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Cinque F, Cespiati A, Lombardi R, Guaraldi G, Sebastiani G. Nutritional and Lifestyle Therapy for NAFLD in People with HIV. Nutrients 2023; 15:nu15081990. [PMID: 37111209 PMCID: PMC10140991 DOI: 10.3390/nu15081990] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/17/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023] Open
Abstract
HIV infection and nonalcoholic fatty liver disease (NAFLD) are two major epidemics affecting millions of people worldwide. As people with HIV (PWH) age, there is an increased prevalence of metabolic comorbidities, along with unique HIV factors, such as HIV chronic inflammation and life-long exposure to antiretroviral therapy, which leads to a high prevalence of NAFLD. An unhealthy lifestyle, with a high dietary intake of refined carbohydrates, saturated fatty acids, fructose added beverages, and processed red meat, as well as physical inactivity, are known to trigger and promote the progression of NAFLD to nonalcoholic steatohepatitis, liver fibrosis, and hepatocellular carcinoma. Furthermore, with no currently approved pharmacotherapy and a lack of clinical trials that are inclusive of HIV, nutritional and lifestyle approaches still represent the most recommended treatments for PWH with NAFLD. While sharing common features with the general population, NAFLD in PWH displays its own peculiarities that may also reflect different impacts of nutrition and exercise on its onset and treatment. Therefore, in this narrative review, we aimed to explore the role of nutrients in the development of NAFLD in PWH. In addition, we discussed the nutritional and lifestyle approaches to managing NAFLD in the setting of HIV, with insights into the role of gut microbiota and lean NAFLD.
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Affiliation(s)
- Felice Cinque
- Division of Gastroenterology and Hepatology, and Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
- Medicine and Metabolic Disease Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy
| | - Annalisa Cespiati
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
- Medicine and Metabolic Disease Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy
| | - Rosa Lombardi
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
- Medicine and Metabolic Disease Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy
| | - Giovanni Guaraldi
- Modena HIV Metabolic Clinic, Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria di Modena, 41124 Modena, Italy
| | - Giada Sebastiani
- Division of Gastroenterology and Hepatology, and Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
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Mabweazara SZ, Manne-Goehler J, Hamer M, Cellini J, Siedner MJ. Characteristics and efficacy of physical activity interventions to improve cardiometabolic and psychosocial outcomes in people living with HIV in sub-Saharan Africa: a protocol for a systematic review. Syst Rev 2023; 12:24. [PMID: 36814348 PMCID: PMC9948386 DOI: 10.1186/s13643-023-02186-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 02/06/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Antiretroviral therapy (ART) has led to an increased lifespan for people living with HIV (PWH). This increased lifespan, coupled with the effects of HIV and adverse effects of ART have resulted in an increasing burden of cardiometabolic disease (CMD) among PWH. Physical activity (PA) has been proposed as an effective strategy to reduce the risk of developing cardiometabolic disease and other health complications in PWH. The aim of this paper is to review the characteristics and efficacy of PA interventions to improve cardiometabolic and psychosocial outcomes among PWH in sub-Saharan Africa. METHODS The review will follow the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P). Literature searches will be conducted in PubMed, Web of Science (WoS), African Index Medicus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Embase. Peer-reviewed publications will be included if they include adults (age 18 or older), PWH in sub-Saharan Africa, and a PA intervention to improve cardiometabolic outcomes and/or psychosocial outcomes. We will include randomized controlled trials and quasi-experimental study designs. Two independent reviewers will screen all abstracts and full-text articles. The study methodological quality (or bias) will be appraised using the Revised tool to assess risk of bias in randomized trials and the Downs and Black checklist. Certainty of evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation guidelines. Meta-analyses will be conducted if our results are adequate for meta-analysis. Outcomes will be analyzed as continuous or dichotomous and meta-analyses will be conducted using random effects models with Stata computer software. DISCUSSION This review will identify and synthesize the current evidence regarding the characteristics and efficacy of PA interventions to improve cardiometabolic and psychosocial outcomes among PWH in sub-Saharan Africa. We also plan to identify the strengths and weaknesses of evaluated interventions. Based on the evidence, recommendations will be made to promote the design and further evaluate the most promising strategies to maximize the efficacy of PA interventions in improving cardiometabolic and psychosocial outcomes in PWH in sub-Saharan Africa. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration ID: CRD42021271937.
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Affiliation(s)
- SZ Mabweazara
- Africa Health Research Institute, Africa Centre Building, Route 618, Somkhele, KwaZulu Natal South Africa
| | - J Manne-Goehler
- Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, USA
| | - M Hamer
- University College London, London, UK
| | | | - MJ Siedner
- Africa Health Research Institute, Africa Centre Building, Route 618, Somkhele, KwaZulu Natal South Africa
- Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, USA
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Kamkuemah M, Gausi B, Oni T, Middelkoop K. Multilevel correlates of abdominal obesity in adolescents and youth living with HIV in peri-urban Cape Town, South Africa. PLoS One 2023; 18:e0266637. [PMID: 36693111 PMCID: PMC9873196 DOI: 10.1371/journal.pone.0266637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 01/11/2023] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Chronic non-communicable disease comorbidities are a major problem faced by people living with HIV (PLHIV). Obesity is an important factor contributing to such comorbidities and PLHIV face an elevated risk of obesity. However, there is data paucity on the intersection of obesity and HIV in adolescents and youth living with HIV (AYLHIV) in sub-Saharan Africa. We therefore aimed to investigate the prevalence of abdominal obesity and associated multilevel factors in AYLHIV in peri-urban Cape Town, South Africa. METHODS We conducted a cross-sectional study enrolling AYLHIV aged 15-24 years attending primary healthcare facilities in peri-urban Cape Town in 2019. All measures, except for physical examination measures, were obtained via self-report using a self-administered electronic form. Our outcome of interest was abdominal obesity (waist-to-height ratio ≥ 0.5). We collected individual-level data and data on community, built and food environment factors. Data was summarized using descriptive statistics, stratified by obesity status. Multilevel logistic regression was conducted to investigate factors associated with abdominal obesity, adjusted for sex and age. FINDINGS A total of 87 participants were interviewed, 76% were female and the median age was 20.7 (IQR 18.9-23.0) years. More than two fifths had abdominal obesity (41%; 95% CI: 31.0-51.7%), compared to published rates for young people in the general population (13.7-22.1%). In multilevel models, skipping breakfast (aOR = 5.42; 95% CI: 1.32-22.25) was associated with higher odds of abdominal obesity, while daily wholegrain consumption (aOR = 0.20; 95% CI: 0.05-0.71) and weekly physical activity (aOR = 0.24; 95% CI: 0.06-0.92) were associated with lower odds of abdominal obesity. Higher anticipated stigma was associated with reduced odds of obesity (aOR = 0.58; 95% CI: 0.33-1.00). Land-use mix diversity (aOR = 0.52; 95% CI: 0.27-0.97), access to recreational places (aOR = 0.37; 95% CI: 0.18-0.74), higher perceived pedestrian and traffic safety (aOR = 0.20; 95% CI: 0.05-0.80) and having a non-fast-food restaurant within walking distance (aOR = 0.30; 95% CI: 0.10-0.93) were associated with reduced odds of abdominal obesity. The main limitations of the study were low statistical power and possible reporting bias from self-report measures. CONCLUSIONS Our findings demonstrate a high prevalence of abdominal obesity and highlight multilevel correlates of obesity in AYLHIV in South Africa. An intersectoral approach to obesity prevention, intervening at multiple levels is necessary to intervene at this critical life stage.
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Affiliation(s)
- Monika Kamkuemah
- Research Initiative for Cities Health and Equity (RICHE), Division of Public Health Medicine, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- * E-mail:
| | - Blessings Gausi
- Research Initiative for Cities Health and Equity (RICHE), Division of Public Health Medicine, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Tolu Oni
- Research Initiative for Cities Health and Equity (RICHE), Division of Public Health Medicine, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Keren Middelkoop
- Desmond Tutu HIV Centre, Institute of Infectious Disease & Molecular Medicine, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Rao CR, Chandrasekaran B, Ravishankar N, Rutebemberwa E, Okello D. Physical activity interventions for glycaemic control in African adults - A systematic review and meta-analysis. Diabetes Metab Syndr 2022; 16:102663. [PMID: 36459907 DOI: 10.1016/j.dsx.2022.102663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 11/03/2022] [Accepted: 11/05/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM Growing evidence indicates that increasing physical activity may aid in regulating altered glycaemic control, thereby mitigating the risk of diabetes. However, the evidence summarising the efficacy of physical activity on glycaemic control among African adults remains unconsolidated. Our objective was to provide an amalgamated summary of the empirical evidence that explored the effectiveness of physical activity interventions on glycaemic control among African adults. METHODS A systematic search of six journal databases for the studies exploring the efficacy of physical activity on glycaemic control among African adults until March 21, 2022, was administered. Two independent reviewers screened the citations based on a priori set eligibility criteria. Data were analysed using inverse variance method and a summary of findings was synthesised using the Grading of Recommendations, Assessment, Development and Evaluations approach. RESULTS Of the 14,624 citations retrieved, 26 articles with 1474 participants were included for final analysis. Most of the included trials had a high risk of bias (N = 20; 76.92%). Our review found a significant reduction in fasting blood glucose (FBG, -2.18 [ 95% CI -3.18, -1.18] mmol/L), insulin (-0.99 [-2.71, 0.74] μU/L), Glycosylated haemoglobin (HbA1C) (-0.53% [-0.88, -0.19]), Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) (-0.74% [-1.10, -0.38]) and insulin sensitivity (-0.90 μU/l/min [-1.75, -0.06]) following physical activity interventions. The review reports low certainty of evidence across all outcome measures. DISCUSSION AND CONCLUSION Physical activity interventions were found to improve glycaemic control among African adults. However, the optimal physical activity dose for demonstrating meaningful benefits on glucose tolerance still remains unclear due to the limited number of primary studies available.
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Affiliation(s)
- Chythra R Rao
- Department of Community Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - Baskaran Chandrasekaran
- Department of Exercise and Sports Sciences, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - N Ravishankar
- Department of Biostatistics, Vallabhbhai Patel Chest Institute, University of New Delhi, Delhi, India.
| | - Elizeus Rutebemberwa
- Department of Health Policy, Planning and Management, School of Public Health, Makerere University, Kampala, Uganda.
| | - David Okello
- African Centre for Global Health and Social Transformation (ACHEST), Kampala, Uganda.
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Adedeji TA, Adedeji NO, Ajeigbe AK, Smith OS, Jeje OA, Fawale MB, Ajose AO, Adebisi SA, Akande AA, Okesina BA. Serum Interleukin-6 and Weight Loss in Antiretroviral-naïve and Antiretroviral-treated Patients with HIV/AIDS: Relationships and Predictors. Curr HIV Res 2022; 20:441-456. [PMID: 36056868 DOI: 10.2174/1570162x20666220901085926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 04/22/2022] [Accepted: 05/05/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Cachexia is usually associated with elevated serum interleukin-6 (IL.6) as it stimulates the breakdown of muscle proteins and promotes wasting. OBJECTIVE A case-control study to evaluate the relationship between weight loss, facial fat loss, and IL-6 in antiretroviral-naïve and treated participants living with HIV/AIDS. METHODS IL-6 was assayed by High performance liquid chromatography (HPLC) in 97 in consecutive newly diagnosed antiretroviral-naive (ART-naïve) people living with HIV/AIDS (age ≥18 years); and 118 consecutive, age-matched participants currently on Highly Active Antiretroviral Therapy (HAART), using age as a criterion. In the treated group, 78 (66.7%) subjects were on zidovudine, lamivudine with nevirapine (Z+L+N); 27(23.1%) on tenofovir, lamivudine with emtricitabine (T+L+E); 5(4.3%) on zidovudine, lamivudine with emtricitabine (Z+L+E); 4(3.4%) on zidovudine, lamivudine with tenofovir (Z+L+T); 2(1.7%) on lamivudine, tenofovir with nevirapine (L+T+N); 1(0.9%) on tenofovir, zidovudine, emtricitabine (Z+T+E). RESULTS A total of 215 participants: 97 ART-naive and 118 HAART-treated, age-matched subjects (40.3±9.6 versus 42.7±10.20years, p=0.08). The mean IL-6 was significantly higher in naïve than treated (0.69±0.04 versus 0.66±0.04 pg/ml, p =0.002). In all, 73 subjects experienced weight loss, 56(76.7%) naive, 17(23.3%) treated, p <0.0001, with significantly higher IL-6 in those with weight loss (0.69±0.05 versus 0.67±0.05pg/ml, p= 0.047). Fifty-eight (27.0%) subjects experienced facial fat loss, 49 (84.5%) naïve, and 9 (15.5%) treated, p <0.0001, with significantly higher IL-6 in those with facial fat loss (0.7 ± 0.05 versus 0.67±0.05pg/ml, p= 0.0001). Negative correlation exists between IL-6 and CD4+ count (r=-0.141, p=0.041). In logistic regression, independent predictors of weight loss include: IL-6 (Adjusted Odds Ratio, aOR 1.3, 95%CI 0·1-2·6, p=0.047); HIV duration (aOR 11.6, p <0.0001); AIDS-defining illness (aOR 3.5, p <0.0001); CD4+ count (aOR 3.2, p=0.004); HAART status (aOR 2.7, p<0.0001). CONCLUSION HIV infection is associated with elevation of serum interleukin-6, which likely contributes to weight and facial fat loss among the treatment-naïve participants; while HAART is associated with suppressed IL-6 levels, thereby ameliorating weight and facial fat loss. Inverse relationship exists between serum IL-6 and CD4+ count; serum IL-6 could differentiate between mild- to moderate and severe immunosuppressive states.
