Physical activity in cardiovascular disease prevention in patients with HIV/AIDS
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Corresponding author Gregory A. Hand, PhD, MPH Arnold School of Public Health, University of South Carolina, 800 Sumter Street, Columbia, SC 29203, USA. E-mail: [email protected] Current Cardiovascular Risk Reports 2009, 3:288–295 Current Medicine Group LLC ISSN 1932-9520 Copyright © 2009 by Current Medicine Group LLC
The introduction of highly active antiretroviral therapy (HAART) has both extended life expectancy and reduced morbidity in people living with HIV/AIDS (PLWHA). These changes have resulted in the emergence of cardiovascular disease (CVD) and associated risk factors as a threat to the health of PLWHA. The major components of CVD risk associated with HIV infection include HIV, HAART, nonmodifiable factors such as genetics or environment, and modifiable risk factors such as inactivity and poor diet. Physical activity has been shown to be beneficial in reducing the risk of CVD through its effect on numerous modifiable risk factors, including functional aerobic impairment, dyslipidemia and insulin resistance, obesity, and atherosclerotic inflammation. A growing body of evidence indicates that exercise has similar benefits for these modifiable CVD risk factors that are exacerbated in PLWHA.
Introduction It is of signifi cant public health importance that the natural progression of HIV infection has been altered by the use of highly active antiretroviral therapy (HAART). This relatively new intervention, a combination of drugs that delay viral replication and reduce viral invasion at the cellular level, has resulted in better survival rates and longer AIDS-free living for people living with HIV/ AIDS (PLWHA) [1–4]. Although enhanced immune function has reduced the incidence of HIV-associated opportunistic infections [2,5], the increased life expectancy has increased the risk of other complications that are associated generally with atherosclerosis and car-
diovascular disease (CVD) (Fig. 1). Chronic conditions that were never seriously considered as primary health outcomes for PLWHA, including obesity, dyslipidemia, and insulin resistance, have begun to emerge as key health issues for the infected population as the risk of CVD morbidity and mortality rises [1,6,7]. This review focuses on the effects of physical activity on modifi able CVD risk factors in PLWHA.
CVD Risk Associated with HIV and HAART Evidence from a number of studies examining risk factors in PLWHA suggests that they have a higher RR of CVD than noninfected individuals. Comparing hospitalization rates for PLWHA and noninfected patients, a group at Kaiser Permanente Medical Center has shown a consistent pattern of higher hospitalization for CVD and acute myocardial infarction (MI) in PLWHA [8]. The Data Collection on Adverse Events of Anti-HIV Drugs (DAD) study of 23,468 PLWHA showed that 27% of individuals treated with protease inhibitors (PIs) were hypercholesterolemic and 27% had low plasma levels of high-density lipoprotein (HDL) cholesterol [9]. Further, the DAD study estimated the adjusted RR for MI to be 1.26 for infected individuals who
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