to assess dietary patterns and evaluate the effectiveness of a specific dietary intervention. Since a relationship has been established and understood between food and human physiological function, diet quality has also been used as a proxy to predict mortality and risk of chronic diseases \u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eSeveral diet quality indices have been developed and used over the years. Some have been used to evaluate adherence to dietary guidelines while others monitor changes in dietary patterns over time \u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e. Examples of diet quality indices include:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eHealthy Eating Index (HEI) \u003csup\u003e[\u003cspan additionalcitationids=\"CR24\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eMediterranean Diet Score (MDS) \u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eDiet Quality Index (DQI) \u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e, updated and renamed as Diet Quality Index-International (DQI-I) \u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eRecommended Food Score (RFS) \u003csup\u003e[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eDietary Diversity Score (DDS),\u003csup\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e and Food Variety Score (FVS),\u003csup\u003e[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eDietary Approaches to Stop Hypertension (DASH) \u003csup\u003e[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eDietary Inflammatory Index (DII) \u003csup\u003e[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003ePoor diet quality increases the risk of mortality and morbidity in the HIV-uninfected population \u003csup\u003e[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/sup\u003e, Some studies have also evaluated diet quality among PLWH (Weiss et al, 2019, Duran and Jaime, 2009, Henderson, 2013, Kadiyala and Rawat, 2013, Palermo et al, 2013, Sackey et al, 2019, Sackey et al, 2018, Stanner et al, 2019). Researchers from Boston in the United States conducted a cross-sectional study using the HEI tool, and reported that diet quality was lower among PLWH and significantly lower among women living with HIV when compared to HIV-negative controls \u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. This study did not link results with risk of CVD.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eFood insecurity\u003c/h2\u003e\u003cp\u003eFood insecurity is defined as limited availability of and access to sufficient, safe, and nutritious food to support healthy living \u003csup\u003e[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]\u003c/sup\u003e. The Food and Agriculture Organization (FAO), in the most recent report on the state of global food security and nutrition, estimated that 690\u0026nbsp;million people are hungry, equivalent to 8.9 percent of the world population. The FAO projects that the Covid-19 pandemic will exacerbate global food insecurity through disrupting social and economic systems, potentially resulting in up to an additional 132\u0026nbsp;million people experiencing undernutrition in 2020 \u003csup\u003e[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eSocioeconomic factors such as food insecurity can influence diet quality. Muhammad et al. \u003csup\u003e[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]\u003c/sup\u003e reported that 55% of their sample of PLWH in the USA (aged 50 years and older) are food insecure, and that food insecurity was linked to lower diet quality, irrespective of income \u003csup\u003e[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]\u003c/sup\u003e. This finding is supported by evidence in the general population,\u003csup\u003e[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]\u003c/sup\u003e, and corroborated by the FAO report \u003csup\u003e[\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]\u003c/sup\u003e. Given the current food security situation and the link with diet quality, we will include studies that assess food security status in our review.\u003c/p\u003e\u003cp\u003eFood security has been assessed by several indicators at national, household, and individual levels. Some indicators measure food consumption adequacy while others gather additional information on experiences and behavioural responses \u003csup\u003e[\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]\u003c/sup\u003e. Food security indicators may include:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eFood Consumption Score (FCS) \u003csup\u003e[\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eHousehold Dietary Diversity Score (HDDS) \u003csup\u003e[\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eHousehold Food Security Survey Module (HFSSM) \u003csup\u003e[\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eHousehold Food Insecurity Access Scale,\u003csup\u003e[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]\u003c/sup\u003e used by the Food and Nutrition Technical Assistance-II (FANTA-II) initiative \u003csup\u003e[\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eFood Insecurity Experience Scale (FIES) developed by FAO \u003csup\u003e[\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eThe extent to which diet quality and food security status have been assessed in the context of HIV is not known. This scoping review is necessary to aggregate information on the depth of research on diet quality and HIV.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eAims\u003c/h3\u003e\n\u003cp\u003eThe aims of this review include:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eTo determine the diet quality and food security status of PLWH with or at risk of CVD.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eTo identify the range and utility of diet quality and food security indices among PLWH with or at risk of CVD.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eThis introductory section has been previously published in the review protocol \u003csup\u003e[\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e"},{"header":"METHODS AND ANALYSIS","content":"\u003cp\u003eThe methodology proposed by Arksey and O\u0026rsquo;Malley,\u003csup\u003e[\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]\u003c/sup\u003e formed the bedrock for this scoping review. Input from other guidelines \u003csup\u003e[\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]\u003c/sup\u003e was also incorporated. The Joanna Briggs Institute (JBI) manual recommends that a protocol stating a stepwise approach to the scoping review be designed and that a set of criteria for including or excluding studies should be determined \u003cem\u003ea priori.\u003c/em\u003e These criteria must reflect the aim as well as the questions of the review \u003csup\u003e[\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe framework proposed by Arksey and O\u0026rsquo;Malley consists of six stages of which five are mandatory. The stages are:\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eIdentifying a research question\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eIdentifying relevant studies\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eStudy selection\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eCharting the data\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eCollating, summarizing and reporting the results\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eConsultation exercise (optional).\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\u003cp\u003eStage six was omitted as this scoping review was not intended to provide evidence to inform clinical decisions. It however provides an overview of the literature on dietary components related to risks of CVD in PLWH and gives an indication whether the type of data is appropriate for meta-analyses. Given the increased risk of CVD in PLWH, this review also informs how best to assess dietary intake in this cohort.\u003c/p\u003e\n\u003ch3\u003eStage 1: Identifying the review question\u003c/h3\u003e\n\u003cp\u003eThis review was carried out to map the breadth of research on diet quality, food security, and risk of CVD among PLWH. The primary review question is:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eWhat is the current diet quality and food insecurity status of PLWH with or at risk of CVD?\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eThe introduction of highly active antiretroviral therapy (HAART) in the late 1990s,\u003csup\u003e[\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e]\u003c/sup\u003e brought a significant change to the health outcomes of PLWH \u003csup\u003e[\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]\u003c/sup\u003e. The word \u0026ldquo;current\u0026rdquo; was included as studies published since 1998 will be considered for the purpose of this scoping review. This time-period has been selected based on the recorded time for the global scale-up of HAART.\u003c/p\u003e\u003cp\u003eIn addition to the main question this scoping review also sought to answer the following secondary questions:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eWhat methodologies have been used to assess the dietary quality and food security of PLWH with or at risk of CVD?