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Balasubramanyam A, Coraza I, Smith EO, Scott LW, Patel P, Iyer D, Taylor AA, Giordano TP, Sekhar RV, Clark P, Cuevas-Sanchez E, Kamble S, Ballantyne CM, Pownall HJ. Combination of niacin and fenofibrate with lifestyle changes improves dyslipidemia and hypoadiponectinemia in HIV patients on antiretroviral therapy: results of "heart positive," a randomized, controlled trial. J Clin Endocrinol Metab 2011; 96:2236-47. [PMID: 21565796 PMCID: PMC3135191 DOI: 10.1210/jc.2010-3067] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
CONTEXT HIV patients on antiretroviral therapy (ART) have a unique dyslipidemia [elevated triglycerides and non-high-density lipoprotein-cholesterol (HDL-C), low HDL-C] with insulin resistance (characterized by hypoadiponectinemia). OBJECTIVE The aim was to test a targeted, comprehensive, additive approach to treating the dyslipidemia. DESIGN AND SETTING We conducted a randomized, double-blind, placebo-controlled, 24-wk trial of lifestyle modification, fenofibrate, and niacin in multiethnic HIV clinics at an academic center. PARTICIPANTS Hypertriglyceridemic adult patients were stratified on three combinations of ART classes. Subjects retained at the first measurement (2 wk) after entry were included in the analysis (n = 191). INTERVENTIONS Subjects were randomized into five treatment groups: usual care (group 1); low-saturated-fat diet and exercise (D/E; group 2); D/E + fenofibrate (group 3); D/E + niacin (group 4); or D/E + fenofibrate + niacin (group 5). MAIN OUTCOME MEASURES We measured changes in fasting triglycerides, HDL-C, and non-HDL-C (primary), and in insulin sensitivity, glycemia, adiponectin, C-reactive protein, energy expenditure, and body composition (secondary). Data were analyzed as a factorial set of treatment combinations using a mixed repeated measures model, last observation carried forward, and complete case approaches (groups 2-5), and as an unstructured set of treatments (groups 1-5). RESULTS Fenofibrate improved triglycerides (P = 0.002), total cholesterol (P = 0.02), and non-HDL-C (P = 0.003), whereas niacin improved HDL-C (P = 0.03), and both drugs decreased the total cholesterol-to-HDL-C ratio (P = 0.005-0.01). The combination of D/E, fenofibrate, and niacin provided maximal benefit, markedly reducing triglycerides (-52% compared to usual care; P = 0.003), increasing HDL-C (+12%; P < 0.001), and decreasing non-HDL-C (-18.5%; P = 0.003) and total cholesterol-to-HDL-C ratio (-24.5%; P < 0.001). Niacin doubled adiponectin levels. CONCLUSIONS A combination of fenofibrate and niacin with low-saturated-fat D/E is effective and safe in increasing HDL-C, decreasing non-HDL-C and hypertriglyceridemia, and ameliorating hypoadiponectinemia in patients with HIV/ART-associated dyslipidemia.
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Affiliation(s)
- Ashok Balasubramanyam
- Translational Metabolism Unit, Division of Diabetes, Endocrinology and Metabolism, Baylor College of Medicine, Houston, Texas 77030, USA.
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Ross AC, McComsey GA. Assessment and modification of cardiovascular disease risk in the HIV-infected individual. Future Virol 2011. [DOI: 10.2217/fvl.11.8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
HIV-infected patients are living decades longer than before owing to combination antiretroviral therapy. However, complications are emerging in this population at rates higher than the general population, including cardiovascular disease (CVD). HIV-infected patients have many traditional risk factors that account for a significant part of their increased risk of CVD. However, HIV factors, including complications from antiretroviral therapy and increased inflammation associated with chronic HIV infection, also play a role. Clinicians need to be ever-vigilant to calculate and help attenuate any modifiable CVD risk factors for each HIV-infected individual.
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Affiliation(s)
- Allison C Ross
- Children’s Healthcare of Atlanta, GA, USA; Department of Pediatrics, Division of Infectious Diseases, Emory University School of Medicine, Emory Children’s Center, 2015 Uppergate Drive NE, Atlanta, GA, 30322, USA
| | - Grace A McComsey
- University Hospitals Case Medical Center, OH, USA
- Case Western Reserve University, OH, USA
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Leite LHM, Sampaio ABDMM. Risco cardiovascular: marcadores antropométricos, clínicos e dietéticos em indivíduos infectados pelo vírus HIV. REV NUTR 2011. [DOI: 10.1590/s1415-52732011000100008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVO: Descrever marcadores antropométricos, clínicos e dietéticos associados ao risco cardiovascular em indivíduos infectados pelo vírus HIV. MÉTODOS: Realizou-se um estudo transversal com 100 indivíduos, adultos, com HIV/Aids, da cidade do Rio de Janeiro. O risco cardiovascular foi estimado pelo escore de risco de Framingham. O consumo alimentar foi avaliado por meio de um recordatório de 24 horas e de uma lista de frequência de consumo de alimentos. Para comparar variáveis, foram utilizados o teste t de Student e o teste Qui-quadrado. RESULTADOS: Dentre os indivíduos avaliados, 63% eram homens, com idade média de 41,8, DP=9,6 anos, 77% faziam uso de antirretrovirais. Escore de risco de Framingham >10% foi identificado em 53% dos indivíduos. Os principais fatores de risco cardiovascular potencialmente modificáveis identificados foram: lipoproteína de alta densidade baixo (70%), hipercolesterolemia (35%), hipertensão arterial (35%), seguidos de tabagismo (23%) e glicose alta (21%). Indivíduos com escore de risco de Framingham >10% apresentavam uma tendência para consumir dietas mais ricas em colesterol (p=0,720), em sódio (p=0,898), em açúcares/doces (p=0,032) e pobres em fibras (p=0,273), associadas a um maior consumo de bebidas alcoólicas (p=0,053). A avaliação dos hábitos de vida revelou maior prevalência de tabagismo e maior nível de sedentarismo no grupo com escore de risco de Framingham >10, porém não significativos. CONCLUSÃO: Os resultados deste estudo mostram que pacientes com HIV/Aids sob terapia Highly Active Antiretroviral Therapy e com mais altos escore de risco de Framingham não seguem as medidas preventivas contra doenças cardiovasculares e devem ser permanentemente encorajados a fazer escolhas alimentares saudáveis, parar de fumar e aumentar a atividade física.