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Affiliation(s)
| | - Nife Olamide Adedeji
- Department of Obstetrics and Gynaecology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | | | - Olufemi Samuel Smith
- Department of Chemical Pathology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Olusola Akanni Jeje
- Department of Chemical Pathology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
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Bowman ER, Wilson M, Riedl KM, MaWhinney S, Jankowski CM, Funderburg NT, Erlandson KM. Lipidome Alterations with Exercise Among People With and Without HIV: An Exploratory Study. AIDS Res Hum Retroviruses 2022; 38:544-551. [PMID: 35302400 PMCID: PMC9297322 DOI: 10.1089/aid.2021.0154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Age-related comorbidities and physical function impairments in aging people with HIV (PWH) can be improved through exercise interventions. The mechanisms underlying these improvements, including lipidomic changes, are unknown. Sedentary adults (50-75 years old) with or without HIV participated in supervised endurance/resistance exercise for 24 weeks. Plasma lipid concentrations (∼1,200 lipid species from 13 lipid classes) at baseline and week 24 were measured by mass spectrometry. Given multiple comparisons, unadjusted and Benjamini-Hochberg corrected p values are reported. Analyses are considered exploratory. Twenty-five PWH and 24 controls had paired samples at baseline and week 24. The change in total triacylglycerol (TAG) concentrations after exercise intervention differed between groups (unadj-p = 0.006, adj-p = 0.078) with concentrations increasing among controls, but not among PWH. Changes in concentrations of TAG species composed of long-chain fatty acids differed between groups (unadj-p < 0.04) with increases among controls, but not among PWH. Changes in total diacylglycerol (DAG) concentration from baseline to week 24 differed between groups (unadj-p = 0.03, adj-p = 0.2) with an increase in PWH and a nonsignificant decrease in controls. Baseline to week 24 changes in DAGs composed of palmitic acid (16:0), palmitoleic acid (16:1), and stearic acid (18:0) differed by serostatus (unadj-p = 0.009-0.03; adj-p 0.10-0.12), with nonsignificant increases and decreases in concentrations in PWH and controls, respectively. Concentrations of individual lysophosphatidylcholine (LPC) and ceramide (CER) species also differed by HIV serostatus (unadj-p < = 0.05). Although exploratory, the effects of exercise on the lipidome may differ among people with and without HIV, potentially due to underlying alterations in lipid processing and fatty acid oxidation in PWH. Clinical Trials NCT02404792.
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Affiliation(s)
- Emily R. Bowman
- College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Melissa Wilson
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kenneth M. Riedl
- College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Samantha MaWhinney
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Catherine M. Jankowski
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | | | - Kristine M. Erlandson
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
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Soares VL, Soares WF, Zanetti HR, Neves FF, Silva-Vergara ML, Mendes EL. Daily Undulating Periodization Is More Effective Than Nonperiodized Training on Maximal Strength, Aerobic Capacity, and TCD4+ Cell Count in People Living With HIV. J Strength Cond Res 2022; 36:1738-1748. [PMID: 32604148 DOI: 10.1519/jsc.0000000000003675] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
ABSTRACT Soares, VL, Soares, WF, Zanetti, HR, Neves, FF, Silva-Vergara, ML, and Mendes, EL. Daily undulating periodization is more effective than nonperiodized training on maximal strength, aerobic capacity, and TCD4+ cell count in people living with HIV. J Strength Cond Res 36(6): 1738-1748, 2022-The aim of this study was to evaluate the effects of daily undulating periodization (DUP) and nonperiodized training (NPT) programs on maximal muscle strength, body composition, aerobic capacity, muscle power, and immune markers in people living with HIV (PLWHIV). A total of 41 PLWHIV were randomly assigned to control (CON [n = 15]), DUP (n = 13), and NPT (n = 13) groups. The DUP and NPT groups performed combined training 3 times a week on nonconsecutive days during 12 weeks, whereas the CON group was asked to maintain their current level of activity. After the 12-week training program, DUP produced greater gains in muscle strength (except for bench press), V̇o2peak, and muscle power than NPT (p < 0.05). Compared to CON, the training groups showed significantly (p < 0.05) increased muscle strength (DUP = 31.0 ± 13.9 kg; NPT = 17.7 ± 9.2 kg; CON = -0.3 ± 1.5 kg), fat-free mass (DUP = 1.9 ± 1.5 kg; NPT = 1.4 ± 1.9 kg; CON = -0.1 ± 1.2 kg), and metabolic equivalent (DUP = 2.3 ± 1.3; NPT = 1.8 ± 1.9), and decreased body fat mass (DUP = -2.1 ± 1.6 kg; NPT = -1.4 ± 1.5 kg; CON = 0.1 ± 0.2) and functional aerobic impairment (DUP = -35.9 ± 17.0%; NPT = -25.8 ± 22.0%; CON = 0.8 ± 3.0%). There was an increase in TCD4+ cells only in the DUP group (p < 0.05). The training effect generally provided a positive correlation between change in leg press strength (r = 0.393, p < 0.05), triceps pulley strength (r = 0.417, p < 0.05), lat pull-down strength (r = 0.459, p < 0.05), and muscle power (r = 0.324, p < 0.05) with changing CD4 + lymphocyte count. Daily undulating periodization protocol showed to be safe, applicable, and more efficient for increasing strength, aerobic capacity, and TCD4+ cells compared to NPT in PLWHIV.
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Affiliation(s)
- Vitor Lopes Soares
- Exercise Science, Health and Human Performance Research Group, Department of Sport Sciences, Postgraduate Program in Physical Education, Federal University of Triângulo Mineiro, Uberaba, MG, Brazil
| | - Weverton Fonseca Soares
- Exercise Science, Health and Human Performance Research Group, Department of Sport Sciences, Postgraduate Program in Physical Education, Federal University of Triângulo Mineiro, Uberaba, MG, Brazil
| | - Hugo Ribeiro Zanetti
- Department of Physical Education, Master Institute of Education President Antônio Carlos, Araguari, MG, Brazil
| | - Fernando Freitas Neves
- Department of Medical Clinics, Institute of Health Sciences, Clinics Hospital, Federal University of Triângulo Mineiro, Uberaba, MG, Brazil ; and
| | - Mário Leon Silva-Vergara
- Department of Medical Clinics, Institute of Health Sciences, Clinics Hospital, Federal University of Triângulo Mineiro, Uberaba, MG, Brazil ; and
| | - Edmar Lacerda Mendes
- Exercise Science, Health and Human Performance Research Group, Department of Sport Sciences, Postgraduate Program in Physical Education, Federal University of Triângulo Mineiro, Uberaba, MG, Brazil
- Department of Sport Sciences, Institute of Health Sciences, Federal University of Triângulo Mineiro, Uberaba, MG, Brazil
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Anthropometric changes following aerobic and resistance training programs among HIV-seropositive female patients. TURKISH JOURNAL OF KINESIOLOGY 2020. [DOI: 10.31459/turkjkin.735636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Ozemek C, Erlandson KM, Jankowski CM. Physical activity and exercise to improve cardiovascular health for adults living with HIV. Prog Cardiovasc Dis 2020; 63:178-183. [PMID: 32014512 DOI: 10.1016/j.pcad.2020.01.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 01/29/2020] [Indexed: 12/11/2022]
Abstract
Pharmacologic advancements in the treatment of human immunodeficiency virus (HIV) has extended the life expectancy of people living with HIV (PLWH). An unfortunate side effect of HIV treatment, however, is an increased prevalence of dyslipidemia, glycemic dysregulation and abnormal distribution of body fat (lipodystrophy). Consequently, the risk of developing cardiovascular disease (CVD) is significantly increased in PLWH and ultimately a major cause of mortality. Physical activity and exercise training are interventions that have effectively protected against the development of CVD and, in the presence of CVD, has help mitigate morbidity and mortality. Early concerns over potential immunosuppressive effects of exercise in PLWH have largely been dispelled and in some cases exercise has been shown to strengthen markers of immune function. Interventions with aerobic exercise, resistance exercise, and their combination, particularly at higher intensities, are showing promising health outcomes in PLWH. This review will summarize the key cardiovascular and metabolic effects of antiretroviral therapy; the effects of the types and intensities of exercise on cardiorespiratory fitness, cardiometabolic markers, and muscle strength; and provide recommendations on strategies to apply exercise interventions in clinical settings.
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Affiliation(s)
- Cemal Ozemek
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA.
| | - Kristine M Erlandson
- School of Medicine, Division of Infectious Diseases, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
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Malete L, Etnier JL, Tladi DM, Vance JC, Anabwani GM. Predicting cognitive performance from physical activity and fitness in adolescents and young adults in Botswana relative to HIV status. Sci Rep 2019; 9:19583. [PMID: 31862947 PMCID: PMC6925206 DOI: 10.1038/s41598-019-55925-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 12/04/2019] [Indexed: 11/09/2022] Open
Abstract
Little is known about whether physical activity and fitness could enhance cognition in adolescents and young adults living with HIV. The purpose of this study was to examine this relationship in a group of 250 HIV+ (n = 88) and HIV negative (n = 162) participants from Botswana, aged 12-23 years (Mean = 17.87, SD = 2.24). Fitness was operationalized as muscular strength (push-ups) and aerobic endurance (PACER). PA was assessed using items from the Youth Risk Behavior Surveillance Survey. Cognition was measured using the Corsi Test, Berg Card Sorting Task (BCST), and Stroop Color Word Task (Stroop). Multiple regression analyses indicated that the HIV x push-ups interaction was a significant predictor of Corsi performance, and HIV status was a significant predictor of BCST performance (p < 0.05). For the Stroop portions, HIV status and HIV x push-ups were significant predictors (p < 0.01). HIV status is predictive of cognition and interacts with muscular fitness to predict cognition.
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Affiliation(s)
- Leapetswe Malete
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA.
| | - Jennifer L Etnier
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Dawn M Tladi
- Department of Physical Education, Health & Recreation, University of Botswana, Gaborone, Botswana
| | - Jarod C Vance
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Gabriel M Anabwani
- The Botswana-Baylor Children's Clinical Centre of Excellence, Gaborone, Botswana
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Poton R, Polito MD. The effects of aerobic training on the CD4 cells, VO2max, and metabolic parameters in HIV-infected patients: a meta-analysis of randomized controlled trials. J Sports Med Phys Fitness 2019; 60:634-642. [PMID: 31818061 DOI: 10.23736/s0022-4707.19.10261-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION To our knowledge, there are no systematic review study with meta-analysis that investigated the influence of training variables on specific outcomes (CD4 cell counts) addressed aerobic training (AT) for HIV+ patients. In this sense, the purpose of this study was to perform a systematic review with meta-analysis of randomized controlled trials on AT in HIV+ patients and to analyze the influence of AT modulating variables on the CD4 cells, VO2max, and metabolic parameters. EVIDENCE ACQUISITION Searches were performed in the databases PubMed, ISI Web of Knowledge, SportDiscus, Lilacs, Science Direct, and Scielo. EVIDENCE SYNTHESIS Twelve studies involving 438 subjects (78.2% male) were included. Overall, the sample was sedentary (pre-training VO2max of 30.5 mL.kg-1.min-1) with a mean time of virus infection of 66.9 months and mean number of CD4 cells of 467.8 cells/mm3. AT increased the VO2max (ES=1050 [0.455 to 1.64]; P<0.001) and CD4 cell count (ES=0.402 [0.203 to 0.601]; P<0.001). AT for 8-12 weeks appears to be sufficient to increase VO2max, and the highest gains are associated with patients who present higher initial CD4 cell values. There was no difference to metabolic parameters. CONCLUSIONS AT did not change the metabolic parameters, but it was AT is able to promote a greater magnitude of improvement in VO2max in the initial weeks of training and a greater increase in the number of CD4 cells in patients who present a better immune condition prior to training.