\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\n\u003ch3\u003eStage 2: Identifying relevant studies\u003c/h3\u003e\n\u003cp\u003eWe searched the following databases: PubMed, Africa wide, CINAHL, APA Psyc info (via EBSCOhost), Scopus, Web of Science, COCHRANE library, and databases for grey literature such as ProQuest and AHRQ Agency for Healthcare Research and Quality. The inclusion criteria and a table of the preliminary full search strategy had been published \u003csup\u003e[\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eStage 3: Study selection\u003c/h2\u003e\u003cp\u003eAfter the search, the identified and collated citations were exported into EndNote X9 (Clarivate, Analytics, PA, USA) to remove duplicates. Titles and abstracts were screened independently against the inclusion criteria by two members of the research team on Rayyan QCRI (Copenhagen: The Nordic Cochrane Centre, Cochrane),\u003csup\u003e[\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]\u003c/sup\u003e. Disagreements were discussed and resolved by consensus. Full text reports of studies were retrieved and screened to verify their conformance with the inclusion criteria. Articles that fail to meet the inclusion criteria here were excluded, and reasons are specified in the results using a Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Review (PRISMA-ScR) flow chart (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStage 4: Charting the data\u003c/h3\u003e\n\u003cp\u003eA pre-designed tabulated data extraction tool template was piloted on ten included studies \u003csup\u003e[\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]\u003c/sup\u003e. Extracted data can be found in the published protocol \u003csup\u003e[\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n\u003ch3\u003eStage 5: Collating, summarizing and reporting the results\u003c/h3\u003e\n\u003cp\u003eExtracted data were thematically described as relevant to the review questions. Meta-analysis of data or qualitative evaluation of included studies was not conducted for this review. This review is intended to give a descriptive overview of diet quality, food insecurity status and risk of CVD of adults living with HIV. A detailed description of the methods was published in the review protocol \u003csup\u003e[\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]\u003c/sup\u003e. An updated search was conducted up to July 29th, 2025.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cstrong\u003eSearch results\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs shown in Figure 1, a total of 1,094 studies were retrieved using the search strategy defined. A search for duplicates, conducted on EndNote, identified 201 duplicate articles, which were subsequently removed. Screening of title and abstract was conducted on Rayyan and COVIDENCE by three independent reviewers \u0026ndash; IO, JH, and YWF; 826 articles were excluded based on the defined criteria, yielding 62 articles eligible for full-text review. A total of 46 studies passed the full-text screening. Reasons for excluding 16 studies at the level of full-text screening are a non-dietary method of assessing nutrient levels (eight studies), a prospective study design that compared dietary changes over time (three studies), on-going study (three studies), unavailable full texts (three studies), not published in English language (one study), and unpublished (one study).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCharacteristics of included studies\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eStudy design:\u003c/u\u003e Studies included were cross-sectional except for two cohort studies \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e54\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e55\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e, and two trials \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e17\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e56\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. These studies were, however, included because they reported baseline dietary cross-sectional data. Five studies employed mixed-methods \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e57-61\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e, and seven studies included uninfected controls \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e62-68\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e, other articles included only PLWH.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eCountry of origin:\u003c/u\u003e Thirteen of these were from the USA \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e54\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e59\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e62\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e66\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e69-77\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e; five from Brazil \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e64\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e78-81\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e; three from each of Croatia \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e65\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e82\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e83\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e and the UK \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e17\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e57\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e84\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e; two from each of Cambodia \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e85\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e86\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e, Eswatini \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e58\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e87\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e, Nepal \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e60\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e88\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e, and Thailand \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e89\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e90\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e; and one from each of Australia \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e91\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e, Canada \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e92\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e, Iran \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e93\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e, Ireland \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e67\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e, Kenya \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e68\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e, Malawi \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e94\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e, Malaysia \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e95\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e, Mexico \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e55\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e, Poland \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e96\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e, Portugal \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e63\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e, South Africa \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e97\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e, Spain \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e56\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e, and Uganda \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e98\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. The final article was from a multinational study, but the first author is from the USA \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e99\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eSample:\u003c/u\u003e Fourteen studies included both ART-na\u0026iuml;ve and ART-experienced participants \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e54\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e60\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e63\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e64\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e70\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e71\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e80\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e84-86\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e88\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e89\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e92\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e93\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. The authors of three studies did not indicate ART usage among the participants \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e73\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e76\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e97\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. The remaining studies included only ART-experienced participants. The authors of most studies reported age range either as part of the inclusion criteria or results. While some provided only lower limits, generally the reported age ranges were between 15 to 70 years. Eight studies did not have an age range, but only the mean (SD) or median age was shown in their results \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e56\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e59\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e71-73\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e77\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e92\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e99\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eQuality of Included Studies: Scoping reviews do not require quality appraisal; thus, we did not appraise the quality of included studies. However, the following points may be important to note: the authors of the five studies did not mention obtaining ethical approval from an ethics committee. However, four of these studies referred to a parent study \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e65\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e66\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e71\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e99\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e, while the authors of the fifth study mentioned obtaining informed consent from the participants \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e96\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. All other studies were approved by an ethics review committee.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eFindings\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003e\u003cu\u003eDiet Quality / Food Security methods used:\u003c/u\u003e As shown in Table I, seven studies included a measure of food security \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e59\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e73\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e76\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e77\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e84\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e93\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e97\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. Of these, two assessed both diet adequacy and food security \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e59\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e97\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e, while the other studies only assessed food security in the context of HIV and NCDs.