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Almeida LB, Segurado AC, Duran ACF, Jaime PC. Impact of a nutritional counseling program on prevention of HAART-related metabolic and morphologic abnormalities. AIDS Care 2011; 23:755-63. [DOI: 10.1080/09540121.2010.525789] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Luara B. Almeida
- a School of Public Health , University of Sao Paulo, Avenida Doutor Arnaldo , São Paulo , Brazil
| | - Aluisio C. Segurado
- b Department of Infectious Diseases, School of Medicine , University of Sao Paulo , Sao Paulo , Brazil
| | - Ana Clara F. Duran
- a School of Public Health , University of Sao Paulo, Avenida Doutor Arnaldo , São Paulo , Brazil
| | - Patricia C. Jaime
- a School of Public Health , University of Sao Paulo, Avenida Doutor Arnaldo , São Paulo , Brazil
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Kalra S, Kalra B, Agrawal N, Unnikrishnan AG. Understanding diabetes in patients with HIV/AIDS. Diabetol Metab Syndr 2011; 3:2. [PMID: 21232158 PMCID: PMC3025836 DOI: 10.1186/1758-5996-3-2] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Accepted: 01/14/2011] [Indexed: 12/25/2022] Open
Abstract
This paper reviews the incidence, pathogenetic mechanisms and management strategies of diabetes mellitus in patients with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). It classifies patients based on the aetiopathogenetic mechanisms, and proposes rational methods of management of the condition, based on aetiopathogenesis and concomitant pharmacotherapy.
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Affiliation(s)
- Sanjay Kalra
- Dept of Endocrinology, Bharti Hospital, Karnal, India
| | - Bharti Kalra
- Dept of Endocrinology, Bharti Hospital, Karnal, India
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Anjos EMD, Pfrimer K, Machado AA, Cunha SFDC, Salomão RG, Monteiro JP. Nutritional and metabolic status of HIV-positive patients with lipodystrophy during one year of follow-up. Clinics (Sao Paulo) 2011; 66:407-10. [PMID: 21552663 PMCID: PMC3071999 DOI: 10.1590/s1807-59322011000300007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Accepted: 11/17/2010] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES The aim of this prospective study was to compare changes in lipid metabolism and nutritional status after either 6 and 12 months of follow-up in subjects with lipodystrophy syndrome after traditional lifestyle therapy with or without fibric acid analogue intervention (bezafibrate and clofibrate). METHODS Food intake, alterations in body composition and metabolic abnormalities were assessed in subjects with lipodystrophy syndrome at the beginning of the study. The nutritional status and metabolic alterations of the subjects were monitored, and the subjects received nutritional counseling each time they were seen. The subjects were monitored either two times over a period no longer than six months (Group A; n = 18) or three times over a period of at least 12 months (Group B; n = 35). All of the subjects underwent nutrition counseling that was based on behavior modification. The fibric acid analogue was only given to patients with serum triglyceride levels above 400 mg/dL. RESULTS After six months of follow-up, Group A showed no alterations in the experimental parameters. After twelve months, there was a decrease in serum triglyceride levels (410.4 ± 235.5 vs. 307.7 ± 150.5 mg/dL, p < 0.05) and an increase in both HDLc levels (37.9 ± 36.6 vs. 44.9 ± 27.9 mg/dL, p,0.05) and lean mass (79.9 ± 7.8 vs. 80.3 ± 9.9 %, p < 0.05) in Group B. CONCLUSION After one year of follow-up (three sessions of nutritional and medical counseling), the metabolic parameters of the subjects with lipodystrophy improved after traditional lifestyle therapy with or without fibric acid analogue intervention.
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Affiliation(s)
- Eloísa Marchi Dos Anjos
- Department of Pediatrics, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
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Bonnet E. New and emerging agents in the management of lipodystrophy in HIV-infected patients. HIV AIDS (Auckl) 2010; 2:167-78. [PMID: 22096395 PMCID: PMC3218685 DOI: 10.2147/hiv.s13429] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Lipodystrophy remains a major long-term complication in human immunodeficiency virus-infected patients under antiretroviral (ARV) therapy. Patients may present with lipoatrophy or lipohypertrophy or both. The choice of treatments to improve fat redistribution depends on the form of lipodystrophy and its duration. Measures known to improve lipoatrophy are switches in ARV therapy (stavudine or zidovudine to abacavir or tenofovir) and filling interventions. Pioglitazone may be added to these measures, although any benefits appear small. Uridine and leptin were found to be disappointing so far. Regarding lipohypertrophy, diet and exercise, recombinant human growth hormone, and metformin may reduce visceral fat, but may worsen subcutaneous lipoatrophy. Surgical therapy may be required. Attractive pharmacologic treatments include growth hormone-releasing factor and leptin. Adiponectin and adiponectin receptors are promising therapeutic targets to explore.