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Affiliation(s)
- Roberto Poton
- Research Group of Cardiovascular Response and Exercise, Londrina State University, Londrina, Brazil.,IBMR University Center, Laureate International Universities, Rio de Janeiro, Brazil
| | - Marcos D Polito
- Research Group of Cardiovascular Response and Exercise, Londrina State University, Londrina, Brazil -
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12
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Tumusiime DK, Stewart A, Venter FWD, Musenge E. The effects of a physiotherapist-led exercise intervention on peripheral neuropathy among people living with HIV on antiretroviral therapy in Kigali, Rwanda. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2019; 75:1328. [PMID: 31535052 PMCID: PMC6739563 DOI: 10.4102/sajp.v75i1.1328] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 05/24/2019] [Indexed: 11/08/2022] Open
Abstract
Background HIV-associated peripheral neuropathy (PN) is common in people living with HIV. Its management is mostly symptomatic utilising pharmacological approaches. Objectives This study determined the effects of an exercise intervention on PN among Rwandan people living with HIV receiving antiretroviral therapy (ART). Methods A 12-week single-blinded randomised controlled trial using the Brief Peripheral Neuropathy Screen (BPNS) as the assessment tool tested the effects of an exercise intervention on PN, followed by a 12-week non-intervention period. A total of 120 people with HIV- associated PN on ART were randomised to an exercise or no exercise group. Both groups continued receiving routine care. A bivariate analysis using Pearson’s chi-square test for significant differences in PN symptoms and signs, between groups, at baseline, after the 12 weeks intervention and 12 weeks post-intervention using generalised linear regression models to determine predictors of treatment outcomes was undertaken, utilising an intention-to-treat analysis (alpha p ≤ 0.05). Results At 12 weeks, the intervention group compared to the control: neuropathic pain 70% versus 94% (p < 0.005), PN symptoms severity – mild and/or none in 85% versus 60% (p < 0.001) and radiation of PN symptoms reduced, 80% versus 37% (p < 0.001). There were no differences in PN signs at 12 weeks intervention and at 12 weeks post-intervention. Having changed the antiretroviral (ARV) and having developed PN symptoms after the start on ARVs predicted treatment improvement, while demographic factors did not predict any treatment outcome. Conclusion A physiotherapist-led exercise intervention improved PN symptoms, but with non-significant improvement in PN signs. Factors related to early diagnosis and treatment of PN were facilitators for the improvement of PN symptoms. Clinical implications Physiotherapist-led exercises should be integrated into the routine management of people living with HIV on ART with PN symptoms.
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Affiliation(s)
- David K Tumusiime
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Aimée Stewart
- Department of Physiotherapy, School of Therapeutic Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Francois W D Venter
- Witwatersrand Reproductive Health and HIV Institute (WRHI), Johannesburg, South Africa.,Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Eustasius Musenge
- Division of Biostatistics and Epidemiology, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
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13
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Quiles NN, Piao L, Ortiz A. The effects of exercise on lipid profile and blood glucose levels in people living with HIV: A systematic review of randomized controlled trials. AIDS Care 2019; 32:882-889. [PMID: 31514520 DOI: 10.1080/09540121.2019.1665163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Exercise is commonly prescribed to improve lipid profile and glucose levels in people living with HIV (PLWH). This systematic review was performed in order to examine the effects of exercise interventions on lipid profile and glucose levels on PLWH. Randomized controlled trials (RCTs) investigating the effects of exercise on blood glucose, triglycerides (TG), total cholesterol (TC), HDL and LDL published up to November 2017 were reviewed. Two reviewers assessed inclusion and exclusion criteria, methodological quality and extracted the data. The PEDro scale was used to assess the quality of the included studies. Nine RCTs involving 638 PLWH met inclusion criteria. The median PEDro scale score was 5 out of 10. Three combined aerobic exercise + resistance exercise studies (AE+RE) showed improvements in blood glucose levels, one study showed improvements in HDL, one showed improvements in TG, and one showed improvements in TC. The AE only study reported improvements in HDL, while the RE only study reported improvements in TG, TC, HDL and LDL. Exercise can be effective for the improvement of some metabolic parameters, especially blood glucose and HDL. However, due to methodological issues, small number of studies and differences in exercise protocols, these findings should be interpreted with caution.
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Affiliation(s)
- Norberto N Quiles
- Department of Family Nutrition and Exercise Sciences, Queens College of the City University of New York, NY, USA
| | - Lin Piao
- Department of Family Nutrition and Exercise Sciences, Queens College of the City University of New York, NY, USA
| | - Alexis Ortiz
- Department of Physical Therapy, University of Texas, San Antonio, TX, USA
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14
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Hanass-Hancock J, Carpenter B, Myezwa H. The missing link: exploring the intersection of gender, capabilities, and depressive symptoms in the context of chronic HIV. Women Health 2019; 59:1212-1226. [PMID: 31043146 DOI: 10.1080/03630242.2019.1607799] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Depressive symptoms occur frequently among people living with HIV, especially women. These symptoms are associated with human, social, financial, and physical/natural capabilities and life stressors that differ between women and men. However, the link between depressive symptoms and functional limitations/disability is seldom discussed in the context of HIV, especially for gender-specific relationships. A cross-sectional survey of 1042 people living with HIV and using long-term antiretroviral therapy (ART) in South Africa was conducted from June to August 2014 to investigate the associations of disability, human, social, physical/natural, and financial capabilities, health, and adherence to ART, including possible gender-specific factors. Socio-demographic information, capabilities, health indicators, functional limitations/disability, and depressive symptoms (CES-D 10) were measured. We applied descriptive and bivariate statistics and multiple regression. Overall, 26% of people presented with depressive symptoms. Greater functional limitations and health symptoms and lower food security were strongly associated with depressive symptoms, while associations with financial capital and body mass index were gender-specific. The results call for the improvement of comprehensive care, including gender-sensitive mental health interventions. The results further indicate that functional limitations/disability needs to be considered, along with linking rehabilitation and livelihood programs with comprehensive HIV-care, in particular for those who experience depressive symptoms.
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Affiliation(s)
- Jill Hanass-Hancock
- HIV Prevention Research Unit, South African Medical Research Council, Cape Town, South Africa.,College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Bradley Carpenter
- HIV Prevention Research Unit, South African Medical Research Council, Cape Town, South Africa.,College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Hellen Myezwa
- Department of Physiotherapy, University of the Witwatersrand, Johannesburg, South Africa
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15
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Ibeneme SC, Omeje C, Myezwa H, Ezeofor SN, Anieto EM, Irem F, Nnamani AO, Ezenwankwo FE, Ibeneme GC. Effects of physical exercises on inflammatory biomarkers and cardiopulmonary function in patients living with HIV: a systematic review with meta-analysis. BMC Infect Dis 2019; 19:359. [PMID: 31035959 PMCID: PMC6489236 DOI: 10.1186/s12879-019-3960-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 04/08/2019] [Indexed: 12/18/2022] Open
Abstract
Background Pro-inflammatory cytokines expressed in human immune deficiency virus (HIV) infection, may induce oxidative stress likely to compromise the patency of the airways or damage the lung tissues/cardiac function. However, physical (aerobic and/or resistance) exercise-induced release of heat shock protein, immune function alteration or reduced tissue hypoxia, have been highlighted as possible mechanisms by which increasing physical activity may reduce plasma pro-inflammatory cytokines in uninfected individuals and should be appraised in the literature for evidence of similar benefits in people living with HIV (PLWH). Therefore, we evaluated the effects of physical exercises on 1) inflammatory biomarkers and 2) cardiopulmonary function (VO2 Max) in PLWH. Method A systematic review was conducted using the Cochrane Collaboration protocol. Searching databases, up to January 2018. Only randomized control trials investigating the effects of either aerobic or resistance or a combination of both exercise types with a control/other intervention(s) for a period of at least 4 weeks among adults living with HIV, were included. Two independent reviewers determined the eligibility of the studies. Data were extracted and risk of bias (ROB) was assessed with the Cochrane Collaboration ROB tool. Meta-analyses were conducted with random effect models using the Review Manager (RevMan) computer software. Result Twenty-three studies met inclusion criteria (n = 1073 participants at study completion) comprising male and female with age range 18–65 years. Three meta-analyses across three sub-groups comparisons were performed. The result showed no significant change in biomarkers of inflammation (IL-6 and IL-1β) unlike a significant (Z = 3.80, p < 0.0001) improvement in VO2 Max. Overall, the GRADE evidence for this review was of moderate quality. Conclusion There was evidence that engaging in either aerobic or resistance exercise, or a combination of both exercises, two to five times per week can lead to a significant improvement in cardiopulmonary function but not biomarkers of inflammation (IL-6 and IL-1β). However, this should not be interpreted as “No evidence of effect” because the individual trial studies did not attain sufficient power to detect treatment effects. The moderate grade evidence for this review suggests that further research may likely have an important impact on our confidence in the estimate of effects and may change the estimate. Electronic supplementary material The online version of this article (10.1186/s12879-019-3960-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S C Ibeneme
- Department of Medical Rehabilitation, Faculty of Health Sciences, University of Nigeria, Enugu Campus, Enugu, Nigeria. .,Department of Physiotherapy, Faculty of Health Sciences, School of Therapeutic Studies, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa. .,Clinical Trial Consortium University of Nigeria, Nsukka, Nigeria.
| | - C Omeje
- Department of Medical Rehabilitation, Faculty of Health Sciences, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - H Myezwa
- Department of Physiotherapy, Faculty of Health Sciences, School of Therapeutic Studies, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa
| | - Salome Nwaelom Ezeofor
- Department of Radiation Medicine, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Ituku-Ozalla Campus, Enugu, Nigeria.,Clinical Trial Consortium University of Nigeria, Nsukka, Nigeria
| | - E M Anieto
- Department of Medical Rehabilitation, Faculty of Health Sciences, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - F Irem
- Department of Medical Rehabilitation, Faculty of Health Sciences, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Amaka Obiageli Nnamani
- Department of Radiation Medicine, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Ituku-Ozalla Campus, Enugu, Nigeria.,Clinical Trial Consortium University of Nigeria, Nsukka, Nigeria
| | - Fortune Elochukwu Ezenwankwo
- Department of Medical Rehabilitation, Faculty of Health Sciences, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - G C Ibeneme
- Department of Nursing Sciences, Ebonyi State University, Abakaliki, Ebonyi State, Nigeria
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16
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Silveira EA, Falco MO. [Nutritional diagnosis of people living with HIV/AIDS: a review of national and international protocols]. CIENCIA & SAUDE COLETIVA 2019; 25:5003-5016. [PMID: 33295518 DOI: 10.1590/1413-812320202512.36262018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 04/15/2019] [Indexed: 11/21/2022] Open
Abstract
HIV infection is a predictor of several metabolic and body composition alterations, in addition to malnutrition, anemia, and hypovitaminosis. There are thus specificities of diagnosis and treatment depending on the stage of the disease and the outpatient or hospital environment. The scope of this narrative review was to update the conceptual and theoretical framework regarding the nutritional diagnosis of people living with HIV/AIDS. Current national and international scientific evidence published in scientific articles, recent books, protocols, consensuses, and guidelines were analyzed. The nutritional diagnosis encompasses several clinical aspects and abilities and specific knowledge about HIV/AIDS, such as: clinical history and current clinical situation, food consumption, anthropometric data, body composition, and biochemistry, blood pressure and physical examination. The nutritional diagnosis process was demonstrated in order to provide subsidies for the health teams in the identification of parameters that make it possible to establish a plan for nutritional care to promote, prevent and recuperate the alterations detected in people living with HIV/AIDS.
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Affiliation(s)
- Erika Aparecida Silveira
- Programa de Pós-Graduação Ciências da Saúde, Faculdade de Medicina, Universidade Federal de Goiás. Av. Primeira Avenida s/n, Setor Leste Universitário. 74605-050 Goiânia GO Brasil.
| | - Marianne Oliveira Falco
- Programa de Pós-Graduação Ciências da Saúde, Faculdade de Medicina, Universidade Federal de Goiás. Av. Primeira Avenida s/n, Setor Leste Universitário. 74605-050 Goiânia GO Brasil.
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17
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Abstract
Evidence would suggest that regardless of disease status, people living with human immunodeficiency virus (HIV)/AIDS can obtain similar health benefits from routine physical activity reported within general populations. Research has shown significant improvements among psychological and physiologic variables within the first 5 to 6 weeks of beginning a routine physical activity program. Daily activity has shown promising results in other clinical populations, but there is still a paucity of research that limits evidence among the HIV population. Additional research is needed to examine the long-term benefits of physical activity, and to discover more practical ways to achieve this lifestyle change.
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Affiliation(s)
- Jason R Jaggers
- Department of Health and Sport Sciences, University of Louisville, 2100 South Floyd Street SAC East 104, Louisville, KY 40208, USA.
