Intensive Lifestyle Modification Reduces Lp-PLA2 in Dyslipidemic HIV/HAART Patients

Purpose: Patients with dyslipidemia associated with HIV-1 infection and highly active antiretroviral therapy (HAART) have elevated levels of Lp-PLA(2) and CCL5/regulated on activation, normal T-cell expressed and secreted (RANTES), which may increase the risk of cardiovascular disease. Purpose: This study aimed to determine whether an intensive diet and exercise (D/E) program, independently or combined with fenofibrate or niacin, could reduce Lp-PLA(2) or RANTES. Methods: Patients with hypertriglyceridemic HIV on stable HAART (n = 107) were randomized to one of five interventions: 1) usual care, 2) D/E with placebos, 3) D/E with fenofibrate and placebo, 4) D/E with niacin and placebo, or 5) D/E with fenofibrate and niacin for 24 wk. Lp-PLA(2) and RANTES concentrations were measured in fasting plasma samples at baseline and postintervention. General linear models were used to compare Lp-PLA(2) and RANTES levels between the five groups postintervention, controlling for baseline levels, age, body mass index, CD4(+) T-cell count, viral load, duration of infection, and HAART. Results: At baseline, fasting plasma Lp-PLA(2) (388.5 +/- 127.5 ng.mL(-1)) and RANTES (43.8 +/- 25.5 ng.mL(-1)) levels were elevated when compared with healthy controls. Posttreatment Lp-PLA(2) mass was lower in patients who received D/E only (323.0 +/- 27.2 ng.mL(-1)), D/E plus fenofibrate (327.2 +/- 25.9 ng.mL(-1)), and D/E plus niacin (311.1 +/- 27.8 ng.mL(-1)) when compared with patients receiving usual care (402.2 +/- 25.3 ng.mL(-1)). RANTES concentrations were not significantly affected by any intervention. Conclusions: Elevated plasma Lp-PLA(2) mass can be reduced by an intensive D/E program in patients with HIV/HAART-associated dyslipidemia. RANTES is elevated but is not reduced by lifestyle modification, fenofibrate, or niacin.