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Affiliation(s)
- Eric Bonnet
- Service des Maladies Infectieuses, Hôpital Purpan, Toulouse, France
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Gandhi V. Nutrition in HIV-infected patients. Explore (NY) 2010; 6:183-5. [PMID: 20451153 DOI: 10.1016/j.explore.2010.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Vani Gandhi
- Center for Comprehensive Care, New York, NY, USA
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Effects of lifestyle modification on oxidized LDL, reactive oxygen species production and endothelial cell viability in patients with coronary artery disease. Clin Biochem 2010; 43:858-62. [PMID: 20416290 DOI: 10.1016/j.clinbiochem.2010.04.056] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Revised: 03/19/2010] [Accepted: 04/14/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVES We evaluated the effects of lifestyle modification (LM) on lipid profile, oxidative stress and serum-stimulated human coronary artery endothelial cell (HCAEC) viability in coronary artery disease (CAD) patients after 6months. DESIGN AND METHODS Thirty patients with CAD were randomly assigned to LM intervention (n=15) and usual care control (n=15) groups. LM-intervened patients were instructed to consume low-fat, high-antioxidants and fiber diets. Moderate exercise and stress management were also advised. Group support to maintain patients' compliance was applied. RESULTS Serum cholesterol, triglyceride, oxidized LDL and protein carbonyl were decreased in LM group. Serum triglyceride was increased in control group. HCAEC viability was increased, while intracellular reactive oxygen species was decreased, by serum from the LM group. CONCLUSION LM is capable of improving lipid profile, reducing oxidative stress and increasing HCAEC survival in the patients with CAD, hence lowering a risk for the future cardiovascular event.
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Effects of tesamorelin, a growth hormone-releasing factor, in HIV-infected patients with abdominal fat accumulation: a randomized placebo-controlled trial with a safety extension. J Acquir Immune Defic Syndr 2010; 53:311-22. [PMID: 20101189 DOI: 10.1097/qai.0b013e3181cbdaff] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND HIV-infected patients receiving antiretroviral therapy often demonstrate excess visceral fat. A growth hormone-releasing factor, tesamorelin, may selectively reduce visceral fat in this population. We investigated the effects of tesamorelin (GHRH(1-44)) in HIV-infected patients with central fat accumulation. METHODS A 12-month study of 404 HIV-infected patients with excess abdominal fat in the context of antiretroviral therapy was conducted between January 2007 and October 2008. The study consisted of 2 sequential phases. In the primary efficacy phase (months 0-6), patients were randomly assigned to receive tesamorelin [2 mg subcutaneous (SC) every day] or placebo in a 2:1 ratio. In the extension phase (months 6-12), patients receiving tesamorelin were rerandomized to continue on tesamorelin (2 mg SC every day) or switch to placebo. Patients initially randomized to placebo switched to tesamorelin. Patients and investigators were blinded to treatment assignment throughout the study. The primary endpoint was visceral adipose tissue (VAT). Secondary endpoints included body image, IGF-I, safety measures, including glucose, and other body composition measures. RESULTS VAT decreased by -10.9% (-21 cm(2)) in the tesamorelin group vs. -0.6% (-1 cm(2)) in the placebo group in the 6-month efficacy phase, P < 0.0001. Trunk fat (P < 0.001), waist circumference (P = 0.02), and waist-hip-ratio (P = 0.001) improved, with no change in limb or abdominal SC fat. Insulin-like growth factor-1 increased (P < 0.001), but no change in glucose parameters was observed. Patient rating of belly appearance distress (P = 0.02) and physician rating of belly profile (P = 0.02) were significantly improved in the tesamorelin vs. placebo-treated groups. The drug was well tolerated. VAT was reduced by approximately 18% (P < 0.001) in patients continuing tesamorelin for 12 months. The initial improvements over 6 months in VAT were rapidly lost in those switching from tesamorelin to placebo. CONCLUSIONS Tesamorelin reduces visceral fat by approximately 18% and improves body image distress in HIV-infected patients with central fat accumulation. These changes are achieved without significant side effects or perturbation of glucose.
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Feigenbaum K, Longstaff L. Management of the Metabolic Syndrome in Patients With Human Immunodeficiency Virus. DIABETES EDUCATOR 2010; 36:457-64. [DOI: 10.1177/0145721710363619] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patients with human immunodeficiency virus (HIV) are an increasing subpopulation of patients seen in endocrine/ diabetes clinics. This article explores evidence-based treatment recommendations for patients with metabolic syndrome who are also positive for HIV. Patients infected with HIV may manifest metabolic abnormalities. They often present with low high-density lipoprotein (HDL-C), hypertension, visceral adiposity, and insulin resistance, among other symptoms consistent with features of the metabolic syndrome. The etiologies of the metabolic abnormalities are not completely understood. The role of highly active antiretroviral therapy (HAART) and the separate effect of HIV on patients who are surviving longer may contribute to the increased incidence of the development of the metabolic syndrome. The role of the health care team is to provide patient education to patients with HIV concerning lifestyle modification in order to prevent complications related to the metabolic syndrome.