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18
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Biraguma J, Mutimura E, Frantz JM. Health-related quality of life and associated factors in adults living with HIV in Rwanda. SAHARA J 2018; 15:110-120. [PMID: 30200815 PMCID: PMC6136357 DOI: 10.1080/17290376.2018.1520144] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
In Rwanda, as in other sub-Saharan African (SSA) countries, life expectancy of people living with HIV (PLWH) has increased dramatically as a result of combined antiretroviral therapy (cART). People living with HIV can now live longer but with increasing rates of non-communicable diseases (NCDs). Thus, prevention of NCD comorbidities in PWLHI is crucial to maintain and gain health-related benefits and to maximise the health-related quality of life (HRQOL) in the long-term management of PLWH. This study determines the association between physical and mental health-related dimensions of quality of life (QOL) with behavioural and biological risk factors, after controlling socio-demographic and HIV-related factors in adults living with HIV in Rwanda. A cross-sectional study using the WHO STEPwise approach and Kinyarwanda version of the MOS-HIV Health Survey, risk factors for NCDs and HRQOL were analysed for 794 PLWH, both HIV+ on ART and ART-naïve. Multiple regression analysis was used to examine the relationship between CMD risk factors and physical health and mental health summary scores. A total of 794 participants were interviewed. The mean age of the sample was 37.9 (±10.8) years and the majority of the participants were women (n = 513; 64.6%). About 16.2% reported daily smoking, 31.4% reported harmful alcohol use and 95% reported insufficient consumption of vegetables and fruits while 26.1% reported being physically inactive. 18.4% were overweight 43.4% had abdominal obesity, i.e. waist-hip-ratio (WHR) ≥0.95 in males and 0.85 in females. High blood pressure (HBP), i.e. systolic blood pressure (SBP) of ≥140 mmHg, or diastolic blood pressure (DBP) ≥90 mmHg was 24.4%. The results reveal that mean physical health summary and mental health summary score values were 63.96 ± 11.68 and 53.43 ± 10.89, respectively. While participants indicated that tobacco users and those who had abdominal obesity reported poor mental HRQOL, physical inactivity and hypertension have a negative impact on physical HRQOL. In addition, certain socio-demographic and HIV-related variables - specifically being unmarried, lack of HIV disclosure and low CD4 count (less 350 cell counts /mm3) - were associated with significantly lower mental and physical dimensions of quality of life. The results of this study reveal that behavioural and biological risk factors for NCDs were significantly associated with a lower HRQOL. These research findings also suggest that the assessment of the association between behavioural and biological risk factors for NCDs and a HRQOL provides opportunities for targeted counselling and secondary prevention efforts, so that health care providers can implement strategies that have a significant impact on the HRQOL.
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Affiliation(s)
- Juvenal Biraguma
- a College of Medicine and Health Sciences , University of Rwanda , Kigali , Rwanda.,b Faculty of Community and Health Sciences , University of the Western Cape , Cape Town , South Africa
| | - Eugene Mutimura
- a College of Medicine and Health Sciences , University of Rwanda , Kigali , Rwanda.,c Regional Alliance for Sustainable Development (RASD) , Kigali , Rwanda
| | - José M Frantz
- b Faculty of Community and Health Sciences , University of the Western Cape , Cape Town , South Africa
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19
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Silva LLG, Santos EMD, Nascimento LCPD, Cavalcanti MCDF, Arruda IKGD, Luz MCL, Cabral PC. Lipodystrophic syndrome of HIV and associated factors: a study in a university hospital. CIENCIA & SAUDE COLETIVA 2018; 25:989-998. [PMID: 32159668 DOI: 10.1590/1413-81232020253.11772018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 07/05/2018] [Indexed: 11/22/2022] Open
Abstract
The use of antiretroviral drugs has increased the survival of HIV patients, but may have side effects, such as lipodystrophic syndrome. This article aims to identify the frequency of the lipodystrophic syndrome and its associated factors in patients with HIV using antiretroviral therapy. It involved a cross-sectional study with HIV patients, monitored on an outpatient basis. The syndrome was evaluated by the association of two parameters: peripheral weight loss through the lipodystrophy severity scale and central fat accumulation, measured by the hip waist ratio. Poisson regression analysis was performed to identify the associated variables. Of the 104 patients evaluated, 27.9% presented the syndrome. After adjustment, the female sex (PRadjusted = 2.16 CI95% 1.43-3.39), being overweight (PRadjusted = 2.23 CI95% 1.35-2.65) and a longer period of use of antiretrovirals (PRadjusted = 1.64 CI95% 1.16-2.78), remained positively associated with the syndrome. On the other hand, a negative association with CD4 count £ 350 (PRadjusted = 0.39 CI95% 0.10-0.97) was observed The high prevalence of the syndrome and its association with specific groups reinforce the need for adequate follow-up and early identification to intervene in modifiable factors.
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Affiliation(s)
- Lídia Laís Gomes Silva
- Programa de Residência em Nutrição Clínica, Hospital das Clínicas, Universidade Federal de Pernambuco. Av. Prof. Moraes Rego 1235, Cidade Universitária. 50670-901, Recife, PE, Brasil.
| | - Eryka Maria Dos Santos
- Programa de Residência em Nutrição Clínica, Hospital das Clínicas, Universidade Federal de Pernambuco. Av. Prof. Moraes Rego 1235, Cidade Universitária. 50670-901, Recife, PE, Brasil.
| | - Luciana Caroline Paulino do Nascimento
- Programa de Residência em Nutrição Clínica, Hospital das Clínicas, Universidade Federal de Pernambuco. Av. Prof. Moraes Rego 1235, Cidade Universitária. 50670-901, Recife, PE, Brasil.
| | - Mikaella Carla de França Cavalcanti
- Programa de Residência em Nutrição Clínica, Hospital das Clínicas, Universidade Federal de Pernambuco. Av. Prof. Moraes Rego 1235, Cidade Universitária. 50670-901, Recife, PE, Brasil.
| | - Ilma Kruze Grande de Arruda
- Programa de Residência em Nutrição Clínica, Hospital das Clínicas, Universidade Federal de Pernambuco. Av. Prof. Moraes Rego 1235, Cidade Universitária. 50670-901, Recife, PE, Brasil.
| | - Marcella Campos Lima Luz
- Programa de Residência em Nutrição Clínica, Hospital das Clínicas, Universidade Federal de Pernambuco. Av. Prof. Moraes Rego 1235, Cidade Universitária. 50670-901, Recife, PE, Brasil.
| | - Poliana Coelho Cabral
- Programa de Residência em Nutrição Clínica, Hospital das Clínicas, Universidade Federal de Pernambuco. Av. Prof. Moraes Rego 1235, Cidade Universitária. 50670-901, Recife, PE, Brasil.
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20
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Oursler KK, Sorkin JD, Ryan AS, Katzel LI. A pilot randomized aerobic exercise trial in older HIV-infected men: Insights into strategies for successful aging with HIV. PLoS One 2018; 13:e0198855. [PMID: 29894513 PMCID: PMC5997336 DOI: 10.1371/journal.pone.0198855] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 05/19/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND HIV-infected adults have increased risk for age-related diseases and low cardiorespiratory fitness that can be prevented and improved with exercise. Yet, exercise strategies have not been well studied in older adults with HIV and may require substantial adaptation to this special population. OBJECTIVE To determine the safety and efficacy of aerobic exercise in older HIV-infected men in a randomized trial comparing different levels of exercise intensity. METHODS We conducted a pilot exercise trial in 22 HIV-infected men ≥50 years of age receiving antiretroviral therapy who were randomized 1:1 to moderate-intensity aerobic exercise (Mod-AEX) or high-intensity aerobic exercise (High-AEX) that was performed three times weekly for 16 weeks in a supervised setting. Primary outcome was cardiorespiratory fitness (VO2peak) measured by treadmill testing. Secondary outcomes were exercise endurance, six-minute walk distance (6-MWD), body composition measured by Dual-energy X-ray absorptiometry (DXA), and fasting plasma levels of lipids and glucose. RESULTS VO2peak increased in the High-AEX group (3.6 ±1.2 mL/kg/min, p = 0.02) but not in the Mod-AEX group (0.4 ±1.4 mL/kg/min, p = 0.7) with a significant between group difference (p<0.01). Exercise endurance increased in both the High-AEX group (27 ±11%, p = 0.02) and the Mod-AEX group (11 ±4%, p = 0.04). The 6-MWD increased in both the High-AEX (62 ±18m, p = 0.01) and the Mod-AEX group (54 ±14m, p = 0.01). Changes in VO2peak and 6-MWD were clinically relevant. There were no serious exercise-related adverse events. Dropouts were similar between group (27% overall) and were related to joint pain. CONCLUSIONS This pilot exercise trial demonstrates that moderate to high-intensity aerobic exercise in older HIV-infected men increases endurance and ambulatory function. However, increased cardiorespiratory fitness was observed only with high-intensity aerobic exercise despite substantial baseline impairment. Future research is needed to determine exercise strategies in older HIV-infected adults that address advanced aging and comorbidity yet are durable and feasible.
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Affiliation(s)
- Krisann K. Oursler
- Geriatric Research, Education, and Clinical Center, Baltimore Veterans Affairs Medical Center, Veterans Affairs Maryland Health Care System, Baltimore, MD, United States of America
- Department of Medicine, Division Gerontology and Geriatric Medicine, The University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - John D. Sorkin
- Geriatric Research, Education, and Clinical Center, Baltimore Veterans Affairs Medical Center, Veterans Affairs Maryland Health Care System, Baltimore, MD, United States of America
- Department of Medicine, Division Gerontology and Geriatric Medicine, The University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Alice S. Ryan
- Geriatric Research, Education, and Clinical Center, Baltimore Veterans Affairs Medical Center, Veterans Affairs Maryland Health Care System, Baltimore, MD, United States of America
- Department of Medicine, Division Gerontology and Geriatric Medicine, The University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Leslie I. Katzel
- Geriatric Research, Education, and Clinical Center, Baltimore Veterans Affairs Medical Center, Veterans Affairs Maryland Health Care System, Baltimore, MD, United States of America
- Department of Medicine, Division Gerontology and Geriatric Medicine, The University of Maryland School of Medicine, Baltimore, MD, United States of America
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21
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Abstract
PURPOSE OF REVIEW The aim of this review is to summarize knowledge of the prevalence, relevant physiology, and consequences of obesity and visceral adiposity in HIV-infected adults, including highlighting gaps in current knowledge and future research directions. RECENT FINDINGS Similar to the general population, obesity prevalence is increasing among HIV-infected persons, and obesity and visceral adiposity are associated with numerous metabolic and inflammatory sequelae. However, HIV- and antiretroviral therapy (ART)-specific factors may contribute to fat gain and fat quality in treated HIV infection, particularly to the development of visceral adiposity, and sex differences may exist. Obesity and visceral adiposity commonly occur in HIV-infected persons and have significant implications for morbidity and mortality. Future research should aim to better elucidate the HIV- and ART-specific contributors to obesity and visceral adiposity in treated HIV infection, with the goal of developing targeted therapies for the prevention and treatment of obesity and visceral adiposity in the modern ART era.
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Affiliation(s)
- Jordan E Lake
- University of Texas Health Science Center at Houston, 6431 Fannin St., MSB 2.112, Houston, TX, 77030, USA.
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22
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Silveira EA, Santos ASEADC, Falco MDO, Cardoso RDC, Vitorino PVDO. Association of physical inactivity with hypertension and low educational level in people living with HIV / AIDS. AIDS Care 2018; 30:1004-1009. [PMID: 29471672 DOI: 10.1080/09540121.2018.1441968] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The aim of this study was to determine the prevalence of physical inactivity and whether it is associated with sociodemographic, lifestyle, clinical, anthropometric, and body composition variables in people living with HIV/AIDS (PLWHA). This study makes use of data from a cohort of 288 adults aged ≥19 years, conducted between October 2009 and July 2011. The variables studied were sex, age, education, income, skin color, tobacco use, alcohol intake, body mass index, body fat percentage, waist circumference, and waist-hip ratio, length of HIV/AIDS diagnosis, use of antiretroviral therapy and length of its use, CD4, hypertension (HT) and diabetes mellitus. Physical inactivity was defined as a score below 600 metabolic equivalent minutes/week according to the International Physical Activity Questionnaire - Short Version. Poisson multiple regression was applied in the multivariate analysis with a significance level of 5%. The prevalence of physical inactivity was 44.1%. Education of ≤4 years of study (prevalence ratio [PR]: 1.71) and HT (PR: 1.49) were associated with physical inactivity. Physical inactivity was highly prevalent in PLWHA and associated with low educational level and HT. We highlight the simultaneous association between two cardiometabolic risk factors, HT and physical inactivity.