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eFood Security:\u003c/u\u003e The measures used to assess food security status included the USDA household food security survey (HFSS) \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e59\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e73\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e, a validated household food insecurity access scale \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e93\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e97\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e, 2-item tool derived from the USDA HFSS \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e77\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e, a one-item questionnaire that is not validated \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e76\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e, and an undefined tool \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e84\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eDietary Intake Assessment Methods:\u003c/u\u003e Dietary intake was measured using a 24-hour recall in 12 studies \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e54\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e57\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e59\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e66\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e75\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e80\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e81\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e88-90\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e95\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e96\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e, FFQ in 11 studies \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e60\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e64\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e65\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e67\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e69\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e74\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e79\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e80\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e82\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e91\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e97\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e, and other studies used food records, nutritional diaries, food protocol in five studies, diet history, WHO STEPwise approach to surveillance, or unvalidated tools. While some studies included repeated 24-hour recall, some only conducted a single measure, and others did not specify. Similarly, some studies used previously validated FFQ while others did not provide this information (Table I). The FFQs consisted of a list of food items ranging from 10 to 150. Food records/nutritional diaries/food protocol were recorded for a range of 3-7 days. Diet history was recorded for the past month. The data from the dietary intake methods were then used to calculate diet quality indices or compared to established standards to report adequacy of dietary intake in most (n=30) studies.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eDiet Quality Index:\u003c/u\u003e One study each assessed diet quality using the Healthy Eating Index (HEI) score \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e75\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e and Healthy Food Diversity Index (HFDI) \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e67\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e, and five studies used the Mediterranean Diet Score (MDS) \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e17\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e56\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e63\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e65\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e74\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e82\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e83\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. An intervention study did not compute a diet quality score, but included dietary goals based on the Mediterranean and DASH guidelines \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e57\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eDietary Adequacy:\u003c/u\u003e Macro- and micronutrient intakes were compared with various dietary guidelines in different studies such as country-specific DRIs and EARs. Some studies included questions that assessed intakes of fruits and vegetables, dietary behavior/ habits, animal protein consumption, and the type of cooking oil used, and compared them with the standard.\u003c/p\u003e\n\u003ch3 id=\"_Toc108529420\"\u003e\u003cstrong\u003eOutcome\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003e\u003cu\u003eFood security:\u003c/u\u003e The studies that assessed food security status indicated a high level of food insecurity among the participants. However, there was a wide range of prevalence reported, ranging from 22.3% \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e84\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e, 31% \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e73\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e, 36.3% \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e77\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e, 46% \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e76\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e, and 54% \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e59\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e, and 70% \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e97\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. The final study assessing food security did not report a prevalence \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e93\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. All included studies reported an association between food insecurity and adverse outcomes. Food insecurity significantly predicted nutrition risk \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e76\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e, was associated with high prevalence of comorbidities \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e73\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e77\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e84\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e97\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e, adversely affected quality of life \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e93\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eDiet quality:\u003c/u\u003e Overall, diet quality was similar among PLWH and uninfected controls, in studies that included controls. Diet quality was associated with reduced risk of comorbidities in some studies. Diet quality, assessed using the Healthy Food Diversity index, was associated with microbiome changes relevant to CVD risk but did not differ among PLWH and un-infected control \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e67\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. Only 8% of treatment group had a high adherence to mediterranean diet at baseline, adherence improved metabolic parameters \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e56\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e, but this was only sustained for a short-term in an intervention study \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e17\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. Policarpo and colleagues \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e63\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e also assessed diet quality using the MDS. The authors used tertiles of the score to group participants into low adherence (\u0026lt;25 points), medium adherence (25-30 points), and high adherence (\u0026gt;30 points) out of a total of 55 points. Although the mean score indicated moderate adherence (27.5 \u0026plusmn; 5.5 points), most of the recommendations for the individual food items that make up the score were followed by a very small percentage of the participants. The authors identified that increased adherence to MD was associated with some cardiometabolic risk and suspected that participants may have adopted the diet after the onset of comorbidities. Three studies in Croatia \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e83\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e100\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e101\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e also used the MDS to assess the diet quality. The scores were dichotomized to give a range of 0-9 and classified as low adherence if scores \u0026lt;4 or scores 4 and above as moderate to high adherence. A study reported that 67% of the participants had moderate to high adherence to the Mediterranean diet \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e101\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e while another found that PLWH had higher adherence to MDS than the uninfected population with median (range) scores of 5 (3 \u0026ndash; 7) and 3 (2 -5) respectively \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e83\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. No further information concerning adherence to the diet score was reported. Webel and colleagues assessed 105 PLWH and 86 uninfected controls in the US. They assessed diet quality using the HEI which has a maximum score of 100 \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e61\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. The overall mean (SD) HEI score for all participants was 45.4 (11), this score and the individual diet component score did not significantly differ between groups.