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Affiliation(s)
- Kathryn Feigenbaum
- Nursing and Patient Care Services, Clinical Center,
National Institutes of Health, Bethesda, Maryland,
| | - Laura Longstaff
- Office of Generic Drugs, Center for Drug Evaluation
and Research, Food and Drug Administration, United States Public Health Service,
Rockville, Maryland
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Souza HF, Marques DC. Benefícios do treinamento aeróbio e/ou resistido em indivíduos HIV+: uma revisão sistemática. REV BRAS MED ESPORTE 2009. [DOI: 10.1590/s1517-86922009000700013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A aids é uma doença crônica, caracterizada pela depleção dos linfócitos T, sendo o vírus HIV o seu agente causador. A sua infecção e tratamento farmacológico estão ligados às alterações físicas e fisiológicas, que podem diminuir a qualidade de vida. Sendo assim, o objetivo do estudo foi elaborar uma revisão sistemática sobre os estudos publicados no PubMed e Capes entre 1998 e 2008, com humanos soropositivos e que investigaram os impactos do treinamento aeróbio e/ou resistido nos aspectos fisiológicos, metabólicos, psicológicos, imunológicos e físicos. Foram discutidos protocolos que utilizaram apenas treinamento de força ou aeróbio e os que utilizaram ambos e a grande maioria encontrou resultados favoráveis às variáveis pesquisadas. Quanto ao modelo de prescrição para essa população, este deve ser composto por exercícios de força, de oito a 15 repetições máximas (trabalho de hipertrofia) e por exercícios aeróbios (contínuo ou intervalado), com duração de 20 a 60 minutos e intensidade variando de 50 a 85% da frequência cardíaca máxima ou 45-85% do consumo máximo de oxigênio, ambos três a cinco vezes por semana. Dessa forma, ao elaborar um programa de atividade física, é importante conhecer a atual condição física e fisiológica do indivíduo HIV+, para que a sua condição de esforço não seja superestimada ou subestimada.
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Hernández S, Vidal M, Pedrol E. Evaluación del riesgo cardiovascular e intervención en los pacientes con VIH. Enferm Infecc Microbiol Clin 2009; 27 Suppl 1:40-7. [DOI: 10.1016/s0213-005x(09)73444-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Fitch KV, Guggina LM, Keough HM, Dolan Looby SE, Hadigan C, Anderson EJ, Hubbard J, Liebau JG, Johnsen S, Wei J, Makimura H, Stanley TL, Lo J, Grinspoon SK. Decreased respiratory quotient in relation to resting energy expenditure in HIV-infected and noninfected subjects. Metabolism 2009; 58:608-15. [PMID: 19375582 PMCID: PMC2691476 DOI: 10.1016/j.metabol.2008.12.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2008] [Accepted: 12/04/2008] [Indexed: 10/20/2022]
Abstract
The purpose of this study was to evaluate the relationship of respiratory quotient (RQ), a surrogate marker of substrate oxidation, as well as body composition and dietary intake to resting energy expenditure (REE) among HIV-infected patients in the current era of highly active antiretroviral therapy and among non-HIV-infected control subjects. Resting energy expenditure is increased in HIV-infected patients; but little is known regarding the potential contribution of altered substrate metabolism, body composition, and dietary intake to increased energy expenditure in this population. Respiratory quotient, REE, body composition, and dietary intake parameters were assessed in 283 HIV-infected patients and 146 community-derived HIV-negative controls who were evaluated for metabolic studies between 1998 and 2005. Respiratory quotient was lower (0.83 +/- 0.00 vs 0.85 +/- 0.01, P = .005), whereas REE adjusted for fat-free mass (FFM) was higher (31.8 +/- 0.3 vs 29.8 +/- 0.3 kcal/[d kg], P < or = .0001), in HIV-infected compared with control subjects. In multivariate modeling among HIV-infected patients, including age, sex, and parameters of immune function, FFM (beta = 24.811334, P < .0001), visceral adiposity (beta = .7182746, P = .008), and total body fat (beta = 8.0506839, P = .041) were positively associated with REE, whereas RQ was negatively associated with REE (beta = -528.4808, P = .024). Overall r(2) was equal to 0.705 and P was less than .0001 for the model. In control subjects, by contrast, only visceral adiposity (beta = 1.0612073, P = .004), total body fat (beta = 15.805547, P = .010), and FFM (beta = 22.613005, P < .0001) were significant predictors of REE; and there was no relationship with RQ. Overall r(2) was equal to 0.825 and P was less than .0001 for the model. These data suggest that alterations in substrate metabolism may contribute to increased REE in HIV-infected patients compared with control subjects.