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Affiliation(s)
- Erika Aparecida Silveira
- a Programa de Pós-graduação em Ciências da Saúde, Faculdade de Medicina , Universidade Federal de Goiás (UFG) , Goiania , Brazil
| | | | - Marianne de Oliveira Falco
- a Programa de Pós-graduação em Ciências da Saúde, Faculdade de Medicina , Universidade Federal de Goiás (UFG) , Goiania , Brazil
| | - Rodrigo de Castro Cardoso
- a Programa de Pós-graduação em Ciências da Saúde, Faculdade de Medicina , Universidade Federal de Goiás (UFG) , Goiania , Brazil
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Schlabe S, Vogel M, Boesecke C, Schwarze-Zander C, Rockstroh JK, Körner C, Brixius K, Wasmuth JC. Moderate endurance training (marathon-training) - effects on immunologic and metabolic parameters in HIV-infected patients: the 42 KM cologne project. BMC Infect Dis 2017; 17:550. [PMID: 28789630 PMCID: PMC5549338 DOI: 10.1186/s12879-017-2651-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 07/30/2017] [Indexed: 12/20/2022] Open
Abstract
Background Improved treatment options of HIV have resulted in regular physical activities of many HIV-infected patients. However, data on effects of sports in HIV-patients are scarce. Methods 21 HIV-infected persons were monitored prospectively while preparing for a marathon run. Multiple parameters with regard to immunology, quality of life and metabolism were measured at 4 time points (at baseline 1 year before the marathon run, 3 and 6 months after beginning of training, and immediately before marathon). Results 13 out of 21 participants completed the marathon (12 male, 1 female; median age 42 years [27–50]; CD4 = 620/μl [146–1268]; 11 were on ART since 3.5 years [1–7]). 8 participants ceased training early. All reasons for stopping (besides one pre-existing metatarsal fracture) were not regarded as training-related (e.g. time limitation n = 3; newly diagnosed anal cancer n = 1; personal reasons/unknown n = 3). We observed a significant increase in absolute CD4-T-cells (620/μl [146–1268] vs. 745 [207–1647]; p = 0.001) with simultaneous decrease of CD4-T-cell apoptosis (53% [47–64] vs. 32% [14–42]); p < 0.01). No effects on viral load independent of ART occurred. Systolic blood pressure and cholesterol improved significantly, although moderate and normal at baseline (cholesterol 185 mg/dl [98–250] vs. 167 [106–222], p = 0.02; RRsys 125 mmHg [100–145] vs. 120 [100–140], p = 0.01). Blood count, liver enzymes, creatinine and CK remained unchanged. Conclusions The results of this pilot study indicated improved metabolic and immunologic parameters in HIV-infected patients undergoing moderate endurance training. Although training effects or ART cannot be ultimately separated as underlying mechanisms, we conclude that marathon training is safe for HIV-infected patients and potentially improves general health. Trial registration DRKS00011592 (retrospectively registered on February 9th 2017).
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Affiliation(s)
- Stefan Schlabe
- Department of Internal Medicine I, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
| | - Martin Vogel
- Department of Internal Medicine I, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Christoph Boesecke
- Department of Internal Medicine I, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | | | - Jürgen K Rockstroh
- Department of Internal Medicine I, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Christian Körner
- Department of Internal Medicine I, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.,Heinrich Pette Institute, Leibniz Institute for Experimental Virology, Hamburg, Germany
| | - Klara Brixius
- Department of Molecular and Cellular Sport Medicine, Institute for Cardiovascular Research and Sport Medicine, German Sport University Cologne, Cologne, Germany
| | - Jan-Christian Wasmuth
- Department of Internal Medicine I, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
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Research on rehabilitation interventions for adults living with HIV: a scoping review. Int J Rehabil Res 2017; 39:106-16. [PMID: 27028287 DOI: 10.1097/mrr.0000000000000166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this paper is to use a scoping review to investigate the extent, range, and nature of research on rehabilitation interventions for adults living with HIV. Electronic databases (MEDLINE, EMBASE, CINAHL, AMED, and PsychINFO) and reference lists of the included articles were searched. Authors were emailed when possible for unavailable articles. A total of 897 titles and abstracts were retrieved. Thirty-three articles were included. There were 27 different rehabilitation interventions delivered by 18 professions. The studies were completed in four different countries. Most studies were published in 2008. A randomized-controlled trial was the most used method. The nature of the studies was analyzed according to the three-core concepts of the International Classification of Functioning, Disability and Health: 28 studies addressed impairments; six studies addressed activity limitations; and 14 studies addressed participation restrictions. This scoping study advances the knowledge of research on rehabilitation interventions for adults living with HIV. More research on rehabilitation interventions is needed in sub-Saharan Africa and other low-income and middle-income countries to ensure that these individuals are receiving the best possible care. There is a need for the HIV field to recognize the important contribution of rehabilitation toward the HIV care continuum.
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25
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Cobbing S, Hanass-Hancock J, Myezwa H. Home-based rehabilitation interventions for adults living with HIV: a scoping review. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2016; 15:77-88. [PMID: 27002360 DOI: 10.2989/16085906.2016.1159968] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Home-based rehabilitation (HBR) has been shown to improve the lives of people living with a wide range of chronic diseases in resource-rich settings. This may also be a particularly effective strategy in resource-poor settings, where access to institution-based rehabilitation is limited. This review aimed to summarise and discuss the evidence related to the effectiveness of home-based rehabilitation (HBR) interventions designed specifically for adults living with HIV. A scoping review methodology was employed, involving systematic search techniques and appraisal of appropriate evidence. English-language journal articles that assessed the quality of life or functional ability outcomes of HBR interventions for adults living with HIV were considered for this review. Out of an initial 1 135 publications retrieved from the search of databases, six articles met this review's inclusion criteria. While this review highlights the scarcity of empirical evidence related to HBR interventions for adults living with HIV, the findings of these six articles are that HBR is a safe management option that may confer a number of physical and psychological benefits for this population. Future research on HBR interventions should include a wider range of assessment measures, including cost-benefit analyses and specific tools designed to assess the functional ability and participation in activities of daily living of participants involved in these programmes. In particular, more research on HBR is required in resource-poor environments, such as sub-Saharan Africa where HIV is endemic, to assess whether this is a feasible strategy that is both effective and practical in the areas that may need it most.
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Affiliation(s)
- Saul Cobbing
- a Department of Physiotherapy , University of KwaZulu-Natal , Durban , South Africa
| | - Jill Hanass-Hancock
- b Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal
| | - Hellen Myezwa
- c Department of Physiotherapy , University of the Witwatersrand , Johannesburg , South Africa
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26
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Managing Pain in Women Living With HIV/AIDS: A Randomized Controlled Trial Testing the Effect of a Six-Week Peer-Led Exercise and Education Intervention. J Nerv Ment Dis 2016; 204:665-72. [PMID: 27002748 DOI: 10.1097/nmd.0000000000000506] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study tested an intervention program based on a chronic pain management model for pain. We conducted a trial of a 6-week, peer-led exercise and education intervention on pain in amaXhosa women living with HIV/AIDS. Participants were monitored over 15 months of routine care before randomization. The control group was provided with educational workbooks, and the experimental group attended the intervention. Pain was reassessed monthly for 4 months. There was no significant reduction in pain during 15 months of routine care and no difference between groups at any of the time points (d = 0.04). Both groups experienced equivalent pain reduction during the intervention compared with the period of routine care with meaningful reductions in pain at months 3 (Cohen's d = 0.41) and 4 (Cohen's d = 0.59). Provision of a workbook and participating in a 6-week peer-led exercise and education intervention are efficacious methods to treat pain in amaXhosa women living with HIV/AIDS.
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27
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Dirks-Naylor AJ, Griffiths CL, Gibson JL, Luu JA. The prevalence of exercise prescription-related course offerings in United States pharmacy school curricula: Exercise is Medicine. ADVANCES IN PHYSIOLOGY EDUCATION 2016; 40:319-322. [PMID: 27445279 DOI: 10.1152/advan.00070.2016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 05/26/2016] [Indexed: 06/06/2023]
Abstract
Exercise training has proven to be beneficial in the prevention of disease. In addition, exercise can improve the pathogenesis and symptoms associated with a variety of chronic disease states and can attenuate drug-induced adverse effects. Exercise is a drug-free polypill. Because the benefits of exercise are clear and profound, Exercise is Medicine, a joint initiative between the American Medical Association and American College of Sports Medicine, was launched in 2007 to call on all health care providers to counsel patients and prescribe exercise in the prevention and treatment of chronic disease states. Pharmacists play an increasing role in direct patient care and are the most accessible health care providers in the community. Thus, pharmacists should be knowledgeable in counseling patients on the frequency, intensity, time, and type of exercise that is appropriate for various conditions and disease states. The aim of the present study was to determine the prevalence of didactic course offerings in United States pharmacy school curricula regarding training in exercise prescription. School websites were accessed for information regarding course offerings in PharmD programs. No United States pharmacy schools offered courses that were dedicted to the role of exercise in disease prevention or exercise prescription in disease management. Ninety percent of pharmacy schools did not offer courses with the keywords "exercise," "fitness, or "physical activity" in the title or description. The data suggest that student pharmacists are not adequately trained to counsel patients on the benefits of exercise or exercise prescription.
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Affiliation(s)
| | | | - Jacob L Gibson
- School of Pharmacy, Wingate University, Wingate, North Carolina
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28
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Shah KN, Majeed Z, Yoruk YB, Yang H, Hilton TN, McMahon JM, Hall WJ, Walck D, Luque AE, Ryan RM. Enhancing physical function in HIV-infected older adults: A randomized controlled clinical trial. Health Psychol 2016; 35:563-73. [PMID: 26867045 PMCID: PMC4868650 DOI: 10.1037/hea0000311] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE HIV-infected older adults (HOA) are at risk of functional decline. Interventions promoting physical activity that can attenuate functional decline and are easily translated into the HOA community are of high priority. We conducted a randomized, controlled clinical trial to evaluate whether a physical activity counseling intervention based on self-determination theory (SDT) improves physical function, autonomous motivation, depression and the quality of life (QOL) in HOA. METHOD In total, 67 community-dwelling HOA with mild-to-moderate functional limitations were randomized to 1 of 2 groups: a physical activity counseling group or the usual care control group. We used SDT to guide the development of the experimental intervention. Outcome measures that were collected at baseline and final study visits included a battery of physical function tests, levels of physical activity, autonomous motivation, depression, and QOL. RESULTS The study participants were similar in their demographic and clinical characteristics in both the treatment and control groups. Overall physical performance, gait speed, measures of endurance and strength, and levels of physical activity improved in the treatment group compared to the control group (p < .05). Measures of autonomous regulation such as identified regulation, and measures of depression and QOL improved significantly in the treatment group compared with the control group (p < .05). Across the groups, improvement in intrinsic regulation and QOL correlated with an improvement in physical function (p < .05). CONCLUSION Our findings suggest that a physical activity counseling program grounded in SDT can improve physical function, autonomous motivation, depression, and QOL in HOA with functional limitations. (PsycINFO Database Record
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Affiliation(s)
- Krupa N. Shah
- Division of Geriatrics and Aging, Department of Medicine, University of Rochester, Rochester, NY, USA
| | - Zahraa Majeed
- Division of Geriatrics and Aging, Department of Medicine, University of Rochester, Rochester, NY, USA
| | - Yilmaz B. Yoruk
- Division of Geriatrics and Aging, Department of Medicine, University of Rochester, Rochester, NY, USA
| | - Hongmei Yang
- Department of Biostatistics and Computational Biology University of Rochester, Rochester, NY, USA
| | | | | | - William J. Hall
- Division of Geriatrics and Aging, Department of Medicine, University of Rochester, Rochester, NY, USA
| | - Donna Walck
- Warner School of Education, Rochester, NY, USA
| | - Amneris E. Luque
- Division of Infectious Diseases, Department of Medicine, University of Rochester, Rochester, NY, USA
| | - Richard M. Ryan
- Institute for Positive Psychology and Education Australian Catholic University, Sydney, Australia
- Clinical and Social Sciences in Psychology, University of Rochester, Rochester, NY, USA
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29
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O'Brien KK, Tynan AM, Nixon SA, Glazier RH. Effectiveness of aerobic exercise for adults living with HIV: systematic review and meta-analysis using the Cochrane Collaboration protocol. BMC Infect Dis 2016; 16:182. [PMID: 27112335 PMCID: PMC4845358 DOI: 10.1186/s12879-016-1478-2] [Citation(s) in RCA: 136] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 03/23/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People with HIV are living longer with the health-related consequences of HIV, multi-morbidity, and aging. Exercise is a key strategy that may improve or sustain health for people living with HIV. Our aim was to examine the safety and effectiveness of aerobic exercise interventions on immunological, virological, cardiorespiratory, strength, weight, body composition, and psychological outcomes in adults living with HIV. METHODS We conducted a systematic review using the Cochrane Collaboration protocol. We searched databases up to April 2013. We included randomized controlled trials comparing aerobic exercise with no exercise or another intervention performed at least three times per week for at least four weeks among adults living with HIV. Two reviewers independently determined study eligibility. Data were extracted from studies that met inclusion criteria using standardized forms. We assessed risk of bias using the Cochrane Collaboration's tool for assessing risk of bias. Outcomes were analyzed as continuous and meta-analyses conducted using random effects models with Review Manager (RevMan) computer software. RESULTS Twenty-four studies met inclusion criteria (n = 936 participants at study completion); the majority of participants were men (73 %) and the majority were taking antiretroviral therapy (19/24 included studies). The exercise intervention included aerobic exercise alone (11 studies) or a combination of aerobic and resistive exercise (13 studies) ranging from 5 to 52 weeks. Fifty-eight meta-analyses were performed. Main results indicated statistically significant improvements in selected outcomes of cardiorespiratory status (maximum oxygen consumption, exercise time), strength (chest press, knee flexion), body composition (lean body mass, percent body fat, leg muscle area), depression symptoms, and quality of life (SF-36 questionnaire) among exercisers compared with non-exercisers. No significant differences in change in CD4 count and viral load were found. CONCLUSIONS Performing aerobic exercise or a combination of aerobic and resistive exercise at least three times per week for at least five weeks is safe and can lead to improvements in cardiorespiratory fitness, strength, body composition and quality of life for adults with HIV. Aerobic exercise is safe and beneficial for adults living with HIV who are medically stable.
