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:
doi: 10.1249/MSS.0b013e3182843961
Clinical Sciences
Abstract

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.

Author Information

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