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Affiliation(s)
- Kathleen V. Fitch
- Program in Nutritional Metabolism, Massachusetts General Hospital, Boston, Massachusetts
| | - Lauren M. Guggina
- Program in Nutritional Metabolism, Massachusetts General Hospital, Boston, Massachusetts
| | - Hester M. Keough
- Program in Nutritional Metabolism, Massachusetts General Hospital, Boston, Massachusetts
| | - Sara E. Dolan Looby
- Program in Nutritional Metabolism, Massachusetts General Hospital, Boston, Massachusetts
| | - Colleen Hadigan
- Program in Nutritional Metabolism, Massachusetts General Hospital, Boston, Massachusetts
- National Institute of Health, National Institute of Allergy and Infectious Disease, Bethesda, Maryland, USA
| | - Ellen J. Anderson
- General Clinical Research Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Jane Hubbard
- General Clinical Research Center, Massachusetts General Hospital, Boston, Massachusetts
| | - James G. Liebau
- Program in Nutritional Metabolism, Massachusetts General Hospital, Boston, Massachusetts
| | - Stine Johnsen
- Program in Nutritional Metabolism, Massachusetts General Hospital, Boston, Massachusetts
| | - Jeffery Wei
- Program in Nutritional Metabolism, Massachusetts General Hospital, Boston, Massachusetts
| | - Hideo Makimura
- Program in Nutritional Metabolism, Massachusetts General Hospital, Boston, Massachusetts
| | - Takara L. Stanley
- Program in Nutritional Metabolism, Massachusetts General Hospital, Boston, Massachusetts
| | - Janet Lo
- Program in Nutritional Metabolism, Massachusetts General Hospital, Boston, Massachusetts
| | - Steven K. Grinspoon
- Program in Nutritional Metabolism, Massachusetts General Hospital, Boston, Massachusetts
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Cofrancesco J, Freedland E, McComsey G. Treatment options for HIV-associated central fat accumulation. AIDS Patient Care STDS 2009; 23:5-18. [PMID: 19055407 DOI: 10.1089/apc.2008.0067] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Central fat accumulation is increasingly recognized as a problem for patients with HIV infection. The term "lipodystrophy" has been used to describe collectively a constellation of body habitus changes and metabolic abnormalities commonly observed in HIV-infected patients, particularly since the advent of highly active antiretroviral therapy. Visceral fat accumulation can place patients at increased risk of coronary artery disease.Furthermore, body shape changes are a source of distress to patients that may compromise treatment adherence.Reduction of abdominal obesity can therefore be considered part of therapy in HIV-positive patients with visceral adipose tissue (VAT) accumulation. Currently, there are no drugs approved by the Food and Drug Administration for the treatment of HIV-associated central fat accumulation. Lifestyle modifications such as diet and exercise and switching antiretroviral therapies appear to be of limited value in reducing VAT. Metformin has shown some benefit in reducing VAT but at the expense of accelerating peripheral fat loss, and the thiazolidinediones have no effect on VAT. Similarly, testosterone does not appear to reduce VAT in these patients,and there are no data on anabolic steroids. Two large, randomized controlled trials have demonstrated the efficacy of recombinant human growth hormone (rhGH) in reducing visceral adipose tissue. There are also promising data regarding treatment with growth hormone releasing hormone (GHRH).
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Bedimo RJ. Body-fat abnormalities in patients with HIV: progress and challenges. ACTA ACUST UNITED AC 2008; 7:292-305. [PMID: 19056708 DOI: 10.1177/1545109708328931] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The introduction of newer antiretroviral drugs has provided greater levels of HIV suppression with fewer of the metabolic effects, lipoatrophy, and body habitus changes associated with earlier therapies. Previously classified under the collective term, lipodystrophy, lipoatrophy and body-fat changes are now known to occur independently in some HIV-infected patients, depending on the type and duration of antiretroviral therapy and a myriad of factors including HIV infection alone that contribute significantly to these changes. This article reviews the current scientific literature and recent clinical trial results that distinguish lipoatrophy or dyslipidemia pathophysiologically from body-fat changes seen as central and peripheral lipohypertrophy and fat redistribution, as well as the nature and extent of changes associated with HIV infection alone and newer antiretroviral therapies. This information may assist physicians in identifying individual risk factors and choosing the type of antiretroviral therapy that may minimize these changes without loss of virologic suppression.
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Affiliation(s)
- Roger J Bedimo
- Internal Medicine, Infectious Diseases Section, VA North Texas Healthcare System, UT Southwestern Medical School, Dallas, Texas, USA.
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Longenberger A, Lim JY, Orchard T, Brooks MM, Brach J, Mertz K, Kingsley LA. Self-reported low physical function is associated with diabetes mellitus and insulin resistance in HIV-positive and HIV-negative men. ACTA ACUST UNITED AC 2008; 2:539-549. [PMID: 23805164 DOI: 10.2217/17469600.2.6.539] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
AIM To investigate the association between self-reported physical function (as a surrogate for physical activity) and diabetes mellitus (DM) and insulin resistance (IR) among HIV-positive and -negative men. METHOD A total of 384 HIV-negative and 274 HIV-positive men from the Pitt Men's Study contributed data. DM was defined by fasting serum glucose levels. IR was calculated using the homeostasis model assessment. The Physical Functioning 10 Scale from the Short Form-36 Health Survey measured physical function. Multivariate logistic regression assessed the independent association between physical function and DM and IR. RESULTS Physical function, older age and Black race were associated with DM in multivariate analyses. Physical function/HIV interaction, older age, higher body mass index, HIV infection and Black race were associated with IR in multivariate analyses. CONCLUSION Self-reported low physical function is associated with DM and IR in HIV-negative and -positive men.