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Affiliation(s)
- Kelly K O'Brien
- Department of Physical Therapy, University of Toronto, 500 University Avenue, Room 160, Toronto, ON, Canada. .,Rehabilitation Sciences Institute (RSI), University of Toronto, 500 University Avenue, Room 160, Toronto, ON, Canada. .,Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada.
| | - Anne-Marie Tynan
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Stephanie A Nixon
- Department of Physical Therapy, University of Toronto, 500 University Avenue, Room 160, Toronto, ON, Canada.,Rehabilitation Sciences Institute (RSI), University of Toronto, 500 University Avenue, Room 160, Toronto, ON, Canada
| | - Richard H Glazier
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada.,Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences, G1 06 2075 Bayview Ave, Toronto, ON, Canada.,Department of Family and Community Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON, Canada
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30
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Schafer JJ, Gill TK, Sherman EM, McNicholl IR. ASHP Guidelines on Pharmacist Involvement in HIV Care. Am J Health Syst Pharm 2016; 73:468-94. [PMID: 26892679 DOI: 10.2146/ajhp150623] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Jason J Schafer
- Department of Pharmacy Practice, Jefferson School of Pharmacy, Thomas Jefferson University, Philadelphia, PA
| | - Taylor K Gill
- Internal Medicine, Via Christi Hospitals Wichita, Wichita, KS
| | - Elizabeth M Sherman
- College of Pharmacy, Nova Southeastern University, Fort Lauderdale, FL, and South Broward Community Health Services, Memorial Healthcare System, Hollywood, FL
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31
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Hanass-Hancock J, Myezwa H, Carpenter B. Disability and Living with HIV: Baseline from a Cohort of People on Long Term ART in South Africa. PLoS One 2015; 10:e0143936. [PMID: 26625001 PMCID: PMC4666651 DOI: 10.1371/journal.pone.0143936] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 11/11/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Through access to life saving antiretroviral treatment (ART) in southern Africa, HIV has been reconceptualised as a chronic disease. This comes with new challenges of HIV-related co-morbidities and disabilities. We still lack an understanding of the types and scope of disabilities experienced by people on long term ART and how this impacts health, adherence, and livelihood. This paper describes the results of a cohort study examining the new health- and disability-related needs of the millions of people on ART in the region. METHODS Data was collected from a cohort of people who had been on ART for six months or longer in a semi-urban public health care setting in South Africa. 1042 adults (18 and older) participated in the cross-sectional study which investigated disabilities/activity limitations, health, ART adherence, depression symptoms, and livelihood. We analysed the associations between these constructs using descriptive statistics, and bivariate and multivariate analyses. RESULTS A large number of participants (35.5%) obtained a weighted score of two or more on the WHODAS 2.0 indicating possible activity limitations. A positive relationship was found between activity limitations and depression symptoms, adherence, and worse health outcomes, while none was found for BMI or CD4 count. These associations varied by type of activity limitations and, in some cases, by gender. CONCLUSION Activity limitations are potentially experienced by a large portion of people on ART in southern Africa which impacts health and ART adherence negatively. These results highlight the importance of better understanding the new health-related needs of people who are on long term ART, as well as the nuances of the disability they experience. This is urgently needed in order to enable HIV-endemic countries to better prepare for the new health-related needs of the millions of people on ART in southern Africa.
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Affiliation(s)
- Jill Hanass-Hancock
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Hellen Myezwa
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Bradley Carpenter
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
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32
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Lopez J, Richardson E, Tiozzo E, Lantigua L, Martinez C, Abreut G, Prendergast T, Atlas SE, Pangilinan AR, Ferris SM, Martinez AH, Konefal J, Woolger J, Ray AM, Simões HG, Campbell CS, Lewis JE. The effect of exercise training on disease progression, fitness, quality of life, and mental health in people living with HIV on antiretroviral therapy: a systematic review. J Clin Transl Res 2015; 1:129-139. [PMID: 30873450 PMCID: PMC6410621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 11/02/2015] [Accepted: 11/18/2015] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Exercise has been associated with improvements in adverse physiological and psychological effects of long-term antiretroviral therapy (ART) in people living with HIV (PLWH). AIM To summarizes the findings on the effects of aerobic or resistance training alone or combined aerobic and resistance exercise training (CARET) on disease progression, fitness, physical functioning, mental health, and quality of life (QOL) in PLWH receiving ART. A systematic search of articles was performed in several databases, and 20 articles that met inclusion criteria were summarized. RELEVANCE FOR PATIENTS Aerobic exercise was associated with improvements in aerobic capacity, QOL, and depressive symptoms, while resistance training improved strength. CARET was related to improved aerobic fitness, strength, physical functioning, QOL, and self-efficacy. At least one of the exercise interventions resulted in improvements in CD4+ cell count and HIV RNA viral load. Moreover, another study showed that HIV-specific biomarkers remained unchanged in the exercise intervention group, while they significantly worsened in the non-exercise group. In general, in spite of their well-known benefits, exercise programs have not been extensively utilized or widely recognized as viable therapeutic treatment options for this patient population. Knowing the possible health benefits of increasing physical activity level is important to better recommend exercise programs. However, the prescription must be done carefully and on an individual basis. Additional studies investigating the efficiency and effectiveness of different exercise training regimens for PLWH are needed.
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Affiliation(s)
- Johanna Lopez
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Erika Richardson
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Eduard Tiozzo
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Laura Lantigua
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Camilo Martinez
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - George Abreut
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Troy Prendergast
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Steven E. Atlas
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Andrew R. Pangilinan
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Serena M. Ferris
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Ana H. Martinez
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Janet Konefal
- Department of Family Medicine, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Judi Woolger
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Anna M. Ray
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Herbert G. Simões
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Carmen S.G. Campbell
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - John E. Lewis
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
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Mocumbi AO. Cardiac Disease and HIV in Africa: A Case for Physical Exercise. Open AIDS J 2015; 9:62-5. [PMID: 26587074 PMCID: PMC4645865 DOI: 10.2174/1874613601509010062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 08/08/2015] [Accepted: 08/16/2015] [Indexed: 11/24/2022] Open
Abstract
AIDS-related deaths and new HIV infections have declined globally, but continue to be a major problem in Africa. Prior to the advent of antiretroviral treatment (ART) HIV patients died of immunodeficiency and associated opportunistic infections; Highly Active Antiretroviral Therapy (HAART) has resulted in increased survival of these patients and has transformed this illness into a chronic condition. Cardiovascular, respiratory, neurological and muscular problems interfere with exercise in HIV-infected patients. Particularly cardiovascular disease may be associated with direct damage by the virus, by antiretroviral therapy and by malnutrition and chronic lung disease, resulting in physical and psychological impairment. Recent studies have shown the benefits of exercise training to improvement of physiologic and functional parameters, with the gains being specific to the type of exercise performed. Exercise should be recommended to all HIV patients as an effective prevention and treatment for metabolic and cardiovascular syndromes associated with HIV and HAART exposure in sub-Saharan Africa.
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Affiliation(s)
- Ana Olga Mocumbi
- Instituto Nacional de Saúde & Universidade Eduardo Mondlane, Av. Eduardo Mondlane 1008, Maputo, Moçambique
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34
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Leach LL, Bassett SH, Smithdorf G, Andrews BS, Travill AL. A Systematic Review of the Effects of Exercise Interventions on Body Composition in HIV+ Adults. Open AIDS J 2015; 9:66-79. [PMID: 26587075 PMCID: PMC4645834 DOI: 10.2174/1874613601509010066] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 08/08/2015] [Accepted: 08/16/2015] [Indexed: 11/22/2022] Open
Abstract
Over the years, physical activity and exercise have been used to positively impact the health and quality of life of persons infected with HIV and, more recently, has been associated with a spectrum of body composition changes. The aim of this review was to examine the effects of various exercise interventions on body composition in HIV positive adults, using a search strategy of randomized, controlled trials (RCTs). A systematic review was performed by five independent reviewers using a predetermined protocol adapted from previous research for assessing the articles for inclusion, the extracted data, and methodological quality. Eight RCTs involving 430 (26% female) HIV positive adults performing exercise a minimum of thrice weekly for at least six weeks were finally selected: Four were progressive resistance training (PRT) studies, three were aerobic training (AT) studies, and one involved yoga. In the PRT studies, there were significant increases in three anthropometric measures, namely, body mass, sum of skinfolds and sum of limb girths. In the AT studies, significant decreases were found in seven anthropometric measures, namely, body mass index, waist-hip ratio, body mass, triceps skinfold, waist circumference and sum of skinfolds. With yoga, the changes were non-significant. Exercise contributes to improved body composition and, when applied safely, appears to be beneficial for adults living with HIV/AIDS. However, these findings should be interpreted cautiously due to the relatively few RCTs published to date. Future studies would benefit from increased attention to sample size, female participants, participant follow-up, complete statistical analysis and intention-to-treat analysis.
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Affiliation(s)
- L L Leach
- Department of Sport, Recreation and Exercise Science, University of the Western Cape, Cape Town, South Africa
| | - S H Bassett
- Department of Sport, Recreation and Exercise Science, University of the Western Cape, Cape Town, South Africa
| | - G Smithdorf
- Department of Sport, Recreation and Exercise Science, University of the Western Cape, Cape Town, South Africa
| | - B S Andrews
- Department of Sport, Recreation and Exercise Science, University of the Western Cape, Cape Town, South Africa
| | - A L Travill
- Department of Sport, Recreation and Exercise Science, University of the Western Cape, Cape Town, South Africa
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35
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Dagenais-Lussier X, Mouna A, Routy JP, Tremblay C, Sekaly RP, El-Far M, Grevenynghe JV. Current topics in HIV-1 pathogenesis: The emergence of deregulated immuno-metabolism in HIV-infected subjects. Cytokine Growth Factor Rev 2015; 26:603-13. [PMID: 26409789 DOI: 10.1016/j.cytogfr.2015.09.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 09/04/2015] [Indexed: 01/17/2023]
Abstract
HIV-1 infection results in long-lasting activation of the immune system including elevated production of pro-inflammatory cytokine/chemokines, and bacterial product release from gut into blood and tissue compartments, which are not fully restored by antiretroviral therapies. HIV-1 has also developed numerous strategies via viral regulatory proteins to hijack cell molecular mechanisms to enhance its own replication and dissemination. Here, we reviewed the relationship between viral proteins, immune activation/inflammation, and deregulated metabolism occurring in HIV-1-infected patients that ultimately dampens the protective innate and adaptive arms of immunity. Defining precisely the molecular mechanisms related to deregulated immuno-metabolism during HIV-1 infection could ultimately help in the development of novel clinical approaches to restore proper immune functions in these patients.
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Affiliation(s)
| | - Aounallah Mouna
- INRS-Institut Armand Frappier, 531 boulevard des Prairies, Laval, Quebec H7V 1B7, Canada
| | - Jean-Pierre Routy
- Division of Hematology and Chronic Viral Illness Service, McGill University Health Centre, Glen site, Montreal, Quebec H4A 3J1, Canada
| | | | | | | | - Julien van Grevenynghe
- INRS-Institut Armand Frappier, 531 boulevard des Prairies, Laval, Quebec H7V 1B7, Canada.
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HIV/AIDS and lipodystrophy: implications for clinical management in resource-limited settings. J Int AIDS Soc 2015; 18:19033. [PMID: 25598476 PMCID: PMC4297925 DOI: 10.7448/ias.18.1.19033] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Revised: 10/11/2014] [Accepted: 10/30/2014] [Indexed: 12/11/2022] Open
Abstract
Introduction Lipodystrophy is a term used to describe a metabolic complication of fat loss, fat gain, or a combination of fat loss and gain, which is associated with some antiretroviral (ARV) therapies given to HIV-infected individuals. There is limited research on lipodystrophy in low- and middle-income countries, despite accounting for more than 95% of the burden of HIV/AIDS. The objective of this review was to evaluate the prevalence, pathogenesis and prognosis of HIV-related lipoatrophy, lipohypertrophy and mixed syndrome, to inform clinical management in resource-limited settings. Methods We conducted a structured literature search using MEDLINE electronic databases. Relevant MeSH terms were used to identify published human studies on HIV and lipoatrophy, lipohypertrophy, or mixed syndrome in low-, low-middle- and upper-middle-income countries through 31 March 2014. The search resulted in 5296 articles; after 1599 studies were excluded (958 reviews, 641 non-human), 3697 studies were extracted for further review. After excluding studies conducted in high-income settings (n=2808), and studies that did not meet inclusion criteria (n=799), 90 studies were included in this review. Results and Discussion Of the 90 studies included in this review, only six were from low-income countries and eight were from lower middle-income economies. These studies focused on lipodystrophy prevalence, risk factors and side effects of antiretroviral therapy (ART). In most studies, lipodystrophy developed after the first six months of therapy, particularly with the use of stavudine. Lipodystrophy is associated with increased risk of cardiometabolic complications. This is disconcerting and anticipated to increase, given the rapid scale-up of ART worldwide, the increasing number and lifespan of HIV-infected patients on long-term therapy, and the emergence of obesity and non-communicable diseases in settings with extensive HIV burden. Conclusions Lipodystrophy is common in resource-limited settings, and has considerable implications for risk of metabolic diseases, quality of life and adherence. Comprehensive evidence-based interventions are urgently needed to reduce the burden of HIV and lipodystrophy, and inform clinical management in resource-limited settings.