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eOthers:\u003c/u\u003e Studies that either did not use a pre-defined diet quality index or assess food security status compared intakes of the participants with standards such as Dietary Reference Intakes (DRIs) and NCEP guidelines, while some did not specify this. Most of these studies have similar findings. The most prominent themes emerging from the findings of these studies are high fat and energy intake, low consumption of fruits, vegetables, dietary fiber, and sources of micronutrients. The authors of one of the studies described this as \u0026ldquo;\u0026hellip;a typical high fat, low fiber Western diet with suboptimal intake of many micronutrients\u0026hellip;\u0026rdquo; \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e92\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. Joy et al., \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e54\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e compared intakes of PLWH with uninfected controls, this study showed that fat consumption was higher, and fiber lower among PLWH compared to the controls. Some studies also compared intakes by gender; the authors of two studies reported that energy intake was higher among men than women.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eFat:\u003c/u\u003e Generally, high consumption of total fat, energy from fat, cholesterol, saturated, and trans-fat was reported \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e62\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e64\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e69\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e71\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e72\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e92\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e96\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. While consumption of essential fat was reported low. Overall, almost all the studies assessing dietary intake showed that fat recommendations were not met by the participants. \u003c/p\u003e\n\u003cp\u003e\u003cu\u003eProteins:\u003c/u\u003e Some studies had protein intake in their results. Jackiewicz et al \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e96\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e reported that PLWH in Poland consumed more meat than fish which consequently increased their saturated fat intake. Leite and Sampaio \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e80\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e assessed dietary calcium and dairy food intake among PLWH in Brazil. Although they reported that milk was the most important dairy product consumed, only 56% consumed up to 1-2 servings per day. Tsiodras et al \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e74\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e compared protein intakes of PLWH and fat redistribution (FR) with PLWH without FR. They reported that the group with FR consumed more protein and red meat products than the group without. They, however, did not report the quantity of intake for any group. Upreti \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e60\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e reported contrary finding in their Nepali study; they reported that the participants typically eat a plant-based diet and have low intakes of animal products.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eMicronutrients:\u003c/u\u003e Authors of all studies with micronutrient intake information reported low intakes, except for Sodium \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e64\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e and vitamin C \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e60\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. Specific nutrients mentioned having low intake levels were Calcium \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e80\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e, B-vitamins \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e88\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e, Iron \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e60\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e, Magnesium, Vitamins A and E \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e92\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. A study showed that Vitamin C intake was satisfactory \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e60\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e, while two studies revealed a high intake of sodium among the participants \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e64\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e92\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. Arendt and colleagues \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e92\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e specifically reported that diet alone did not meet the micronutrient requirement of PLWH.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eOthers:\u003c/u\u003e Other dietary components mentioned are fiber; fruits and vegetables; alcohol; sweet drinks, snacks, and added sugars. All the studies that assessed fiber \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e62\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e70\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e72\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e92\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e, fruits, and vegetables \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e86\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e94\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e recorded a low intake among the participants. One study showed a lower intake of alcohol by PLWH than in control but did not quantify the intake \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e54\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. Finally, some studies included the intake of sweet drinks, snacks, and added sugars \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e78\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e96\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. Jackiewicz and colleagues reported a high intake of this among their study participants.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eRisk of CVD reported:\u003c/u\u003e Thirty-seven studies included one or more risks of CVD in their report. As shown in Table II, the risks of CVD reported are lipodystrophy/fat redistribution (five studies), obesity/overweight (10 studies), central obesity (five studies), hypertension (15 studies), dyslipidemia (10 studies), insulin resistance/hyperglycemia/diabetes (11 studies), metabolic syndrome (six studies), 10-year risk estimation using the Framingham scale (three studies), and 1 study for established CVD. A study \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e94\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e highlighted that CVD risks were more common among PLWH on long-term ART while Turcinov and Begovac \u003csup\u003e[82]\u003c/sup\u003e showed that metabolic syndrome was more frequent in females than in males.\u003c/p\u003e\n\u003cp\u003eIt is important to note that nine studies recruited the participants based on the presence of the risk of CVD of their interest \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e54\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e62\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e70\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e91\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e92\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e102\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. The findings of these studies might not be representative, so the CVD data were not included in the summary. However, we included these studies in our review because of our primary outcome of interest \u0026ndash; diet quality. Similarly, as mentioned above, some studies recruited some HIV uninfected participants \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e54\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e73\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e75\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e83\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. Notably, two studies assessed gut microbiome/microbiota \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e56\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e67\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. Table II shows the ranges of the prevalence of each risk, the number of studies from which the ranges were generated, and the reported association with diet.\u003c/p\u003e\n\u003cp\u003eLipodystrophy: Studies reporting all forms of fat redistribution among PLWH were included.\u003c/p\u003e\n\u003cp\u003eObesity/overweight: Studies estimating BMI categories were included. One study reported a prevalence of underweight at 29% \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e60\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eCentral obesity: Studies estimating Waist or abdominal circumference, as well as waist-to-hip ratio, were included\u003c/p\u003e\n\u003cp\u003eHypertension: Studies reporting high values of systolic, diastolic, or both pressures.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis scoping review aimed to determine the diet quality and food security status of PLWH with or at risk of CVD and to identify the range and utility of diet quality and food security indices among PLWH with or at risk of CVD. Generally, the diet quality of PLWH is suboptimal, there is a high prevalence of CVD risk among the population, and there is evidence of an association between diet and the risk of CVD. The higher risk of CVD among PLWH \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e, and the possibility of dietary intervention reducing this risk \u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e emphasize the need for research evidence among PLWH.