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Affiliation(s)
- Allison Longenberger
- Graduate School of Public Health, Department of Epidemiology, University of Pittsburgh, Fifth Avenue and Desoto Street, Pittsburgh, PA 15261, USA
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Grinspoon SK, Grunfeld C, Kotler DP, Currier JS, Lundgren JD, Dubé MP, Lipshultz SE, Hsue PY, Squires K, Schambelan M, Wilson PWF, Yarasheski KE, Hadigan CM, Stein JH, Eckel RH. State of the science conference: Initiative to decrease cardiovascular risk and increase quality of care for patients living with HIV/AIDS: executive summary. Circulation 2008; 118:198-210. [PMID: 18566320 PMCID: PMC3642216 DOI: 10.1161/circulationaha.107.189622] [Citation(s) in RCA: 175] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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69
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Stein JH, Hadigan CM, Brown TT, Chadwick E, Feinberg J, Friis-Møller N, Ganesan A, Glesby MJ, Hardy D, Kaplan RC, Kim P, Lo J, Martinez E, Sosman JM. Prevention strategies for cardiovascular disease in HIV-infected patients. Circulation 2008; 118:e54-60. [PMID: 18566315 DOI: 10.1161/circulationaha.107.189628] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Leite LHM, Sampaio ABDMM. Metabolic abnormalities and overweight in HIV/AIDS persons-treated with antiretroviral therapy. REV NUTR 2008. [DOI: 10.1590/s1415-52732008000300002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE: To describe the proportion of overweight among patients with human immunodeficiency virus/Acquired Immune Deficiency Syndrome and correlate overweight and highly active antiretroviral therapy with metabolic complications. METHODS: A cross-sectional study was conducted among human immunodeficiency virus/Acquired Immune Deficiency Syndrome outpatients undergoing nutritional therapy from 2000 to 2006 in a University Health Center. The sample consisted of 393 human immunodeficiency virus/Acquired Immune Deficiency Syndrome patients. Nutritional and medical records were used as a source of data on personal, clinical and biochemical information. Data analysis included descriptive statistics and the Chi-square test. RESULTS: Sixty-nine percent of the patients were males aging from 26 to 49 years. Overweight and obesity were identified in 49% of this population. The most important metabolic complications were low levels of high-density lipoprotein (70%) and high levels of triglycerides (48%) and cholesterol (40%). Higher body mass index was associated with higher lipid levels and more evidence of insulin resistance. CONCLUSION: This study demonstrated an important proportion of overweight and obesity among human immunodeficiency virus/Acquired Immune Deficiency Syndrome patients. These results suggest that nutritional interventions and lifestyle modifications may be useful strategies to decrease the cardiovascular risk in this population.
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71
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Conventional cardiovascular risk factors in HIV infection: how conventional are they? Curr Opin HIV AIDS 2008; 3:214-9. [DOI: 10.1097/coh.0b013e3282f6a613] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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72
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Mutimura E, Stewart A, Crowther NJ, Yarasheski KE, Cade WT. The effects of exercise training on quality of life in HAART-treated HIV-positive Rwandan subjects with body fat redistribution. Qual Life Res 2008; 17:377-85. [PMID: 18320351 DOI: 10.1007/s11136-008-9319-4] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2007] [Accepted: 02/07/2008] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Our objective was to examine the effects of exercise training (EXS) on quality of life (QoL) in highly active antiretroviral therapy (HAART)-treated HIV-positive (HIV+) subjects with body fat redistribution (BFR) in Rwanda. METHODS The effects of a randomised controlled trial of EXS on QoL were measured using World Health Organisation Quality of Life (WHOQOL)-BREF in HIV+ subjects with BFR randomised to EXS (n = 50; BFR + EXS) or no exercise training (n = 50; BFR + noEXS). RESULTS At 6 months, scores on the psychological [1.3 (0.3) vs. 0.5 (0.1); P < 0.0001], independence [0.6 (0.1) vs. 0.0 (0.0); P < 0.0001], social relationships [0.6 (0.2) vs. 0.0 (0.0); P < 0.0001] and HIV HAART-specific QoL domains [1.4 (0.2) vs. -0.1 (0.2); P < 0.0001] improved more in BFR + EXS than BFR + noEXS group, respectively. Self-esteem [1.3 (0.8) vs. 0.1 (0.6); P < 0.001], body image [1.5 (0.6) vs. 0.0 (0.5); P < 0.001] and emotional stress [1.6 (0.7) vs. 0.2 (0.5); P < 0.001] improved more in the BFR + EXS group than BFR + noEXS group, respectively. Psychological [1.5 (0.2) vs. 1.1 (0.3); P < 0.0001], social relationship [0.8 (0.2) vs. 0.4 (0.2); P < 0.0001], and HIV HAART-specific well-being [1.8 (0.2) vs. 1.0 (0.0); P < 0.0001] improved more in BFR + EXS female than male subjects. CONCLUSIONS Exercise training improved several components of QoL in HAART-treated HIV+ African subjects with BFR. Exercise training is an inexpensive and efficacious strategy for improving QoL in HIV+ African subjects, which may improve HAART adherence and treatment initiatives in resource-limited areas of sub-Saharan Africa.
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Affiliation(s)
- Eugene Mutimura
- Faculty of Allied Health Sciences, Kigali Health Institute, PO Box 3286, Kigali, Rwanda.
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73
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Reeds DN. Metabolic Syndrome Risks of Cardiovascular Disease: Differences Between HIV-Positive and HIV-Negative? ACTA ACUST UNITED AC 2008; 3:79-82. [DOI: 10.1111/j.1559-4572.2008.07592.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Joy T, Keogh HM, Hadigan C, Dolan SE, Fitch K, Liebau J, Johnsen S, Lo J, Grinspoon SK. Relation of body composition to body mass index in HIV-infected patients with metabolic abnormalities. J Acquir Immune Defic Syndr 2008; 47:174-84. [PMID: 17971710 PMCID: PMC4393650 DOI: 10.1097/qai.0b013e31815b0792] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To determine visceral adiposity (VAT), subcutaneous adiposity (SAT), and regional body adipose differences between HIV-infected and non-HIV-infected subjects in relation to body mass index (BMI) and World Health Organization BMI categories. DESIGN, SETTING, AND PARTICIPANTS Analyses were conducted of 306 HIV-infected and 107 community-derived HIV-negative subjects evaluated for metabolic studies between 1999 and 2006. Analyses were stratified by gender. Additional analyses were performed stratifying subjects by metabolic syndrome status. RESULTS HIV-infected men and women demonstrated decreased total extremity fat by 1.1 kg and 0.85 kg, respectively, relative to non-HIV-infected control subjects. VAT was increased among HIV-infected men and women in the normal (18.5 to 24.9 kg/m2) and overweight (25.0 to 29.9 kg/m2) categories relative to control subjects but not among those in the obese category (> or =30.0 kg/m2). In contrast, abdominal SAT was reduced among HIV-infected men in the normal and overweight categories but was similar among HIV-infected women and control subjects in these categories. Abdominal SAT was increased among HIV-infected women in the obese category relative to control subjects. Similar results were obtained limiting the analysis to HIV-infected (n = 204) and control subjects (n = 89) without the metabolic syndrome. CONCLUSIONS Peripheral lipoatrophy is a consistent finding among HIV-infected men and women with metabolic abnormalities. Relative increases in VAT are most pronounced among male and female HIV-infected subjects in the normal weight and overweight categories. Gender differences in abdominal SAT accumulation are observed, with preservation of SAT among HIV-infected women relative to control subjects.
