Although the use of potent antiretrovirals has improved mortality and morbidity associated with HIV-1 infection, new constellations of side effects continue to challenge nurses and other providers. One new syndrome associated with the antiretroviral therapy, lipodystrophy or fat redistribution, includes peripheral wasting, central fat accumulation, elevated blood lipids, glucose and insulin and places patients at risk for cardiovascular disease, diabetes, pancreatitis and may influence adherence to drug therapy; thus, the management of troubling side effects and symptoms such as lipodystrophy has taken on new importance and underscores the need to examine strategies that may attenuate or alleviate these side effects/symptoms. Subsequent work will need to focus on the prevention of the syndrome once strategies for managing the syndrome(s) have been identified. The purpose of the proposed study is to examine the effects of a 16-week integrated intervention designed to improve body composition, blood lipids and metabolic variables in HIV-1 infected individuals who are enrolled in NIH funded clinical trials of highly active antiretroviral therapy (HAART) and who are experiencing lipodystrophy. The intervention consists of three major components: physical activities intended to increase cardiorespiratory endurance, physical activities that will enhance strength, flexibility and increase cross-sectional area of muscle, and a nutrition component. Each component of the intervention is intended to improve some aspect of the lipodystrophy syndrome and is consistent with the Healthy People 2010. This experimental study will use a 2-group design with subjects in the experimental group (n=42) encouraged to accumulate 30 minutes of physical activity most if not all days of the week and set measurable dietary goals with the dietitian. Subjects in the control group (n=42) will maintain usual activity and usual diet for 16 weeks and then enter the intervention phase of the project. Subjects will be recruited from the ALLRT protocol or FRAM study at the UAB Outpatient HIV Clinic. A two by two, mixed model ANCOVA will be used to test study hypotheses related to body composition, blood lipids, glucose, insulin and C-peptide. Data from the study will be used to develop evidence-based guidelines for advanced practice nurses, dietitians, physicians and other health care providers to assist patients in managing lipodystrophy associated with HIV-1 therapies.
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| Curtis, Jeffrey R; Smith, Barbara; Weaver, Michael et al. (2006) Ethnic variations in the prevalence of metabolic bone disease among HIV-positive patients with lipodystrophy. AIDS Res Hum Retroviruses 22:125-31 |