\u003c/p\u003e\u003cp\u003eThe use of a wide range of methodologies to assess dietary adequacy and food insecurity made it very difficult to aggregate the findings of the included studies. Dietary intake was assessed using several methods and compared with different quality standards based on the objectives of each study. Some authors failed to adequately describe their method of dietary assessment in a replicable manner. This is a challenge frequently encountered in studies involving dietary assessment among uninfected population \u003csup\u003e[\u003cspan citationid=\"CR103\" class=\"CitationRef\"\u003e103\u003c/span\u003e]\u003c/sup\u003e, thus our findings emphasize the need for authors to use validated tools for dietary assessment and include a comprehensive description of how the tool was used in their study \u003csup\u003e[\u003cspan citationid=\"CR104\" class=\"CitationRef\"\u003e104\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eDespite the high level of heterogeneity in the included studies, similar themes regarding food insecurity and dietary intake were reported. Food insecurity level was high and dietary quality ranged from low to medium adherence to quality standards. Notably, the South African study reported household food insecurity as high as 70% among their adolescent participants \u003csup\u003e[\u003cspan citationid=\"CR97\" class=\"CitationRef\"\u003e97\u003c/span\u003e]\u003c/sup\u003e. Even when diet quality had overall medium adherence to quality standards, adherence to the recommendation of individual food items was generally low. Few studies compared the diet adequacy of PLWH with uninfected controls, and mixed findings emerged. While some studies reported no significant differences in the diet of the two groups, others reported a lower diet quality for PLWH. Overall, results from included study reflect poor food security, moderate adherence to diet quality indices recommendations (MDS, HEI, and HFDI), and poor adherence to DRIs and other guidelines. This finding underscores the importance of continued nutritional screening and intervention among PLWH. We recommend that this be integrated into primary health care systems that are in contact with PLWH.\u003c/p\u003e\u003cp\u003eDiet quality assessment using a predefined diet quality index, which is the primary outcome of this review, was reported in eight studies, representing only about 17% of included studies. In contrast, studies among the general population have shifted more from nutrient assessment towards assessing overall dietary pattern \u003csup\u003e[\u003cspan citationid=\"CR105\" class=\"CitationRef\"\u003e105\u003c/span\u003e]\u003c/sup\u003e. Overall dietary pattern or consumption of food groups better reflects the dietary quality and is a more efficient way of assessing the association that may exist between diet and chronic diseases \u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR106\" class=\"CitationRef\"\u003e106\u003c/span\u003e]\u003c/sup\u003e. We recommend that researchers employ the use of these diet quality indices to assess the dietary adequacy of PLWH when possible. This will also facilitate easy comparison between studies and highlight the need for nutritional intervention in a specific population.\u003c/p\u003e\u003cp\u003eGlobally, CVD has been identified as the leading cause of mortality \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. The most reported comorbidity, and risk for CVD, in the included studies were hypertension and diabetes, followed by obesity and dyslipidemia. Similar findings have been reported in studies among PLWH \u003csup\u003e[\u003cspan citationid=\"CR107\" class=\"CitationRef\"\u003e107\u003c/span\u003e, \u003cspan citationid=\"CR108\" class=\"CitationRef\"\u003e108\u003c/span\u003e]\u003c/sup\u003e, and the general population \u003csup\u003e[\u003cspan citationid=\"CR109\" class=\"CitationRef\"\u003e109\u003c/span\u003e]\u003c/sup\u003e. As the global prevalence of hypertension and other risks of CVD continues to rise, \u003csup\u003e[\u003cspan citationid=\"CR110\" class=\"CitationRef\"\u003e110\u003c/span\u003e]\u003c/sup\u003e there is need for continued screening and monitoring, especially among PLWH as they continue to live longer and potentially face a higher risk \u003csup\u003e[\u003cspan citationid=\"CR111\" class=\"CitationRef\"\u003e111\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe association between diet and the risks of CVD reported in the included studies is complex. Most studies had findings suggesting that a diet that adheres to the quality standard used in the study may reduce the risk of CVD \u003csup\u003e[\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e, \u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e, \u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e, \u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e, \u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e83\u003c/span\u003e, \u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e, \u003cspan citationid=\"CR90\" class=\"CitationRef\"\u003e90\u003c/span\u003e, \u003cspan citationid=\"CR95\" class=\"CitationRef\"\u003e95\u003c/span\u003e]\u003c/sup\u003e. While a few had findings that suggested no association between diet and risk of CVD \u003csup\u003e[\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan citationid=\"CR82\" class=\"CitationRef\"\u003e82\u003c/span\u003e]\u003c/sup\u003e, others did not report any association between diet and the risk of CVD. We opine that this variation in the association between the risk of CVD and diet may be largely due to the heterogeneity in methodology and possibly in the study population. Additionally, this may be because the articles included in this scoping review were cross-sectional, observational study which is prone to confounding. This is especially true as previous dietary interventions have been shown to reduce the risk of CVD among PLWH (Lazzaretti et al., 2012, Stradling et al., 2021). Again, we recommend that researchers use a standardized method of dietary assessment within their context, and report overall dietary patterns with reference to the risk of CVD when possible.\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003ePLWH continue to be at nutritional risk and complication which necessitates nutritional screening and intervention \u003csup\u003e[\u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e]\u003c/sup\u003e. While being affected by food insecurity, the diet quality of PLWH has medium adherence to recommendations. More standardized methods of dietary assessment should be employed by researchers to facilitate easy comparison. The treatment outcome of PLWH may be strongly affected by the dietary intervention \u003csup\u003e[\u003cspan citationid=\"CR96\" class=\"CitationRef\"\u003e96\u003c/span\u003e]\u003c/sup\u003e. Therefore, it is important to include a dietitian in the treatment continuum of PLWH, especially at the PHC level.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate:\u003c/strong\u003e\u003cp\u003eThe review did not require any generation of primary data; all documents will be retrieved from the public domain. This review, therefore, did not require ethical approval. It forms part of a dissertation towards a Master of Medical Science in Nutrition (MMedSci Nutrition), which was completed in 2022. This protocol is registered on Open Science Framework (OSF) with registration number: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://osf.io/7k3ja\u003c/span\u003e\u003cspan address=\"https://osf.io/7k3ja\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e and published in Oyetunji et al., (2021)\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for Publication:\u003c/strong\u003e\u003cp\u003eNA\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e\u003cp\u003eThe Mastercard Foundation Scholars Program funded the degree of IOO. This work does not reflect the views of the funder, but the views of the authors based on research findings.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eIOO, JH, and AD were involved in the conceptualization of the scoping review protocol. YWF was involved in additional screening of studies, review, and extraction of data. IOO led the process and wrote the manuscript under the supervision of JH and AD. All authors reviewed and approved the publication of the scoping review findings.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors acknowledge and appreciate the effort of Namhla Madini of the Bongani Mayosi Health Sciences Library, University of Cape Town, for the assistance she provided with the preliminary search and development of the search strategy.\u003c/p\u003e\u003ch2\u003eAvailability of Data and Materials:\u003c/h2\u003e\u003cp\u003eNA\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eContribution\u003c/span\u003e: IOO, JH, and AD were involved in the conceptualization of the scoping review protocol. YWF was involved in additional screening of studies, review, and extraction of data. IOO led the process and wrote the manuscript under the supervision of JH and AD. All authors reviewed and approved the publication of the scoping review findings.\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eCompeting Interest\u003c/span\u003e: The authors have no competing interests to declare that are relevant to the content of this article.\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eClinical Trial Number\u003c/span\u003e: NA\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization. Hypertension. 2020/06/10, 2020. Accessed 2020/06/10, 2020. https://www.who.int/news-room/fact-sheets/detail/hypertension\u003c/li\u003e\n\u003cli\u003eNaghavi M, Abajobir AA, Abbafati C, et al. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980\u0026ndash;2016: a systematic analysis for the Global Burden of Disease Study 2016. \u003cem\u003eThe Lancet\u003c/em\u003e. 2017;390(10100):1151-1210. doi:10.1016/S0140-6736(17)32152-9\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. Cardiovascular diseases. 2020/06/10, 2020. Accessed 2020/06/10, 2020. https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)\u003c/li\u003e\n\u003cli\u003eShah AS, Stelzle D, Lee KK, et al. Global burden of atherosclerotic cardiovascular disease in people living with HIV: systematic review and meta-analysis. \u003cem\u003eCirculation\u003c/em\u003e. 2018;138(11):1100-1112.\u003c/li\u003e\n\u003cli\u003eMutevedzi PC, Newell M-L. The changing face of the HIV epidemic in sub-Saharan Africa.(Report). \u003cem\u003eTropical Medicine and International Health\u003c/em\u003e. 2014;19(9):1015. doi:10.1111/tmi.12344\u003c/li\u003e\n\u003cli\u003eWeiss JJ, Sanchez L, Hubbard J, Lo J, Grinspoon SK, Fitch KV. Diet quality is low and differs by sex in people with HIV. \u003cem\u003eThe Journal of nutrition\u003c/em\u003e. 2019;149(1):78-87.