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Affiliation(s)
- Tisha Joy
- Program in Nutritional Metabolism, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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75
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Colafigli M, Di Giambenedetto S, Bracciale L, Tamburrini E, Cauda R, De Luca A. Cardiovascular risk score change in HIV-1-infected patients switched to an atazanavir-based combination antiretroviral regimen. HIV Med 2008; 9:172-9. [PMID: 18217998 DOI: 10.1111/j.1468-1293.2007.00541.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND We aimed to establish whether the limited impact of atazanavir on the plasma lipid profile could translate into a reduction in the predicted cardiovascular risk in antiretroviral (ARV)-experienced patients switching to an atazanavir-containing regimen. METHODS HIV-1-infected treatment-experienced patients, switched to atazanavir for whatever reason and without prior major cardiovascular events, were selected and followed for at least 1 month. An individual cardiovascular risk score (10-year risk of major cardiovascular events) based on validated events and measurable risk factors in Italian cardiovascular cohorts was calculated using software available online. RESULTS A total of 197 patients were selected for inclusion in the study. After switching to atazanavir, the mean changes from pre-switch to last available measurement were -6.5% (P<0.001) for total cholesterol, -1.7% (P=0.029) for high-density lipoprotein (HDL) cholesterol, -11.3% (P<0.001) for non-HDL cholesterol and -8.6% (P<0.001) for triglycerides. The crude cardiovascular risk score was reduced from 3.43 to 3.38% (P=0.51); the analysis normalized by age showed a reduction from 3.43 to 3.14% (P<0.001). Subsets of patients with high baseline total cholesterol or triglycerides showed more marked reductions. CONCLUSIONS A treatment switch to atazanavir caused significant reductions in plasma lipids and a modest but significant reduction in the normalized-for-age cardiovascular risk score. Efforts should be made to concomitantly reduce the other preventable cardiovascular risk factors.
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Affiliation(s)
- M Colafigli
- Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy.
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Mutimura E, Crowther NJ, Cade TW, Yarasheski KE, Stewart A. Exercise training reduces central adiposity and improves metabolic indices in HAART-treated HIV-positive subjects in Rwanda: a randomized controlled trial. AIDS Res Hum Retroviruses 2008; 24:15-23. [PMID: 18275343 DOI: 10.1089/aid.2007.0023] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
As HAART becomes more accessible in sub-Saharan Africa, metabolic syndromes, body fat redistribution (BFR), and cardiovascular disease may become more prevalent. We conducted a 6-month, randomized controlled trial to test whether cardiorespiratory exercise training (CET), improves metabolic, body composition and cardiorespiratory fitness parameters in HAART-treated HIV(+) African subjects with BFR. Six months of CET reduced waist circumference (-7.13 +/- 4.4 cm, p < 0.0001), WHR (-0.10 +/- 0.1, p < 0.0001), sum skinfold thickness (-6.15 +/- 8.2 mm, p < 0.0001) and % body fat mass (-1.5 +/- 3.3, p < 0.0001) in HIV(+)BFR(+)EXS. Hip circumference was unchanged in non-exercise control groups. CET reduced fasting total cholesterol (-0.03 +/- 1.11 mM, p < 0.05), triglycerides (-0.22 +/-0.48 mM, p < 0.05) and glucose levels (-0.21 +/- 0.71 mM, p < 0.05) (p < 0.0001). HDL-, LDL-cholesterol and HOMA values were unchanged after CET. Interestingly, HIV(+) subjects randomized to non-exercising groups experienced increases in fasting plasma glucose levels, whereas HIV seronegative controls did not (p < 0.001). Predicted VO(2) peak increased more in the HIV(+)BFR(+)EXS than in all other groups (4.7 +/- 3.9 ml/kg/min, p < 0.0001). Exercise training positively modulated body composition and metabolic profiles, and improved cardiorespiratory fitness in HAART-treated HIV(+) Africans. These beneficial adaptations imply that exercise training is a safe, inexpensive, practical, and effective treatment for evolving metabolic and cardiovascular syndromes associated with HIV and HAART exposure in resource-limited sub-Saharan countries, where treatment is improving, morbidity and mortality rates are declining, but where minimal resources are available to manage HIVand HAART-associated cardiovascular and metabolic syndromes.
