Executive Summary: U.S. Conference on HIV/AIDS (USCHA) 2025 NIH Session: Lifestyle-Based Interventions for Prevention and Management of HIV-Associated Comorbidities

Introduction/Background

The National Institutes of Health (NIH) session “Lifestyle-Based Interventions for Prevention and Management of HIV-Associated Comorbidities” was held on September 5, 2025, during the U.S. Conference on HIV/AIDS (USCHA) in Washington, DC, organized by the NIH Office of AIDS Research (OAR) in collaboration with the National Heart, Lung, and Blood Institute (NHLBI), the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the National Institute on Drug Abuse (NIDA), and the National Institute on Mental Health (NIMH). The session convened NIH program staff, researchers, and community members to examine NIH-funded research efforts on lifestyle-based strategies to prevent and manage HIV-associated chronic comorbidities across the lifespan. Access to effective antiretroviral therapy (ART) enables people with HIV to live longer, but chronic comorbidities such as metabolic dysfunction, cardiovascular disease, chronic kidney disease, substance use, mental health disorders, geriatric issues, and multimorbidity have now become more common. This may be due to the combined influences of HIV, long-term ART use, and social and economic conditions.

Presentations from NIH leadership, experts, and researchers highlighted evidence-based strategies for physical activity, nutrition, smoking cessation, and social and peer support to aid in the prevention and management of HIV-associated comorbidities, along with implementation science approaches to translate research into practice. The session was moderated by Richard Adkins (Icons and Rising Stars), a lifetime survivor of HIV, who shared his experiences of getting diagnosed very young and living with HIV. Laying out the session objectives and expectations, Geetanjali Bansal, M.Sc., Ph.D., (OAR) stressed the need to integrate lifestyle approaches as core components of health and quality of life for people with HIV.

In her opening remarks, Geri Donenberg, Ph.D. (OAR) highlighted comprehensive HIV priorities that underscore NIH’s commitments to a research-to-practice continuum, strengthening workforce capacity, and supporting early-career investigators. She emphasized the need to adapt and bring evidence-based strategies to key communities like older adults with HIV that face unique challenges such as multimorbidity and social isolation.

Nutrition, Metabolism, and Food Access

Minnjuan Flournoy Floyd, Ph.D., M.P.H., M.B.A., NIDDK
Dr. Flournoy Floyd discussed how diet and physical activity influence diabetes and metabolic disorders in people with HIV, noting promising strategies such as medically tailored meals and “Food is Medicine” initiatives. She emphasized that integrating social and medical care and leveraging implementation science are essential for supporting people living and aging with HIV.

Community-Driven Nutrition Research

Marianna Wetherill, Ph.D., M.P.H., R.D.N/L.D., Dip.A.C.L.M., University of Oklahoma
Dr. Wetherill presented findings from a community-based project entitled Nutrition to Optimize, Understand, and Restore Insulin Sensitivity in HIV for Oklahoma (NOURISH-OK). Her findings revealed high levels of food insecurity, poor diet quality, undiagnosed diabetes, and mental health challenges among people with HIV. Participants emphasized distrust in food systems and preferred holistic interventions incorporating stress management and family support.

Implementation Science for Chronic Disease

Mary Masterson, Ph.D., M.S., NHLBI
Dr. Masterson highlighted the growing burden of non-communicable diseases as people with HIV live longer. The ImPlementation REsearCh to Develop interventions for People Living with HIV (PRECluDE) initiative funded multidisciplinary projects to improve care coordination and management of key issues related to heart health. She emphasized adapting evidence-based approaches for chronic disease management in real-world HIV care settings by fostering community partnerships to address complex comorbidities.

Integrating Heart Health into HIV Care

Mechelle Sanders, Ph.D., University of Rochester Medical Center
Dr. Sanders described a multisite trial aiming to integrate shared decision making to improve health practices within HIV care for adults at elevated cardiovascular risk (ABCS: Aspirin, Blood pressure, Cholesterol, Smoking cessation). The study demonstrated feasibility of tailored implementation strategies with improvements in diet and exercise and strong engagement with digital tools, showing the promise of technology-driven interventions.

Exercise as Medicine for Aging with HIV

Raymond Jones, Ph.D., University of Alabama at Birmingham
Dr. Jones highlighted the benefits of regular exercise for older adults with HIV. He presented evidence that exercise, especially high-intensity interval training, improves fitness and function in older people with HIV. He identified strategies to stay consistent with exercise, including starting small, making it enjoyable, and seeking community support.

Addressing Smoking, Substance Use, and Loneliness

Vasundhara Varthakavi, D.V.M., Ph.D., NIDA
Candace Webb, M.P.H., M.C.H.E.S., NIDA
Drs. Varthakavi and Webb focused on strategies to address smoking and loneliness that lead to poorer HIV outcomes and comorbidities. NIDA-supported research showed improved smoking quit rates with varenicline use, especially among fast nicotine metabolizers, thus underscoring the need for adherence support and personalized cessation strategies. They also emphasized that loneliness is a major modifiable risk factor for people with HIV, especially older adults, as it can predict frailty, depression, disrupted care, and substance-use relapse, while social support boosts ART adherence and recovery. They identified routine loneliness screening, integrating cessation and substance-use discussions, and embedding peer and community-based social-connection interventions as core elements of HIV care.

Conclusion/Next steps

The workshop underscored the importance of integrating evidence-based lifestyle interventions, community-driven approaches, and implementation science in the prevention and management of chronic conditions, particularly metabolic disorders, and improving the health and quality of life for people with HIV across the lifespan. Nutrition, physical activity, and sleep emerged as essential pillars of HIV care, alongside smoking cessation, strengthened social connection, and support for mental health. Key recommendations from the panel discussion and community Q&A included strengthening provider training, expanding community partnerships, addressing social and economic factors affecting health and quality of life, examining implications of policy changes, and incorporating de-implementation of ineffective practices. Meaningful, ongoing collaboration with community members and organizations across all stages of research will be central to developing sustainable, relevant, and impactful interventions and advancing HIV care across the lifespan.