\u003c/li\u003e\n\u003cli\u003eRasmussen LD, May MT, Kronborg G, et al. Time trends for risk of severe age-related diseases in individuals with and without HIV infection in Denmark: a nationwide population-based cohort study. \u003cem\u003eThe Lancet HIV\u003c/em\u003e. 2015;2(7):e288-e298. doi:10.1016/S2352-3018(15)00077-6\u003c/li\u003e\n\u003cli\u003eBozkurt B. Cardiovascular toxicity with highly active antiretroviral therapy. \u003cem\u003eCardiovascular Toxicology\u003c/em\u003e. 2004;4(3):243-60. doi:10.1385/CT:4:3:243\u003c/li\u003e\n\u003cli\u003eRawdanowicz J, Pikto-Pietkiewicz W, Marczynska M. Cardiovascular diseases associated with HIV infection and their management. \u003cem\u003eKardiologia Polska\u003c/em\u003e. 2013;71(11):1183-1187. doi:10.5603/KP.2013.0301\u003c/li\u003e\n\u003cli\u003eNou KE, Lo KJ, Grinspoon KS. Inflammation, immune activation, and cardiovascular disease in HIV. \u003cem\u003eAIDS\u003c/em\u003e. 2016;30(10)doi:10.1097/QAD.0000000000001109\u003c/li\u003e\n\u003cli\u003eNduka C, Sarki A, Uthman O, Stranges S. Impact of antiretroviral therapy on serum lipoprotein levels and dyslipidemias: A systematic review and meta-analysis. Article. \u003cem\u003eInt J Cardiol\u003c/em\u003e. 2015;199:307-318. doi:10.1016/j.ijcard.2015.07.052\u003c/li\u003e\n\u003cli\u003eClaudia Daniele Tavares D, Anny Karulinny Mesquita M, Daniele Almeida S, et al. RISK FACTORS FOR CARDIOVASCULAR DISEASES IN PATIENTS WITH HIV LIPODYSTROPHIC SYNDROME. \u003cem\u003eRevista Gest\u0026atilde;o \u0026amp; sa\u0026uacute;de (Bras\u0026iacute;lia)\u003c/em\u003e. 2012;3(3):836-851.\u003c/li\u003e\n\u003cli\u003eEstruch R, Ros E, Salas-Salvad\u0026oacute; J, et al. Primary Prevention of Cardiovascular Disease with a Mediterranean Diet Supplemented with Extra-Virgin Olive Oil or Nuts. \u003cem\u003eNew England Journal of Medicine\u003c/em\u003e. 2018;378(25):e34. doi:10.1056/NEJMoa1800389\u003c/li\u003e\n\u003cli\u003eLazzaretti RK, Kuhmmer R, Sprinz E, Polanczyk CA, Ribeiro JP. Dietary intervention prevents dyslipidemia associated with highly active antiretroviral therapy in human immunodeficiency virus type 1\u0026ndash;infected individuals: a randomized trial. \u003cem\u003eJournal of the American College of Cardiology\u003c/em\u003e. 2012;59(11):979-988.\u003c/li\u003e\n\u003cli\u003eStradling C, Thomas G, Hemming K, et al. The Mediterranean portfolio diet in HIV dyslipidaemia: a randomized controlled trial. \u003cem\u003eTopics in Antiviral Medicine\u003c/em\u003e. 2018;26:306s.\u003c/li\u003e\n\u003cli\u003eGrundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. \u003cem\u003eJournal of the American College of Cardiology\u003c/em\u003e. 2019;73(24):3168-3209.\u003c/li\u003e\n\u003cli\u003eStradling C, Thomas GN, Hemming K, Taylor S, Taheri S. Randomized parallel-group pilot trial (Best foods for your heart) comparing the effects of a Mediterranean Portfolio diet with a low saturated fat diet on HIV dyslipidemia. \u003cem\u003eClinical Nutrition\u003c/em\u003e. 2021;40(3):860-869.\u003c/li\u003e\n\u003cli\u003eFeinstein MJ, Hsue PY, Benjamin LA, et al. Characteristics, Prevention, and Management of Cardiovascular Disease in People Living With HIV: A Scientific Statement From the American Heart Association. \u003cem\u003eCirculation (New York, NY)\u003c/em\u003e. 2019;140(2):e98-e124. doi:10.1161/cir.0000000000000695\u003c/li\u003e\n\u003cli\u003eDrewnowski A, Henderson SA, Shore A, Fischler C, Preziosi P, Hercberg S. Diet Quality and Dietary Diversity in France: Implications for the French Paradox. \u003cem\u003eJournal of the American Dietetic Association\u003c/em\u003e. 1996;96(7):663-669. doi:10.1016/S0002-8223(96)00185-X\u003c/li\u003e\n\u003cli\u003eAlkerwi Aa. Diet quality concept. \u003cem\u003eNutrition\u003c/em\u003e. 2014/06/01/ 2013;30(6):613-618. doi:https://doi.org/10.1016/j.nut.2013.10.001\u003c/li\u003e\n\u003cli\u003eMiller V, Webb P, Micha R, Mozaffarian D. Defining diet quality: a synthesis of dietary quality metrics and their validity for the double burden of malnutrition. \u003cem\u003eThe Lancet Planetary Health\u003c/em\u003e. 2020/08/01/ 2020;4(8):e352-e370. doi:https://doi.org/10.1016/S2542-5196(20)30162-5\u003c/li\u003e\n\u003cli\u003eFransen PH, Ock\u0026eacute; CM. Indices of diet quality. \u003cem\u003eCurrent Opinion in Clinical Nutrition and Metabolic Care\u003c/em\u003e. 2008;11(5):559-565. doi:10.1097/MCO.0b013e32830a49db\u003c/li\u003e\n\u003cli\u003eReedy J, Lerman JL, Krebs-Smith SM, et al. Evaluation of the Healthy Eating Index-2015. \u003cem\u003eJournal of the Academy of Nutrition and Dietetics\u003c/em\u003e. 2018;118(9):1622-1633. doi:10.1016/j.jand.2018.05.019\u003c/li\u003e\n\u003cli\u003eGuenther P, Kirkpatrick S, Reedy J, et al. The Healthy Eating Index-2010 Is a Valid and Reliable Measure of Diet Quality According to the 2010 Dietary Guidelines for Americans1-3. \u003cem\u003eThe Journal of Nutrition\u003c/em\u003e. 2014;144(3):399-407. doi:10.3945/jn.113.183079\u003c/li\u003e\n\u003cli\u003eKrebs-Smith SM, Pannucci TE, Subar AF, et al. Update of the Healthy Eating Index: HEI-2015. \u003cem\u003eJournal of the Academy of Nutrition and Dietetics\u003c/em\u003e. 2018;118(9):1591-1602. doi:10.1016/j.jand.2018.05.021\u003c/li\u003e\n\u003cli\u003eTrichopoulou A, Kouris-Blazos A, Wahlqvist ML, et al. Diet And Overall Survival In Elderly People. \u003cem\u003eBMJ: British Medical Journal\u003c/em\u003e. 1995;311(7018):1457-1460.\u003c/li\u003e\n\u003cli\u003ePatterson RE, Haines PS, Popkin BM. Diet quality index: Capturing a multidimensional behavior. \u003cem\u003eJournal of the American Dietetic Association\u003c/em\u003e. 1994;94(1):57-64. doi:10.1016/0002-8223(94)92042-7\u003c/li\u003e\n\u003cli\u003eKim S, Haines PS, Siega-Riz AM, Popkin BM. The Diet Quality Index-International (DQI-I) provides an effective tool for cross-national comparison of diet quality as illustrated by China and the United States. \u003cem\u003eThe Journal of nutrition\u003c/em\u003e. 2003;133(11):3476-3484.\u003c/li\u003e\n\u003cli\u003eBhattacharjee NV, Schumacher AE, Aali A, et al. Global fertility in 204 countries and territories, 1950\u0026ndash;2021, with forecasts to 2100: a comprehensive demographic analysis for the Global Burden of Disease Study 2021. Article. \u003cem\u003eThe Lancet\u003c/em\u003e. 2024;403(10440):2057-2099. doi:10.1016/S0140-6736(24)00550-6\u003c/li\u003e\n\u003cli\u003eJayawardena R, Byrne N, Soares M, Katulanda P, Yadav B, Hills AP. High dietary diversity is associated with obesity in Sri Lankan adults: an evaluation of three dietary scores. \u003cem\u003eBmc Public Health\u003c/em\u003e. 2013;13doi:10.1186/1471-2458-13-314\u003c/li\u003e\n\u003cli\u003eHatl\u0026oslash;y A, Torheim LE, Oshaug A. Food variety--a good indicator of nutritional adequacy of the diet? A case study from an urban area in Mali, West Africa. \u003cem\u003eEuropean journal of clinical nutrition\u003c/em\u003e. 1998;52(12):891. doi:10.1038/sj.ejcn.1600662\u003c/li\u003e\n\u003cli\u003eFung T, Chiuve S, McCullough M, Rexrode K, Logroscino G, Hu F. Adherence to a DASH-Style diet and risk of coronary heart disease and stroke in women. \u003cem\u003eArchives Of Internal Medicine\u003c/em\u003e. 2008;168(7):713-720.\u003c/li\u003e\n\u003cli\u003eShivappa N, Steck SE, Hurley TG, et al. A population-based dietary inflammatory index predicts levels of C-reactive protein in the Seasonal Variation of Blood Cholesterol Study (SEASONS). 2014;17(8):1825-1833. doi:10.1017/S1368980013002565\u003c/li\u003e\n\u003cli\u003eOlstad D, Campbell N, Raine K. Diet quality in Canada: policy solutions for equity. \u003cem\u003eCanadian Medical Association Journal\u003c/em\u003e. 2019;191(4):E100-E102. doi:10.1503/cmaj.180938\u003c/li\u003e\n\u003cli\u003eEaton LA, Cain DN, Pitpitan EV, et al. Exploring the relationships among food insecurity, alcohol use, and sexual risk taking among men and women living in South African townships. \u003cem\u003eThe Journal of Primary Prevention\u003c/em\u003e. 2014;35(4):255-265. doi:10.1007/s10935-014-0346-3\u003c/li\u003e\n\u003cli\u003eGoosen A, Venter D, Beeforth M, et al. Food insecurity among students living with HIV: Strengthening safety nets at the Nelson Mandela Metropolitan University, South Africa. \u003cem\u003eSahara Journal of the Social Aspects of HIV/AIDS\u003c/em\u003e. 01/01/ 2016;13(1):106-111.\u003c/li\u003e\n\u003cli\u003eFAO, IFAD, UNICEF, WFP, WHO. \u003cem\u003eThe State of Food Security and NUtrition in the World 2020\u003c/em\u003e. The State of Food Security and NUtrition in the World (SOFI). FAO, IFAD, UNICEF, WFP, WHO; 2020:320.\u003c/li\u003e\n\u003cli\u003eMuhammad J, Fernandez J, Clay O, Saag M, Overton E, Willig A. Associations of food insecurity and psychosocial measures with diet quality in adults aging with HIV. \u003cem\u003eAIDS care\u003c/em\u003e. 2019;31(5):554-562.\u003c/li\u003e\n\u003cli\u003eHanson K, Connor L. Food insecurity and dietary quality in US adults and children: a systematic review. \u003cem\u003eAmerican Journal Of Clinical Nutrition\u003c/em\u003e. 2014;100(2):684-692. doi:10.3945/ajcn.114.084525\u003c/li\u003e\n\u003cli\u003eHenderson C. Study Results from International Food Policy Research Institute Provide New Insights into Public Health (Food access and diet quality independently predict nutritional status among people living with HIV in Uganda). \u003cem\u003eAIDS Weekly\u003c/em\u003e. 2013:a70.\u003c/li\u003e\n\u003cli\u003eCafiero C, Melgar‐Qui\u0026ntilde;onez HR, Ballard TJ, Kepple AW. Validity and reliability of food security measures. \u003cem\u003eAnnals of the New York Academy of Sciences\u003c/em\u003e. 2014;1331(1):230-248. doi:10.1111/nyas.12594\u003c/li\u003e\n\u003cli\u003eProgramme WF. Food consumption analysis: Calculation and use of the food consumption score in food security analysis. World Food Programme Rome, Italy; 2008.\u003c/li\u003e\n\u003cli\u003eSwindale A, Bilinsky P. Household dietary diversity score (HDDS) for measurement of household food access: indicator guide. \u003cem\u003eWashington, DC: Food and Nutrition Technical Assistance Project, Academy for Educational Development\u003c/em\u003e. 2006;\u003c/li\u003e\n\u003cli\u003eBickel G, Nord M, Price C, Hamilton W, Cook J. Guide to measuring household food security. Revised; 2000.