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Affiliation(s)
- Eugene Mutimura
- Faculty of Allied Health Sciences and Programs in HIV/AIDS Clinical Research and Community Interventions, Kigali Health Institute, Kigali, Rwanda
- School of Therapeutic Sciences, University of the Witwatersrand, Johannesburg, Republic of South Africa
| | - Nigel J. Crowther
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri 63130
| | - Todd W. Cade
- Division of Endocrinology, Metabolism and Lipid Research, Washington University School of Medicine, St. Louis, Missouri 63130
| | - Kevin E. Yarasheski
- Department of Chemical Pathology, National Health Laboratory Service, University of the Witwatersrand, Johannesburg, Republic of South Africa
| | - Aimee Stewart
- Faculty of Allied Health Sciences and Programs in HIV/AIDS Clinical Research and Community Interventions, Kigali Health Institute, Kigali, Rwanda
- Department of Chemical Pathology, National Health Laboratory Service, University of the Witwatersrand, Johannesburg, Republic of South Africa
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Behrens GMN. Treatment options for lipodystrophy in HIV-positive patients. Expert Opin Pharmacother 2007; 9:39-52. [DOI: 10.1517/14656566.9.1.39] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Falutz J, Allas S, Blot K, Potvin D, Kotler D, Somero M, Berger D, Brown S, Richmond G, Fessel J, Turner R, Grinspoon S. Metabolic effects of a growth hormone-releasing factor in patients with HIV. N Engl J Med 2007; 357:2359-70. [PMID: 18057338 DOI: 10.1056/nejmoa072375] [Citation(s) in RCA: 129] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Visceral adipose tissue accumulates during antiretroviral therapy in many patients who are infected with the human immunodeficiency virus (HIV); this process is associated with an increased cardiovascular risk. We assessed the use of a growth hormone-releasing factor analogue, tesamorelin, to decrease visceral adiposity. METHODS We randomly assigned 412 patients with HIV (86% of whom were men) who had an accumulation of abdominal fat to receive a daily subcutaneous injection of either 2 mg of tesamorelin or placebo for 26 weeks. The primary end point was the percent change from baseline in visceral adipose tissue as shown on computed tomography. Secondary end points included triglyceride levels, the ratio of total cholesterol to high-density lipoprotein (HDL) cholesterol, the level of insulin-like growth factor I (IGF-I), and self-assessed body image. Glycemic measures included glucose and insulin levels. RESULTS The measure of visceral adipose tissue decreased by 15.2% in the tesamorelin group and increased by 5.0% in the placebo group; the levels of triglycerides decreased by 50 mg per deciliter and increased by 9 mg per deciliter, respectively, and the ratio of total cholesterol to HDL cholesterol decreased by 0.31 and increased by 0.21, respectively (P<0.001 for all comparisons). Levels of total cholesterol and HDL cholesterol also improved significantly in the tesamorelin group. Levels of IGF-I increased by 81.0% in the tesamorelin group and decreased by 5.0% in the placebo group (P<0.001). Adverse events did not differ significantly between the two study groups, but more patients in the tesamorelin group withdrew from the study because of an adverse event. No significant differences were observed in glycemic measures. CONCLUSIONS Daily tesamorelin for 26 weeks decreased visceral fat and improved lipid profiles, effects that might be useful in HIV-infected patients who have treatment-associated central fat accumulation. (ClinicalTrials.gov number, NCT00123253 [ClinicalTrials.gov] .).
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Affiliation(s)
- Julian Falutz
- Montreal General Hospital, McGill University Health Centre, Montreal
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Joy T, Keogh HM, Hadigan C, Lee H, Dolan SE, Fitch K, Liebau J, Lo J, Johnsen S, Hubbard J, Anderson EJ, Grinspoon S. Dietary fat intake and relationship to serum lipid levels in HIV-infected patients with metabolic abnormalities in the HAART era. AIDS 2007; 21:1591-600. [PMID: 17630554 PMCID: PMC4393713 DOI: 10.1097/qad.0b013e32823644ff] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To evaluate dietary intake and its relationship to lipid parameters in HIV-infected patients with metabolic abnormalities. METHOD We prospectively determined dietary intake (4-day food records or 24-h recall) in 356 HIV-infected patients and 162 community-derived HIV-negative controls evaluated for metabolic studies between 1998-2005. Differences in dietary intake between HIV-infected patients and non-HIV-infected controls, in relation to the established 2005 USDA (United States Department of Agriculture) Recommended Dietary Guidelines, were determined. The relationship between dietary fat intake and serum lipid levels among HIV-infected individuals was also evaluated. RESULTS Assessment of dietary intake in this group of HIV-infected patients demonstrated increased intake of total dietary fat (P < 0.05), saturated fat (P = 0.006), and cholesterol (P = 0.006) as well as a greater percentage of calories from saturated fat (P = 0.002) and from trans fat (P = 0.02), despite similar caloric intake to the control individuals. A significantly higher percentage of HIV-infected patients were above the 2005 USDA Recommended Dietary Guidelines for saturated fat (> 10%/day) (76.0% HIV vs. 60.9% controls, P = 0.003), and cholesterol (> 300 mg/day) (49.7% HIV vs. 37.9% controls, P = 0.04). Saturated fat intake was strongly associated with triglyceride level [triglyceride level increased 8.7 mg/dl (parameter estimate) per gram of increased saturated fat intake, P = 0.005] whereas total fat was inversely associated with triglyceride level [triglyceride level decreased 3.0 mg/dl (parameter estimate) per gram of increased total fat intake, P = 0.02] among HIV-infected individuals. CONCLUSIONS Increased intake of saturated fat is seen and contributes to hypertriglyceridemia among HIV-infected patients who have developed metabolic abnormalities. Increased saturated fat intake should be targeted for dietary modification in this population.
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Affiliation(s)
- Tisha Joy
- Program in Nutritional Metabolism, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
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