HIV This Week

Mutimura E, Crowther NJ, Cade TW, Yarasheski KE, Stewart A.Exercise training reduces central adiposity and improves metabolic indices in HAART-treated HIV-positive subjects in Rwanda: a randomized controlled trial. AIDS Res Hum Retroviruses. 2008; 24(1):15-23.

As HAART becomes more accessible in sub-Saharan Africa, metabolic syndromes, body fat redistribution, and cardiovascular disease may become more prevalent. Mutimura and colleagues conducted a 6-month, randomized controlled trial to test whether cardiorespiratory exercise training (CET), improves metabolic, body composition and cardiorespiratory fitness parameters in HAART-treated HIV(+) African subjects with body fat redistribution (BFR). Persons with HIV and body fat redistribution were randomly assigned to exercise (HIV(+)BFR(+)EXS, N=50) or no exercise (N=50). These groups were compared with a group of persons with HIV but without BFR (N=50) and a group of persons without HIV (N=50). Six months of cardiorespiratory exercise training reduced waist circumference (-7.13 +/- 4.4 cm, p < 0.0001), waist-hip ratio (-0.10 +/- 0.1, p < 0.0001), sum skinfold thickness (-6.15 +/- 8.2 mm, p < 0.0001) and % body fat mass (-1.5 +/- 3.3, p < 0.0001) in HIV(+)BFR(+)EXS. Hip circumference was unchanged in non-exercise control groups.  Cardiorespiratory exercise training reduced fasting total cholesterol (-0.03 +/- 1.11 mM, p < 0.05), triglycerides (-0.22 +/-0.48 mM, p < 0.05) and glucose levels (-0.21 +/- 0.71 mM, p < 0.05) (p < 0.0001). HDL-, LDL-cholesterol and homeostasis model assessment values were unchanged after CET. Interestingly, HIV(+) subjects randomized to non-exercising groups experienced increases in fasting plasma glucose levels, whereas HIV seronegative  controls did not (p < 0.001). Predicted VO(2) peak increased more in the HIV(+)BFR(+)EXS than in all other groups (4.7 +/- 3.9 ml/kg/min, p < 0.0001). Exercise training positively modulated body composition and metabolic profiles, and improved cardiorespiratory fitness in HAART-treated HIV(+) Africans. These beneficial adaptations imply that exercise training is a safe, inexpensive, practical, and effective treatment for evolving metabolic and cardiovascular syndromes associated with HIV and HAART exposure in resource-limited sub-Saharan countries, where treatment is improving, morbidity and mortality rates are declining, but where minimal resources are available to manage HIV- and HAART-associated cardiovascular and metabolic syndromes.

Editors’ note: Minimal resources and medications (anti-hypertensives, anti-diabetics, anti-hyperlipidemics) are available to manage HIV-related and antiretroviral drug-associated metabolic syndromes and increased risk of cardiovascular disease in the many countries where antiretroviral treatment access is improving. This randomised controlled trial found that cardio-respiratory exercise led to considerable reductions in waist circumference, increases in lean body mass, and improved cardiovascular fitness in Rwandans with body fat alterations due to antiretroviral drugs. Exercise training is safe, practical, and efficacious ― we should all be doing more of it, whether we have HIV or not!