944
Effects of Diet and Exercise and Rosiglitazone on Body Composition and Lipids, including Oxidized LDL in HIV+ and HIV- Men and Women
David Mun*1, E Engelson1,2, J Albu1,2, M Sharma2, T Pitea2, and D Kotler1,2
1Columbia Univ Coll of Physicians and Surgeons, New York, NY, US and 2St Luke`s Roosevelt Hosp Ctr, New York, NY, US
Background: Antiretrovirals (ARV) for HIV may lead
to fat redistribution, insulin resistance, and dyslipidemia; increased oxidized
LDL (OxLDL) also has been reported. Whether HIV+ and HIV–
individuals respond similarly to intervention is unknown.
Methods: This was a prospective, randomized trial of
rosiglitazone (Rosi), diet + exercise + placebo (DEAP) and diet + exercise +
Rosi (DEAR) in 20- to 60-year-old HIV+ and HIV– men and
women with BMI ≥25 kg/m2 and fasting insulin ≥16 µIU/mL.
Measurements at baseline and week 16 included body composition by whole body magnetic
resonance imaging (MRI) and dual energy X-ray absorptiometry (DEXA), as well as
lipid levels in frozen plasma. HIV groups were compared by Student's t test
and Fisher's exact test. Treatments were compared by ANOVA. Smoking was
statistically controlled for lipid results. Variables showing trends (p <0.20)
for correlations were chosen for multiple regression analysis of OxLDL.
Results: At baseline, HIV+ (n = 14)
and HIV– (n = 13) did not differ (p >0.05) by age,
sex, body mass index, waist circumference, fasting insulin, glucose, lipids,
blood pressure, skeletal muscle (SM), subcutaneous (SAT) or visceral adipose tissue
(VAT). HIV+ had less leg fat (p <0.05). Change in body
weight, SM, SAT, VAT, or leg fat did not differ by HIV status. In DEAP, HIV–
increased and HIV+ decreased OxLDL (p = .02). With Rosi, HIV- increased and
HIV+ decreased LDL (p = 0.03). Change in triglycerides (TG) was the best
predictor of OxLDL changes, which were directly related.
|
|
Rosi (n=5)
|
DEAP (n = 12)
|
DEAR (n = 9)
|
p
(ANOVA)
|
|
Weight, kg
|
+1.7±1.4*
|
–5.6±3.8#
|
–4.8±3.9*
|
0.004
|
|
SM, L
|
–0.5±1.7
|
–1.3±1.6*
|
–0.8±2.1
|
0.73
|
|
SAT, L
|
+0.8±1.8
|
–4.1±3.5#
|
–3.2±2.1#
|
0.01
|
|
VAT, L
|
–0.2±0.5
|
–0.6±0.7#
|
–1.1±0.9*
|
0.11
|
|
OxLDL, %Δ
|
16.5±23.6
|
–5.9±18.7
|
–12.2±17.2*
|
0.03
|
|
LDL, %Δ
|
–1.7±18.7
|
–0.9±22.3
|
8.3±71.6
|
0.89
|
|
OxLDL/LDL, %Δ
|
20.1±21.6
|
–3.0±21.4
|
–4.2±32.3
|
0.17
|
|
Cholesterol, %Δ
|
5.6±16.1
|
–0.2±16.4
|
4.6±42.2
|
0.90
|
|
TG, %Δ
|
41.8±54.6
|
–9.4±39.1
|
–9.2±29.6
|
0.04
|
|
HDL, %Δ
|
–4.0±18.1
|
16.7±25.5
|
3.1±17.2
|
0.15
|
* p
<0.05, #
p <0.01 baseline
vs week 16
Conclusions: HIV does not affect changes in body
composition in response to diet and exercise or Rosi. Diet and exercise can
ameliorate weight gain with Rosi. Increased OxLDL is a function of the
metabolic syndrome rather than HIV. Diet and exercise may counteract increased OxLDL
and TG associated with Rosi. HIV may affect the OxLDL response to diet and
exercise and the response of LDL to Rosi.
|