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Fillipas S, Cherry CL, Cicuttini F, Smirneos L, Holland AE. The Effects of Exercise Training on Metabolic and Morphological Outcomes for People Living With HIV: A Systematic Review of Randomised Controlled Trials. HIV CLINICAL TRIALS 2015; 11:270-82. [DOI: 10.1310/hct1105-270] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Ramírez-Marrero FA, Santana-Bagur JL, Joyner MJ, Rodríguez-Zayas J, Frontera W. Metabolic syndrome in relation to cardiorespiratory fitness, active and sedentary behavior in HIV+ Hispanics with and without lipodystrophy. PUERTO RICO HEALTH SCIENCES JOURNAL 2014; 33:163-169. [PMID: 25563033 PMCID: PMC4329015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Hispanics in Puerto Rico (PR) have a high prevalence of metabolic syndrome (met-syn), partially explained by low physical activity (PA) and possibly low cardiorespiratory fitness (VO2peak). Met-syn is also associated with lipodystrophy in HIV infected (HIV+) adults taking antiretroviral therapies. However, associations between met-syn, VO2peak, PA, sedentary behavior and lipodystrophy among HIV+ Hispanics have not been adequately reported. We tested the following hypotheses: 1) HIV+ Hispanics with lipodystrophy (HIV-Lipo) would have a higher prevalence of met-syn, lower VO2peak and PA, and higher sedentary behavior compared with those without lipodystrophy (HIV-no-Lipo) and without HIV infection (Non-HIV); and 2) met-syn would be inversely associated with VO2peak and PA, and directly associated with sedentary behavior. METHODS Ninety Hispanic adults (32 HIV-Lipo, 28 HIV-no-Lipo, 30 Non-HIV) completed measurements of VO2,peak, anthropometry, PA and sedentary behavior with accelerometry, blood pressure, fasting glucose, insulin, and lipids. ANOVA and chi-square tests were used to detect differences between groups, and regression analyses to test associations between variables. RESULTS More HIV-Lipo (69%) had met-syn compared with HIV-no-Lipo (39%) and Non-HIV (37%) (P = 0.002). Sedentary behavior and PA were not different, but VO2peak differed between all groups: lowest in HIV-Lipo and highest in non-HIV. PA and sedentary behavior were not associated with met-syn, but PA was directly associated with VO2peak (R2 = 0.26, p < 0.01). Also, a lower odds ratio for met-syn was observed with higher VO2peak (0.87; 95% CI: 0.83-0.95). CONCLUSION Met-syn is related to lipodystrophy in HIV+ Hispanics in PR, and high VO2peak may protect against met-syn in this population.
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Jaggers JR, Hand GA. Health Benefits of Exercise for People Living With HIV: A Review of the Literature. Am J Lifestyle Med 2014; 10:184-192. [PMID: 30202273 DOI: 10.1177/1559827614538750] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 02/20/2014] [Accepted: 03/07/2014] [Indexed: 11/15/2022] Open
Abstract
With life expectancy increasing and the symptomatology of HIV being altered since the advent of antiretroviral therapy (ART), we now have begun to see metabolic changes with negative implications among people living with HIV/AIDS (PLWHA). Some of these changes include increased blood lipids, central fat accumulation, lipodystrophy, and decreased aerobic capacity. All of which are known risk factors for cardiovascular disease, cancer, and all-cause mortality. A common practice among healthy and other clinical populations to help modify these risk factors is some form of aerobic exercise, resistance exercise, or a combination of both. It has been demonstrated that PLWHA could respond in a similar manner, which in turn may enhance life expectancy and/or quality of life. The purpose of this literature review was to examine the evidence of health benefits of routine exercise training among PLWHA since the advent of ART. Although limited in strength because of small sample sizes and limited intervention durations, there is overall consistency in the general findings. An overview of the findings would indicate that physical activity and exercise are both safe and effective in improving cardiorespiratory fitness, metabolic profile, and quality of life among PLWHA.
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Affiliation(s)
- Jason R Jaggers
- Department of Applied Health Sciences, Murray State University, Murray, Kentucky (JRJ).,Department of Exercise Science, University of South Carolina, Columbia, South Carolina (GAH)
| | - Gregory A Hand
- Department of Applied Health Sciences, Murray State University, Murray, Kentucky (JRJ).,Department of Exercise Science, University of South Carolina, Columbia, South Carolina (GAH)
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Cade WT, Reeds DN, Overton ET, Herrero P, Waggoner AD, Laciny E, Bopp C, Lassa-Claxton S, Gropler RJ, Peterson LR, Yarasheski KE. Pilot study of pioglitazone and exercise training effects on basal myocardial substrate metabolism and left ventricular function in HIV-positive individuals with metabolic complications. HIV CLINICAL TRIALS 2014; 14:303-12. [PMID: 24334183 DOI: 10.1310/hct1406-303] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Individuals with HIV infection and peripheral metabolic complications have impaired basal myocardial insulin sensitivity that is related to left ventricular (LV) diastolic dysfunction. It is unknown whether interventions shown to be effective in improving peripheral insulin sensitivity can improve basal myocardial insulin sensitivity and diastolic function in people with HIV and peripheral metabolic complications. OBJECTIVE In a pilot study, we evaluated whether the peroxisome proliferator-activated receptor-gamma (PPAR-γ) agonist pioglitazone or combined endurance and resistance exercise training improves basal myocardial insulin sensitivity and diastolic function in HIV+ adults with peripheral metabolic complications. DESIGN Twenty-four HIV+ adults with metabolic complications including peripheral insulin resistance were randomly assigned to 4 months of pioglitazone (PIO; 30 mg/d) or supervised, progressive endurance and resistance exercise training (EXS; 90-120 min/d, 3 d/wk). Basal myocardial substrate metabolism was quantified by radioisotope tracer methodology and positron emission tomography (PET) imaging, and LV function was measured by echocardiography. RESULTS Twenty participants completed the study. Neither PIO nor EXS resulted in a detectable improvement in basal myocardial insulin sensitivity or diastolic function. Post hoc analyses revealed sample sizes of more than 100 participants are needed to detect significant effects of these interventions on basal myocardial insulin sensitivity and function. CONCLUSIONS PIO or EXS alone did not significantly increase basal myocardial insulin sensitivity or LV diastolic function in HIV+ individuals with peripheral metabolic complications.
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Affiliation(s)
- W Todd Cade
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri
| | - Dominic N Reeds
- Division of Geriatrics and Nutritional Science, Washington University School of Medicine, St. Louis, Missouri
| | - E Turner Overton
- Division of Infectious Disease, Washington University School of Medicine, St. Louis, Missouri
| | - Pilar Herrero
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Alan D Waggoner
- Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri
| | - Erin Laciny
- Division of Endocrinology, Metabolism, & Lipid Research, Washington University School of Medicine, St. Louis, Missouri
| | - Coco Bopp
- Division of Endocrinology, Metabolism, & Lipid Research, Washington University School of Medicine, St. Louis, Missouri
| | - Sherry Lassa-Claxton
- Division of Endocrinology, Metabolism, & Lipid Research, Washington University School of Medicine, St. Louis, Missouri
| | - Robert J Gropler
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Linda R Peterson
- Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri
| | - Kevin E Yarasheski
- Division of Endocrinology, Metabolism, & Lipid Research, Washington University School of Medicine, St. Louis, Missouri
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Della Justina LB, Luiz MC, Maurici R, Schuelter-Trevisol F. Prevalence and factors associated with lipodystrophy in AIDS patients. Rev Soc Bras Med Trop 2014; 47:30-7. [DOI: 10.1590/0037-8682-0240-2013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Accepted: 01/28/2014] [Indexed: 12/13/2022] Open
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Shacham E, Hipp JA, Scheuermann M, Önen N, Overton ET. Parks as a tool for HIV management. J Int Assoc Provid AIDS Care 2013; 14:8-11. [PMID: 23995296 DOI: 10.1177/2325957413500853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Access to parks improves overall health outcomes in the general population. Given that HIV infection has become a chronic disease to manage, among populations engaged in medical care, parks may be promoted as physical activity opportunities in order to manage chronic comorbid conditions. We conducted a cross-sectional examination of the relationships between sociodemographic and biomedical characteristics to park proximity among 635 individuals receiving outpatient HIV care. The data collected included HIV-related biomarkers, depression, and diagnoses of other chronic diseases. The total acres of parks an individual is exposed within one-quarter mile from their home were assessed. The cohort included 635 individuals (67% men, 73% black, and 21% white, mean age 42 years). Unemployment was negatively associated with park availability. Park proximity was not associated with depression or HIV biomarkers. As yet, little effort has been committed to promoting park usage as a low-cost, sustainable method to addressing comorbidities among individuals with HIV.
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Affiliation(s)
- Enbal Shacham
- Department of Behavioral Sciences and Health Education, College for Public Health and Social Justice, Saint Louis University, St Louis, MO, USA
| | - J Aaron Hipp
- Brown School of Social Work, Washington University, St Louis, MO, USA
| | - Mary Scheuermann
- Brown School of Social Work, Washington University, St Louis, MO, USA
| | - Nur Önen
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St Louis, MO, USA
| | - E Turner Overton
- Department of Medicine, Division of Infectious Diseases, University of Alabama, Birmingham, AL, USA
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Brito CJ, Mendes EL, Ferreira AP, De Paula SO, Nóbrega ODT, Córdova C. Impacto do treinamento resistido na força e hipertrofia muscular em HIV-soropositivos. MOTRIZ: REVISTA DE EDUCACAO FISICA 2013. [DOI: 10.1590/s1980-65742013000200009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
O presente estudo investigou o efeito de 24 semanas de treinamento resistido (TR) sobre a força e hipertrofia muscular de pacientes HIV-soropositivos. Participaram deste estudo 45 voluntários submetidos à terapia antirretroviral fortemente ativa (HAART), destes, 23 realizaram 3 sessões semanais, com 10 repetições a 80% 1RM. O teste de 1RM foi realizado de acordo com a metodologia proposta por Kraemer e Fry (1995), para estimativa da hipertrofia muscular adotou-se as equações de Frisancho (1984). Em comparação aos valores, o TR melhorou a força de 1RM nos exercícios de agachamento em 49% (21,0±4,9 vs. 31,2±5,1; P=0,001), supino reto em 13% (34,3±8,1 vs. 39,8±9,4; P=0,04), cadeira extensora em 34,1% (26,3±7,1 vs. 37,1±6,6; P=0,01), tríceps em 51% (22,9±4,0 vs. 38,3±4,9; P=0,001), pulley costas em 31,5% (31,7±3,9 vs. 41,7±4,4; P=0,01), cadeira flexora em 37,2% (18,9±3,4 vs. 27,3±3,2; P=0,01) e rosca bíceps em 60% (27,9±6,9 vs. 40,4±4,5; P=0,001). Não foram observadas diferenças (P<0,05) entre os valores basais e finais para o grupo controle. Observou-se aumento significativo (P<0,05) na área muscular do braço isenta de massa óssea, no grupo TR (52,8±14,5 cm²) em relação ao controle (39,5±12,4 cm²). Ademais, o TR resultou em significativa (P<0,05) redução da glicemia sanguínea de jejum (96,5±18,3 vs. 90,5±12,6), pressão arterial sistólica (126,3±14,3 vs. 120,0±10,0) e circunferência de cintura (83,0±12,5 vs. 80,6±10,2). Conclui-se que seis meses de TR resultaram em melhora na força e hipertrofia, ademais, o treinamento aplicado contribuiu para a regulação das variáveis metabólicas dos pacientes. Uma vez que a HAART é inevitável ao HIV-soropositivo, recomenda-se que o exercício físico seja realizado no intuito de dirimir os efeitos colaterais advindos desta terapia.
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Botros D, Somarriba G, Neri D, Miller TL. Interventions to address chronic disease and HIV: strategies to promote exercise and nutrition among HIV-infected individuals. Curr HIV/AIDS Rep 2013; 9:351-63. [PMID: 22933247 DOI: 10.1007/s11904-012-0135-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Food insecurity, micronutrient deficits, dyslipidemia, insulin resistance, obesity, cardiovascular disease, and bone disorders complicate the treatment of HIV infection. Nutrition and exercise interventions can be effective in ameliorating these symptoms that are associated with HIV and antiretroviral therapy (ART). In this literature review, we examine the most recent nutrition and exercise interventions for HIV-infected patients. Macronutrient supplementation can be useful in treating malnutrition and wasting. Multivitamin (vitamin B complex, vitamin C, and vitamin E) supplements and vitamin D may improve quality of life and decrease morbidity and mortality. Nutritional counseling and exercise interventions are effective for treating obesity, fat redistribution, and metabolic abnormalities. Physical activity interventions improve body composition, strength, and fitness in HIV-infected individuals. Taken collectively, the evidence suggests that a proactive approach to nutrition and physical activity guidance and interventions can improve outcomes and help abrogate the adverse metabolic, cardiovascular, and psychological consequences of HIV and its treatments.
