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: firstname.lastname@example.org; 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: email@example.com.
Submitted for publication September 2012.
Accepted for publication December 2012.