HIV Infections Clinical Trial
Official title:
Effects of Mixed Exercise Regime and L-Carnitine Supplementation on Kinetics of Triglyceride-rich Lipoproteins in HIV Patients on HAART
HIV patients treated with Highly Active AntiRetroviral Therapy (HAART) show significant metabolic symptoms, such as lipodystrophy, dyslipidemia, and insulin resistance. A possible contribution to these symptoms in HIV/HAART is a decrease in mitochondrial function, resulting in a decreased fatty acid oxidation. A combined regime of aerobic and resistance training has been demonstrated to increase lean body mass and reduce overall fat and truncal fat and the levels of triglyceride and LDL cholesterol.
The introduction of Highly Active AntiRetroviral Therapy (HAART) for AIDS and HIV has
improved survival considerably. However, HIV patients treated with HAART show significant
metabolic symptoms, such as lipodystrophy, dyslipidemia, and insulin resistance. A possible
contribution to these dysmetabolic symptoms in HIV/HAART is a decrease in mitochondrial
function, resulting in a decreased fatty acid oxidation. Life style modulation such as
aerobic exercise and L-carnitine supplementation may be beneficial to mitochondrial
function. Aerobic exercise improves the biogenesis and function of mitochondria. A combined
regime of aerobic and resistance training has been demonstrated to increase lean body mass
and reduce overall fat and truncal fat and the levels of triglyceride and LDL cholesterol.
L-Carnitine plays an important role in the transfer of long-chain acyl groups into the
mitochondrial matrix and potentially improves energy metabolism. Further, L-carnitine
supplementation decreases serum triglyceride levels in HIV/HAART patients with
hypertriglyceridemia. However, little is known whether these life style modulations act
synergistically in HIV/HAART patients.
We hypothesize that a mixed regimen of exercise (including both resistance and aerobic
exercise) and L-carnitine supplementation will improve mitochondrial dysfunction in
HIV/HAART patients, and therefore, alleviate dysmetabolic symptoms such as dyslipidemia and
insulin resistance. In this randomized, placebo-controlled study, we will explore whether a
mixed regimen of exercise, including both resistance and aerobic exercise, and L-carnitine
supplementation affect lipids and remnant lipoproteins, adipokines, insulin resistance;
blood lactate levels and VO2max; and kinetics of leucine and triglyceride-rich lipoproteins
among African-American and Hispanic HIV-positive subjects undergoing HAART. Effects on
muscle mitochondrial function will be assessed using exercise tests and body composition
assessment (DEXA and Bioimpedance), while effects on hepatic mitochondrial function will be
assessed measuring the relation between leucine and VLDL-apoB metabolism. We believe that
the proposed study will help to elucidate underlying mechanisms for metabolic complications
and will offer new possibilities for intervention to reduce negative metabolic effects in
HIV/HAART patients.
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Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Single Group Assignment, Masking: Double Blind (Subject, Investigator), Primary Purpose: Treatment
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