\u003c/li\u003e\n\u003cli\u003eAhmadi D, Melgar-Qui\u0026ntilde;onez H. Use of the Food Insecurity Experience Scale to assess food security status in Ireland, 2014\u0026ndash;17: a cross-sectional analysis. \u003cem\u003eThe Lancet\u003c/em\u003e. 2018;392:S16-S16. doi:10.1016/S0140-6736(18)32868-X\u003c/li\u003e\n\u003cli\u003eOyetunji IO, Duncan A, Booley S, Harbron J. Diet quality, food insecurity and risk of cardiovascular diseases among adults living with HIV/AIDS: a scoping review protocol. \u003cem\u003eBMJ Open\u003c/em\u003e. Oct 12 2021;11(10):e047314. doi:10.1136/bmjopen-2020-047314\u003c/li\u003e\n\u003cli\u003eArksey H, O\u0026apos;Malley L. Scoping studies: towards a methodological framework. \u003cem\u003eInternational Journal of Social Research Methodology\u003c/em\u003e. 2005;8(1):19-32. doi:10.1080/1364557032000119616\u003c/li\u003e\n\u003cli\u003eLevac D, Colquhoun H, O\u0026apos;Brien KK. Scoping studies: advancing the methodology. \u003cem\u003eImplementation science\u003c/em\u003e. 2010;5(1):69.\u003c/li\u003e\n\u003cli\u003ePeters MD, Godfrey C, McInerney P, Baldini Soares C, Khalil H, Parker D. Chapter 11: scoping reviews. \u003cem\u003eJoanna Briggs Institute Reviewer\u0026apos;s Manual The Joanna Briggs Institute\u003c/em\u003e. 2017;\u003c/li\u003e\n\u003cli\u003eOduwole EO, Pienaar ED, Mahomed H, Wiysonge CS. Current tools available for investigating vaccine hesitancy: a scoping review protocol. \u003cem\u003eBMJ Open\u003c/em\u003e. 2019;9(12)doi:10.1136/bmjopen-2019-033245\u003c/li\u003e\n\u003cli\u003ePau AK, George JM. Antiretroviral Therapy. \u003cem\u003eInfectious Disease Clinics of North America\u003c/em\u003e. 2014;28(3):371-402. doi:10.1016/j.idc.2014.06.001\u003c/li\u003e\n\u003cli\u003eWeldehaweria NB, Abreha EH, Weldu MG, Misgina KH. Psychosocial correlates of nutritional status among people living with HIV on antiretroviral therapy: A matched case-control study in Central zone of Tigray, Northern Ethiopia. Article. \u003cem\u003ePLoS ONE\u003c/em\u003e. 2017;12(3)e0174082. doi:10.1371/journal.pone.0174082\u003c/li\u003e\n\u003cli\u003eOuzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan \u0026mdash; a web and mobile app for systematic reviews. \u003cem\u003eSystematic Reviews\u003c/em\u003e. 2016;(5):210. doi:10.1186/s13643-016-0384-4\u003c/li\u003e\n\u003cli\u003eJoy T, Keogh HM, Hadigan C, et al. Dietary fat intake and relationship to serum lipid levels in HIV-infected patients with metabolic abnormalities in the HAART era. \u003cem\u003eAids\u003c/em\u003e. Jul-31 2007;21(12):1591-600.\u003c/li\u003e\n\u003cli\u003eOsuna-Padilla IA, Brice\u0026ntilde;o O, Aguilar-Vargas A, et al. Zinc and selenium indicators and their relation to immunologic and metabolic parameters in male patients with human immunodeficiency virus. \u003cem\u003eNutrition\u003c/em\u003e. 2020/02/01/ 2020;70:110585. doi:https://doi.org/10.1016/j.nut.2019.110585\u003c/li\u003e\n\u003cli\u003ePastor-Ib\u0026aacute;\u0026ntilde;ez R, Blanco-Heredia J, Etcheverry F, et al. Adherence to a Supplemented Mediterranean Diet Drives Changes in the Gut Microbiota of HIV-1-Infected Individuals. \u003cem\u003eNutrients\u003c/em\u003e. Mar 30 2021;13(4)doi:10.3390/nu13041141\u003c/li\u003e\n\u003cli\u003eDuncan AD, Peters BS, Rivas C, Goff L. Reducing risk of type 2 diabetes in HIV: a mixed‐methods investigation of the STOP‐diabetes diet and physical activity intervention. \u003cem\u003eDiabetic Medicine\u003c/em\u003e. 2020;37(10):1705-1714.\u003c/li\u003e\n\u003cli\u003eHarris TG, Fl\u0026ouml;ren S, Mantell JE, et al. HIV and aging among adults aged 50 years and older on antiretroviral therapy in Eswatini. \u003cem\u003eAfr J AIDS Res\u003c/em\u003e. Mar 2021;20(1):107-115. doi:10.2989/16085906.2021.1887301\u003c/li\u003e\n\u003cli\u003eNoble CA. \u003cem\u003eLeast of My Worries: Food Security, Diet Quality, and Antiretroviral Adherence among People Living with HIV\u003c/em\u003e. University of South Florida; 2019.\u003c/li\u003e\n\u003cli\u003eUpreti D. \u003cem\u003eDiet and nutritional assessment of people living with HIV/AIDS in Nepal (Kathmandu Valley and Terai Highway)\u003c/em\u003e. University of Aberdeen; 2014.\u003c/li\u003e\n\u003cli\u003eWebel A, Davey CH, Schexnayder J, et al. Impact of perceived cardiovascular risk on cardiovascular disease prevention behaviors in people with and without HIV infection. \u003cem\u003eJAIDS Journal of Acquired Immune Deficiency Syndromes\u003c/em\u003e. 2020;83(5):513-521.\u003c/li\u003e\n\u003cli\u003eCapili B, Anastasi JK. Body mass index and nutritional intake in patients with HIV and chronic diarrhea: A secondary analysis. \u003cem\u003eJournal of the American Academy of Nurse Practitioners\u003c/em\u003e. 2008 2008;20(9):463-470.\u003c/li\u003e\n\u003cli\u003ePolicarpo S, Rodrigues T, Moreira AC, Valadas E. Adherence to Mediterranean diet in HIV infected patients: Relation with nutritional status and cardiovascular risk. \u003cem\u003eClin Nutr ESPEN\u003c/em\u003e. Apr 2017;18:31-36.\u003c/li\u003e\n\u003cli\u003eSilva EF, Lewi DS, Vedovato GM, Garcia VR, Tenore SB, Bassichetto KC. Nutritional and clinical status, and dietary patterns of people living with HIV/AIDS in ambulatory care in Sao Paulo, Brazil. \u003cem\u003eRev Bras Epidemiol\u003c/em\u003e. Dec 2010;13(4):677-88.\u003c/li\u003e\n\u003cli\u003eTurcinov D, Stanley C, Canchola JA, Rutherford GW, Novotny TE, Begovac J. Dyslipidemia and adherence to the Mediterranean diet in Croatian HIV-infected patients during the first year of highly active antiretroviral therapy. \u003cem\u003eColl Antropol\u003c/em\u003e. Jun 2009;33(2):423-30.\u003c/li\u003e\n\u003cli\u003eFletcher AA, Durieux JC, Bederman I, et al. Associations of Plasma Erythritol with Dietary Factors, Cardiometabolic, Inflammatory, and Gut Health Markers in People with and without HIV: A Cross-Sectional Study. \u003cem\u003eNutrients\u003c/em\u003e. 2024;16(20):3449.\u003c/li\u003e\n\u003cli\u003eMacCann R, Li J, Leon AAG, et al. Associations between the gut microbiome, inflammation, and cardiovascular profiles in people with human immunodeficiency virus. \u003cem\u003eThe Journal of Infectious Diseases\u003c/em\u003e. 2025;231(4):e781-e791.\u003c/li\u003e\n\u003cli\u003eTilahun H, Masyuko SJ, Mogaka JN, et al. Prevalence and correlates of dyslipidemia in HIV positive and negative adults in Western Kenya: a cross-sectional study. \u003cem\u003eMedicine\u003c/em\u003e. 2021;100(10):e24800.\u003c/li\u003e\n\u003cli\u003eGavrila A, Tsiodras S, Doweiko J, et al. Exercise and vitamin E intake are independently associated with metabolic abnormalities in human immunodeficiency virus-positive subjects: a cross-sectional study. \u003cem\u003eClin Infect Dis\u003c/em\u003e. Jun-15 2003;36(12):1593-601.\u003c/li\u003e\n\u003cli\u003eHadigan C, Jeste S, Anderson EJ, Tsay R, Cyr H, Grinspoon S. Modifiable dietary habits and their relation to metabolic abnormalities in men and women with human immunodeficiency virus infection and fat redistribution. \u003cem\u003eClin Infect Dis\u003c/em\u003e. Sep-1 2001;33(5):710-7.\u003c/li\u003e\n\u003cli\u003eHendricks KM, Jones CY, Hendricks KM, Houser R, Hendricks KM, Willis K. Obesity in HIV-Infection: Dietary Correlates. \u003cem\u003eJournal of the American College of Nutrition\u003c/em\u003e. 2006 2006;25(4):321-331.\u003c/li\u003e\n\u003cli\u003eShah M, Tierney K, Adams-Huet B, et al. The role of diet, exercise and smoking in dyslipidaemia in HIV-infected patients with lipodystrophy. \u003cem\u003eHIV Med\u003c/em\u003e. Jul 2005;6(4):291-8.\u003c/li\u003e\n\u003cli\u003eSirotin N, Hoover DR, Shi Q, Anastos K, Weiser SD. Food insecurity with hunger is associated with obesity among HIV-infected and at risk women in Bronx, NY. \u003cem\u003ePLoS One\u003c/em\u003e. 2014 2014;9(8):e105957.\u003c/li\u003e\n\u003cli\u003eTsiodras S, Poulia KA, Yannakoulia M, et al. Adherence to Mediterranean diet is favorably associated with metabolic parameters in HIV-positive patients with the highly active antiretroviral therapy-induced metabolic syndrome and lipodystrophy. \u003cem\u003eMetabolism\u003c/em\u003e. Jun 2009;58(6):854-9.\u003c/li\u003e\n\u003cli\u003eWebel A, Horvat Davey C, Schexnayder J, et al. Impact of Perceived Cardiovascular Risk on Cardiovascular Disease Prevention Behaviors in People With and Without HIV Infection. \u003cem\u003eJournal of acquired immune deficiency syndromes (1999)\u003c/em\u003e. 2020 2020;83(5):513-521.\u003c/li\u003e\n\u003cli\u003eWright L, Epps JB. Nutrition Risk and Complications in HIV/AIDS. \u003cem\u003eTopics in Clinical Nutrition\u003c/em\u003e. 2014 2014;29(4):288-293.\u003c/li\u003e\n\u003cli\u003eValerio LA, Rzepka MC, Davy-Mendez T, et al. Food Insecurity Prevalence and Risk Factors among Persons with HIV in a Southeastern US Clinical Care Setting. \u003cem\u003eAIDS and Behavior\u003c/em\u003e. 2025;29(1):45-54.\u003c/li\u003e\n\u003cli\u003eda Cunha GH, Franco KB, Galv\u0026atilde;o MTG, et al. Diabetes mellitus in people living with HIV/AIDS: prevalence and associated risk factors. \u003cem\u003eAIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV\u003c/em\u003e. 2020 2020;32(5):600-607.\u003c/li\u003e\n\u003cli\u003eda Silva TA, Barboza RR, de Andrade RD, et al. Relationship between dietary intake and use of protease inhibitors with anthropometric and biochemical parameters of lipodystrophy in people living with hiv. \u003cem\u003eNutr Hosp\u003c/em\u003e. Oct-1 2014;30(4):935-40.\u003c/li\u003e\n\u003cli\u003eLeite LH, Sampaio AB. Dietary calcium, dairy food intake and metabolic abnormalities in HIV-infected individuals. \u003cem\u003eJ Hum Nutr Diet\u003c/em\u003e. Oct 2010;23(5):535-43.\u003c/li\u003e\n\u003cli\u003eVercesi BF, Moscardini IS, Esteves GP, Beraldo RA. Patients living with HIV have quantitatively inadequate food consumption. \u003cem\u003eArchives of Endocrinology and Metabolism\u003c/em\u003e. 2023;67(5):e000623.\u003c/li\u003e\n\u003cli\u003eTurcinov D, Begovac J. Predicted coronary heart disease risk in croatian HIV infected patients treated with combination antiretroviral therapy. \u003cem\u003eColl Antropol\u003c/em\u003e. Mar 2011;35(1):115-21.\u003c/li\u003e\n\u003cli\u003eVi\u0026scaron;ković K, Rutherford GW, Stemberger L, Brnić Z, Begovac J. Ultrasound measurements of carotid intima-media thickness and plaque in HIV-infected patients on the Mediterranean diet. \u003cem\u003eCroatian medical journal\u003c/em\u003e. 2013;54(4):330-338.\u003c/li\u003e\n\u003cli\u003eDominguez-Dominguez L, Campbell L, Barbini B, et al. Associations between social determinants of health and comorbidity and multimorbidity in people of black ethnicities with HIV. \u003cem\u003eAIDS\u003c/em\u003e. 2024;38(6)\u003c/li\u003e\n\u003cli\u003eChhoun P, Tuot S, Harries AD, et al. High prevalence of non-communicable diseases and associated risk factors amongst adults living with HIV in Cambodia. \u003cem\u003ePLoS ONE\u003c/em\u003e. 2017 2017;12(11)\u003c/li\u003e\n\u003cli\u003eChhounPheak, Ngin C, Tuot S, et al. Non-communicable diseases and related risk behaviors among men and women living with HIV in Cambodia: findings from a cross-sectional study. \u003cem\u003eInternational journal for equity in health\u003c/em\u003e. 01-01 2017;16(1):125-125.