Objective: The improved understanding of the pathogenesis of HIV and the use of highly active antiretroviral therapy (HAART) to treat it has substantially reduced mortality and morbidity in HIV infected adults and even prompted speculation that a cure was within reach. Recently this optimism has been diminished by the report of persistence of HIV transcription despite long-term viral suppression and the emergence of new constellations of side effects and symptoms. One syndrome, HIV-1 related lipodystrophy (fat redistribution), includes peripheral wasting (lipoatrophy), marked visceral adiposity, lipid abnormalities, hyperinsulinemia and/or hyperglycemia and puts patients at risk for cardiovascular disease, diabetes, pancreatitis and it may influence patient adherence to therapy. In addition, we have new evidence that HAART may contribute to the development of osteopenia. Knowing that a cure may be years in the future, the management of HAART-related side effects and symptoms has taken on new importance and underscores the need to examine strategies that may prevent, attenuate or alleviate them. The purposes of this paper are to compare the effects of an exercise intervention on physical functioning, fat mass, lean mass, and measures of fatigue in HIV infected adults who are HAART naïve with those who are on HAART and to present data comparing HIV infected women on HAART to matched HIV negative controls as additional rationale for an intervention that will reduce central adiposity, improve blood lipids, decrease fasting glucose and insulin, and increase bone density.
Study 1 Methods: The study was a randomized clinical trial of exercise in HIV-1 infected adults. Experimental subjects completed a 12-week supervised exercise program. Control subjects continued usual activity to week 12. There were an equal number of subjects on HAART in both groups. Findings: Despite relatively low physical functioning at baseline exercise subjects increased physical functioning, lost weight, decreased abdominal girth and reported less fatigue when compared to controls. There was no significant difference in CD4+ cells/mm3 or HIV RNA between groups. Conclusions: Exercise safely improves physical functioning, improves body composition measures and decreases fatigue in HIV-1 infected individuals on HAART as well as those who are HAART naive.
Study 2 Methods: We compared fat mass, lean mass, and bone density using DEXA, and abdominal adipose tissue using CT, in 20 HIV-1 infected women on HAART with 20 HIV-1 negative matched controls Findings: Despite the fact that BMI, total fat and subcutaneous abdominal adipose tissue were similar, the HIV infected women had almost twice the visceral adipose tissue and the HIV infected Caucasian women had significantly lower bone density when compared to their non-infected controls. Conclusions: Use of common clinical measures of body composition such as height, weight, BMI and skin folds may not be appropriate in HIV-related lipodystrophy. More sophisticated measures of fat distribution along with DEXA technology to assess bone density, may need to be incorporated into the care of HIV infected adults.
Implications: Body composition and bone density data in HIV infected adults from our lab and lipid, insulin and glucose data from others support the need for further investigation of an intervention in HIV infected adults that integrates physical activities intended to increase physical functioning (moderate intensity aerobic activity), physical activities that will increase cross-sectional area of muscle and increase bone density (resistive activity), and a nutrition component aimed at helping patients achieve a healthy weight. This intervention would be consistent with the Healthy People 2010 objectives and data could be used to develop evidence-based guidelines for advanced practice nurses and other health care professionals to assist patients in managing the lipodystrophy syndrome associated with HIV therapies.
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