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Affiliation(s)
- Diana Botros
- Division of Pediatric Clinical Research, Department of Pediatrics (D820), University of Miami, Miller School of Medicine, Batchelor Children's Research Institute, PO Box 016820, Miami, FL 33101, USA.
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Mendes EL, Andaki ACR, Amorim PRDS, Natali AJ, Brito CJ, Paula SOD. Treinamento físico para indivíduos HIV positivo submetidos à HAART: efeitos sobre parâmetros antropométricos e funcionais. REV BRAS MED ESPORTE 2013. [DOI: 10.1590/s1517-86922013000100003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO: A terapia antirretroviral fortemente ativa (HAART) tem melhorado a prognose em indivíduos infectados pelo HIV. No entanto, a HAART tem sido associada ao desenvolvimento de anormalidades metabólicas e na distribuição de gordura corporal conhecida como síndrome lipodistrófica associada ao HIV (SLHIV). OBJETIVO: Este estudo investigou o impacto de 24 semanas de exercício resistido com componente aeróbico (ERCA) sobre parâmetros antropométricos e funcionais de portadores de HIV submetidos à HAART. MÉTODOS: Noventa e nove indivíduos infectados pelo HIV foram randomicamente alocados em quatro grupos: exercício e lipodistrofia (n = 24; EX+LIP); exercício sem lipodistrofia (n = 21; EX+NoLIP); controle e lipodistrofia (n = 27; NoEX+LIP); controle sem lipodistrofia (n = 27; NoEX+NoLIP). Os indivíduos dos grupos exercitados (EX+LIP e EX+NoLIP) participaram de 24 semanas de ERCA. Nos momentos pré e pós 24 semanas de intervenção foram realizadas medidas antropométricas, testes de força e aptidão cardiorrespiratória. RESULTADOS: Vinte e quatro semanas de ERCA alteraram os perímetros corporais avaliados (P < 0,0001) e a relação cintura/quadril (P = 0,017) nos dois grupos exercitados. Reduções foram observadas (P < 0,0001) para o somatório das sete dobras cutâneas avaliadas, percentual de gordura corporal, massa corporal gorda, gordura subcutânea total, central e periférica em resposta ao ERCA. A massa corporal magra aumentou (P < 0,0001) nos grupos exercitados, independente do desfecho (LIP ou NoLIP). A força muscular e a aptidão cardiorrespiratória aumentaram (P < 0,0001), para os dois grupos exercitados em resposta ao ERCA. CONCLUSÃO: Vinte e quatro semanas de ERCA impediram a manifestação das alterações decorrentes da SLHIV e contribuíram para a redução destas.
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Affiliation(s)
| | | | | | | | - Ciro José Brito
- Universidade Federal de Sergipe; Universidade Federal de Sergipe
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Gomes-Neto M, Conceição CS, Oliveira Carvalho V, Brites C. A systematic review of the effects of different types of therapeutic exercise on physiologic and functional measurements in patients with HIV/AIDS. Clinics (Sao Paulo) 2013; 68:1157-67. [PMID: 24037014 PMCID: PMC3752639 DOI: 10.6061/clinics/2013(08)16] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 04/01/2013] [Indexed: 11/18/2022] Open
Abstract
Several studies have reported the benefits of exercise training for adults with HIV, although there is no consensus regarding the most efficient modalities. The aim of this study was to determine the effects of different types of exercise on physiologic and functional measurements in patients with HIV using a systematic strategy for searching randomized controlled trials. The sources used in this review were the Cochrane Library, EMBASE, MEDLINE, and PEDro from 1950 to August 2012. We selected randomized controlled trials examining the effects of exercise on body composition, muscle strength, aerobic capacity, and/or quality of life in adults with HIV. Two independent reviewers screened the abstracts using the Cochrane Collaboration's protocol. The PEDro score was used to evaluate methodological quality. In total, 29 studies fulfilled the inclusion criteria. Individual studies suggested that exercise training contributed to improvement of physiologic and functional parameters, but that the gains were specific to the type of exercise performed. Resistance exercise training improved outcomes related to body composition and muscle strength, with little impact on quality of life. Aerobic exercise training improved body composition and aerobic capacity. Concurrent training produced significant gains in all outcomes evaluated, although moderate intensity and a long duration were necessary. We concluded that exercise training was shown to be a safe and beneficial intervention in the treatment of patients with HIV.
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Affiliation(s)
- Mansueto Gomes-Neto
- Departamento de Biofunção, Curso de Fisioterapia, Universidade Federal da Bahia (UFBA), SalvadorBA, Brazil
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Segatto AFM, Junior IFF, Santos VRD, Alves KCDLRP, Barbosa DA, Filho AMP, Monteiro HL. Indices of body fat distribution for assessment of lipodysthrophy in people living with HIV/AIDS. BMC Res Notes 2012; 5:543. [PMID: 23031203 PMCID: PMC3502469 DOI: 10.1186/1756-0500-5-543] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Accepted: 09/22/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Metabolic and morphological changes associated with excessive abdominal fat, after the introduction of Antiretroviral Therapy, increase the risk of cardiovascular disease in people living with HIV/AIDS(PLWHA). Accurate methods for body composition analysis are expensive and the use of anthropometric indices is an alternative. However the investigations about this subject in PLWHA are rare, making this research very important for clinical purpose and to advance scientific knowledge. The aim of this study is to correlate results of anthropometric indices of evaluation of body fat distribution with the results obtained by Dual-energy X-Ray Absorptiometry(DEXA), in people living with HIV/AIDS. METHODS The sample was of 67 PLWHA(39 male and 28 female), aged 43.6±7.9 years. Body mass index, conicity index, waist/hip ratio, waist/height ratio and waist/thigh were calculated. Separated by sex, each index/ratio was plotted in a scatter chart with linear regression fit and their respective Pearson correlation coefficients. Analyses were performed using Prism statistical program and significance was set at 5%. RESULTS The waist/height ratio presented the highest correlation coefficient, for both male (r=0.80, p<0.001) and female (r=0.87, p <001), while the lowest were in the waist/thigh also for both: male group (r=0.58, p<0.001) and female group (r=0.03, p=0.86). The other indices also showed significant positive correlation with DEXA. CONCLUSION Anthropometric indices, especially waist/height ratio may be a good alternative way to be used for evaluating the distribution of fat in the abdominal region of adults living with HIV/ADIS.
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Affiliation(s)
| | - Ismael Forte Freitas Junior
- Departamento de Educação Física, Universidade Estadual PaulistaUNESP, Rua Roberto Simonsen, 305 Centro Educacional, Presidente Prudente, São Paulo, CEP 19.060-900, Brasil
| | | | | | | | | | - Henrique Luiz Monteiro
- Department of Physical Education, Univ. Estadual Paulista, Campus of Bauru, São Paulo, Brazil
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De Lorenzo A, Meirelles V, Vilela F, Souza FCC. Use of the exercise treadmill test for the assessment of cardiac risk markers in adults infected with HIV. J Int Assoc Provid AIDS Care 2012; 12:110-6. [PMID: 23015380 DOI: 10.1177/1545109712460098] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Despite the association between HIV and coronary artery disease (CAD), there are no specific recommendations for the cardiovascular evaluation of the HIV-infected population. Besides being a tool for the evaluation of CAD, the exercise treadmill test (ETT) provides insights into functional capacity and autonomic function, which have been frequently affected in HIV infection, and thus may be useful in this setting. METHODS Forty-nine HIV-infected individuals without known CAD underwent ETT. Peak oxygen consumption during exercise (VO2 peak), functional capacity (in metabolic equivalents [METs]), exercise-induced ischemia, chronotropic incompetence (CI) and abnormal heart rate recovery (HRR) after exercise were studied. RESULTS VO2 peak was 31.4±4.8 mL/kg/min and functional capacity was 9.2±1.6 MET. CI was observed in 30.6%, and 10.2% had abnormal HRR. VO2 peak was lower in women and inversely correlated with age and body mass index. None of the patients displayed ischemic changes. CONCLUSION Although functional capacity was good, risk markers such as CI and abnormal HRR were not infrequent. This study identifies a subgroup of HIV-infected patients-the older, overweight, or obese-who may have higher risk and deserve cardiovascular screening with the ETT.
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Omech B, Sempa J, Castelnuovo B, Opio K, Otim M, Mayanja-Kizza H, Colebunders R, Manabe YC. Prevalence of HIV-Associated Metabolic Abnormalities among Patients Taking First-Line Antiretroviral Therapy in Uganda. ISRN AIDS 2012; 2012:960178. [PMID: 24052885 PMCID: PMC3767451 DOI: 10.5402/2012/960178] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Accepted: 06/25/2012] [Indexed: 11/23/2022]
Abstract
Introduction. While the introduction of highly active antiretroviral therapy decreased HIV-related morbidity and mortality rates in the sub-Saharan Africa, a subsequent increase in metabolic abnormalities has been observed. We sought to determine the prevalence of HIV-associated metabolic abnormalities among patients on first-line antiretroviral therapy (ART) in an ART clinic in Kampala, Uganda. Methods. Four hundred forty-two consecutive patients on first-line ART for at least 12 months were screened for eligibility in a cross-sectional study, and 423 were enrolled. Pre-ART patient characteristics were abstracted from medical charts, examinations included anthropometric measurement and physical assessment for lipodystrophy. Results. The prevalence of hyperglycemia and dyslipidemia was 16.3% (69/423) and 81.5% (345/423), respectively. Prevalence of dyslipidemia between stavudine- and zidovudine-based regimens (91% versus 72%; P < 0.001). Being on stavudine (aOR 4.79, 95%, 2.45-9.38) and peak body weight (aOR 1.44, 95% CI 1.05-1.97) were independent risk factors for dylipidemia. Stavudine (aOR 0.50, 95% CI 0.27-0.93) use was associated with lower risk for hyperglycemia while, and older age (aOR 1.31, 95% CI 1.11-1.56) and having a family history of DM (aOR 2.18, 95% CI 1.10-4.34) were independent risk factors for hyperglycemia. Conclusions. HIV-associated metabolic complications were prevalent among patients on thymidine analogue-containing ART regimens. Screening for lipid and glucose abnormalities should be considered in ART patients because of cardiovascular risks.
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Affiliation(s)
- Bernard Omech
- School of Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
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Stradling C, Chen YF, Russell T, Connock M, Thomas GN, Taheri S. The effects of dietary intervention on HIV dyslipidaemia: a systematic review and meta-analysis. PLoS One 2012; 7:e38121. [PMID: 22701607 PMCID: PMC3372478 DOI: 10.1371/journal.pone.0038121] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 05/01/2012] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Efficacy of dietary intervention for treatment and prevention of HIV-related lipid disturbances has not been well established. METHODS We conducted a systematic search of electronic databases supplemented with manual searches and conference abstracts, without language restriction. All randomised controlled trials (RCTs) with blood lipid outcomes, involving dietary intervention or supplementation for the treatment or prevention of adult HIV dyslipidaemia, versus no or other intervention were included. Two authors using predefined data fields, including study quality indicators, extracted data independently. RESULTS Eighteen studies (n = 873) met our inclusion criteria. Seven RCTs for omega-3 supplementation (n = 372), and four RCTs for dietary intervention (n = 201) were meta-analysed using random-effects models. Mild statistical heterogeneity was observed. Dietary intervention reduced triglyceride levels by -0·46 mmol/l (95%CI: -0·85 to -0·07 mmol/l) compared to control. Omega-3 supplementation reduced triglyceride levels by -1.12 mmol/l, (95%CI: -1·57 to -0·67 mmol/l) and total cholesterol, -0·36 mmol/l (95%CI: -0·67 to -0·05 mmol/l) compared to placebo/control. CONCLUSIONS Both omega-3 supplementation and dietary intervention reduced triglyceride level, with the latter possibly to a smaller extent. While dietary interventions are beneficial, more stringent dietary approaches may be necessary to fully address lipid disturbances in HIV patients. TRIAL REGISTRATION PROSPERO 2011:CRD42011001329.
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Affiliation(s)
- Clare Stradling
- HIV Metabolic Clinic, Heart of England NHS Foundation Trust, Birmingham, United Kingdom
- Birmingham and Black Country NIHR CLAHRC, University of Birmingham, Birmingham, United Kingdom
| | - Yen-Fu Chen
- Birmingham and Black Country NIHR CLAHRC, University of Birmingham, Birmingham, United Kingdom
| | - Tracy Russell
- Dietetic Department, Western General Hospital, Edinburgh, United Kingdom
| | - Martin Connock
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - G. Neil Thomas
- School of Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, United Kingdom
| | - Shahrad Taheri
- HIV Metabolic Clinic, Heart of England NHS Foundation Trust, Birmingham, United Kingdom
- Birmingham and Black Country NIHR CLAHRC, University of Birmingham, Birmingham, United Kingdom
- School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, United Kingdom
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