\u003c/li\u003e\n\u003cli\u003eDye CK, Wu H, Jackson GL, et al. Epigenetic aging in older people living with HIV in Eswatini: a pilot study of HIV and lifestyle factors and epigenetic aging. \u003cem\u003eClinical Epigenetics\u003c/em\u003e. 2024;16(1):32.\u003c/li\u003e\n\u003cli\u003ePoudel-T, ukar K. Dietary B vitamins and depression in persons with human immunodeficiency virus infection: The positive living with HIV (POLH) study. \u003cem\u003eJournal of Nutritional Science and Vitaminology\u003c/em\u003e. 2016 2016;62(6):388-396.\u003c/li\u003e\n\u003cli\u003eJantarapakde J, Phanuphak N, Chaturawit C, et al. Prevalence of metabolic syndrome among antiretroviral-naive and antiretroviral-experienced HIV-1 infected Thai adults. \u003cem\u003eAIDS Patient Care STDS\u003c/em\u003e. Jul 2014;28(7):331-40.\u003c/li\u003e\n\u003cli\u003ePongthananikorn S, Jantarathaneewat K, Somnikha P, Jaturapullarp S, Meksawan K. Prevalence and Risk Factors of Metabolic Syndrome in HIV-Infected Patients Receiving the Highly Active Antiretroviral Therapy. \u003cem\u003eTopics in Clinical Nutrition\u003c/em\u003e. Jan-Mar 2018;33(1):41-49.\u003c/li\u003e\n\u003cli\u003eSamaras K, H, Law M, Emery S, Cooper DA, Carr A. Dietary intake in HIV-infected men with lipodystrophy: Relationships with body composition, visceral fat, lipid, glucose and adipokine metabolism. \u003cem\u003eCurrent HIV Research\u003c/em\u003e. 2009 2009;7(4):456-461.\u003c/li\u003e\n\u003cli\u003eArendt BM, Aghdassi E, Mohammed SS, et al. Dietary intake and physical activity in a Canadian population sample of male patients with HIV infection and metabolic abnormalities. \u003cem\u003eCurr HIV Res\u003c/em\u003e. Jan 2008;6(1):82-90.\u003c/li\u003e\n\u003cli\u003eForoozanfar Z, Hooshyar D, Joulaei H. Psychosocial predictors of quality of life among women living with HIV/AIDS: a cross-sectional study in a VCT centre in Shiraz, Iran. \u003cem\u003eQuality of Life Research\u003c/em\u003e. 2024;33(4):1063-1073.\u003c/li\u003e\n\u003cli\u003eMuronya W, Sanga E, Talama G, Kumwenda JJ, Van Oosterhout JJ. Cardiovascular risk factors in adult Malawians on long-term antiretroviral therapy. \u003cem\u003eTransactions of the Royal Society of Tropical Medicine and Hygiene\u003c/em\u003e. 2011 2011;105(11):644-649.\u003c/li\u003e\n\u003cli\u003eHejazi N, Huang MS, Lin KG, Choong LC. Hypertension among HIV-infected adults receiving highly active antiretroviral therapy (HAART) in Malaysia. \u003cem\u003eGlob J Health Sci\u003c/em\u003e. Dec-1 2013;6(2):58-71.\u003c/li\u003e\n\u003cli\u003eJackiewicz A, Czarnecki M, Przeliorz-Pyszczek A, Knysz B. Effect of fatty acid content in the diet on lipid profile in HIV-infected patients treated with antiretroviral drugs. \u003cem\u003eHiv \u0026amp; Aids Review\u003c/em\u003e. 2019 2019;18(1):25-32.\u003c/li\u003e\n\u003cli\u003eKamkuemah M, Gausi B, Oni T. High prevalence of multimorbidity and non-communicable disease risk factors in South African adolescents and youth living with HIV: Implications for integrated prevention. \u003cem\u003eSouth African Medical Journal\u003c/em\u003e. 2022;112(4):259-267.\u003c/li\u003e\n\u003cli\u003eKazooba P, Kasamba I, Mayanja BN, et al. Cardiometabolic risk among HIV-POSITIVE Ugandan adults: prevalence, predictors and effect of long-term antiretroviral therapy. \u003cem\u003eThe Pan African medical journal\u003c/em\u003e. 01-01 2017;27(1):40-40.\u003c/li\u003e\n\u003cli\u003eFitch KV, McCallum SA, Erlandson KM, et al. Diet in a global cohort of adults with HIV at low-to-moderate traditional cardiovascular disease risk. \u003cem\u003eAids\u003c/em\u003e. 2022;36(14):1997-2003.\u003c/li\u003e\n\u003cli\u003eTurčinov D, Begovac J. Predicted coronary heart disease risk in croatian HIV infected patients treated with combination antiretroviral therapy. \u003cem\u003eCollegium antropologicum\u003c/em\u003e. 2011;35(1):115-121.\u003c/li\u003e\n\u003cli\u003eTurčinov D, Stanley C, Canchola JA, Rutherford GW, Novotny TE, Begovac J. Dyslipidemia and adherence to the Mediterranean diet in Croatian HIV-infected patients during the first year of highly active antiretroviral therapy. \u003cem\u003eCollegium antropologicum\u003c/em\u003e. 2009;33(2):423-430.\u003c/li\u003e\n\u003cli\u003eKassebaum NJ, Arora M, Barber RM, et al. Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990\u0026ndash;2015: a systematic analysis for the Global Burden of Disease Study 2015. Article. \u003cem\u003eThe Lancet\u003c/em\u003e. 2016;388(10053):1603-1658. doi:10.1016/S0140-6736(16)31460-X\u003c/li\u003e\n\u003cli\u003eHutchinson JM, Raffoul A, Pepetone A, et al. Advances in methods for characterising dietary patterns: a scoping review. \u003cem\u003eBritish Journal of Nutrition\u003c/em\u003e. 2024:1-15.\u003c/li\u003e\n\u003cli\u003eClarke ED, Ferguson JJ, Stanford J, Collins CE. Dietary assessment and metabolomic methodologies in human feeding studies: a scoping review. \u003cem\u003eAdvances in Nutrition\u003c/em\u003e. 2023;14(6):1453-1465.\u003c/li\u003e\n\u003cli\u003eChan VWK, Gebretsadik GG, Panchal P, et al. Evolving Research Focus on Diet and Cardiovascular Disease: A Systematic Review of 298 Cohort Studies Published from 2019 to 2024. \u003cem\u003eNutrients\u003c/em\u003e. 2025;17(13):2126.\u003c/li\u003e\n\u003cli\u003eCoulston AM. The search continues for a tool to evaluate dietary quality. \u003cem\u003eThe American journal of clinical nutrition\u003c/em\u003e. 2001;74(4):417. doi:10.1093/ajcn/74.4.417\u003c/li\u003e\n\u003cli\u003ePaudel M, Prajapati G, Buysman EK, et al. Comorbidity and comedication burden among people living with HIV in the United States. \u003cem\u003eCurr Med Res Opin\u003c/em\u003e. Aug 2022;38(8):1443-1450. doi:10.1080/03007995.2022.2088714\u003c/li\u003e\n\u003cli\u003eWebel AR, Schexnayder J, Cioe PA, Zu\u0026ntilde;iga JA. A Review of Chronic Comorbidities in Adults Living With HIV: State of the Science. \u003cem\u003eJ Assoc Nurses AIDS Care\u003c/em\u003e. May-Jun 01 2021;32(3):322-346. doi:10.1097/jnc.0000000000000240\u003c/li\u003e\n\u003cli\u003eChowdhury SR, Das DC, Sunna TC, Beyene J, Hossain A. Global and regional prevalence of multimorbidity in the adult population in community settings: a systematic review and meta-analysis. \u003cem\u003eEClinicalMedicine\u003c/em\u003e. 2023;57\u003c/li\u003e\n\u003cli\u003eMills KT, Bundy JD, Kelly TN, et al. Global Disparities of Hypertension Prevalence and Control: A Systematic Analysis of Population-Based Studies From 90 Countries. \u003cem\u003eCirculation\u003c/em\u003e. Aug 9 2016;134(6):441-50. doi:10.1161/circulationaha.115.018912\u003c/li\u003e\n\u003cli\u003eGutierrez J, Albuquerque ALA, Falzon L. HIV infection as vascular risk: a systematic review of the literature and meta-analysis. \u003cem\u003ePloS one\u003c/em\u003e. 2017;12(5):e0176686. \u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 and 2 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"HIV infections, diet quality, food insecurity, cardiovascular diseases","lastPublishedDoi":"10.21203/rs.3.rs-7463524/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7463524/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe introduction of antiretroviral therapy reduced HIV mortality, but was followed by increased comorbidities, including hypertension and dyslipidemia. A higher quality diet can delay the onset of comorbidities related to HIV infection. Diet quality measures are not established among People Living with HIV (PLWH). This review identified the diet quality and food insecurity indices used among PLWH and their associations with risk of cardiovascular diseases (CVD). We used recommendations from Arksey and O’Malley, the Joanna Briggs Institute’s manual, and the Preferred Reporting Items for Systematic review and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. A preliminary search was conducted on MEDLINE to develop a comprehensive search strategy. The final search was conducted on PubMed, EbscoHost, Scopus, Web of Science and COCHRANE library databases, and review conducted by two independent reviewers. Of 1094 retrieved records, 46 passed full text screening. Forty-two were cross-sectional, thirteen in the United States. Seven studies assessed food security; all indicated a high level of food insecurity. One study used the Healthy Eating Index, and six used Mediterranean Diet Score to assess diet quality with varying outcomes. Other studies compared dietary intake with various dietary guidelines. Hypertension, diabetes, obesity, and dyslipidemia were the most reported risk for CVD, with varying degrees of association with diet. Diet quality is not widely explored among PLWH, studies assessing this use heterogenous methods making it difficult to compare and summarize findings. There is evidence of association between diet and CVD among PLWH, but we need standardized methods to study this association.\u003c/p\u003e","manuscriptTitle":"Diet Quality, Food Insecurity and Risk of Cardiovascular Diseases Among Adults Living with Hiv/Aids: A Scoping Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-01 09:06:31","doi":"10.21203/rs.3.rs-7463524/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-12T20:15:37+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-28T07:01:11+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-28T06:58:24+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Public Health","date":"2025-08-26T13:30:42+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2727dba2-7aff-4b58-b22a-10941c1eef40","owner":[],"postedDate":"September 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-02-23T16:00:12+00:00","versionOfRecord":{"articleIdentity":"rs-7463524","link":"https://doi.org/10.1186/s12982-026-01602-0","journal":{"identity":"discover-public-health","isVorOnly":false,"title":"Discover Public Health"},"publishedOn":"2026-02-22 15:57:00","publishedOnDateReadable":"February 22nd, 2026"},"versionCreatedAt":"2025-09-01 09:06:31","video":"","vorDoi":"10.1186/s12982-026-01602-0","vorDoiUrl":"https://doi.org/10.1186/s12982-026-01602-0","workflowStages":[]},"version":"v1","identity":"rs-7463524","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7463524","identity":"rs-7463524","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}