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Intensive Lifestyle Modification Reduces Lp-PLA2 in Dyslipidemic HIV/HAART Patients

WOOTEN, JOSHUA S.1; NAMBI, PREETHI1; GILLARD, BAIBA K.1; POWNALL, HENRY J.1; CORAZA, IVONNE2,3; SCOTT, LYNNE W.1,4; NAMBI, VIJAY1,4; BALLANTYNE, CHRISTIE M.1,4; BALASUBRAMANYAM, ASHOK2,3

Medicine & Science in Sports & Exercise: June 2013 - Volume 45 - Issue 6 - p 1043–1050
doi: 10.1249/MSS.0b013e3182843961
Clinical Sciences

Purpose: Patients with dyslipidemia associated with HIV-1 infection and highly active antiretroviral therapy (HAART) have elevated levels of Lp-PLA2 and CCL5/regulated on activation, normal T-cell expressed and secreted (RANTES), which may increase the risk of cardiovascular disease.

Purpose: This study aimed to determine whether an intensive diet and exercise (D/E) program, independently or combined with fenofibrate or niacin, could reduce Lp-PLA2 or RANTES.

Methods: Patients with hypertriglyceridemic HIV on stable HAART (n = 107) were randomized to one of five interventions: 1) usual care, 2) D/E with placebos, 3) D/E with fenofibrate and placebo, 4) D/E with niacin and placebo, or 5) D/E with fenofibrate and niacin for 24 wk. Lp-PLA2 and RANTES concentrations were measured in fasting plasma samples at baseline and postintervention. General linear models were used to compare Lp-PLA2 and RANTES levels between the five groups postintervention, controlling for baseline levels, age, body mass index, CD4+ T-cell count, viral load, duration of infection, and HAART.

Results: At baseline, fasting plasma Lp-PLA2 (388.5 ± 127.5 ng·mL−1) and RANTES (43.8 ± 25.5 ng·mL−1) levels were elevated when compared with healthy controls. Posttreatment Lp-PLA2 mass was lower in patients who received D/E only (323.0 ± 27.2 ng·mL−1), D/E plus fenofibrate (327.2 ± 25.9 ng·mL−1), and D/E plus niacin (311.1 ± 27.8 ng·mL−1) when compared with patients receiving usual care (402.2 ± 25.3 ng·mL−1). RANTES concentrations were not significantly affected by any intervention.

Conclusions: Elevated plasma Lp-PLA2 mass can be reduced by an intensive D/E program in patients with HIV/HAART-associated dyslipidemia. RANTES is elevated but is not reduced by lifestyle modification, fenofibrate, or niacin.

1Division of Atherosclerosis and Vascular Biology, Department of Medicine, Baylor College of Medicine, Houston, TX; 2Translational Metabolism Unit, Division of Diabetes, Endocrinology and Metabolism, Baylor College of Medicine, Houston, TX; 3Endocrine Service, Ben Taub General Hospital, Houston, TX; and 4Methodist-DeBakey Heart and Vascular Center, Houston, TX

Address for correspondence: Joshua S. Wooten, Ph.D., Department of Kinesiology and Health Education, Southern Illinois University Edwardsville, Box 1126, Edwardsville, IL 62026-1126; E-mail: jwooten@siue.edu; and Ashok Balasubramanyam, M.D., Translational Metabolism Unit, Diabetes Research Center, Division of Diabetes, Endocrinology and Metabolism, Baylor College of Medicine, Houston, TX 77030; E-mail: ashokb@bcm.edu.

Submitted for publication September 2012.

Accepted for publication December 2012.

©2013The American College of Sports Medicine