Aerobic Exercise Increases Cognition and Brain Volume in HIV+ People

Background: HIV infected (HIV+) individuals are now reaching an advanced age, through stable treatment with highly active anti-retroviral therapy (HAART). However, HIV and aging are still risk factors for cognitive decline and neuropathologic deterioration seen in magnetic resonance imaging (MRI). Healthy lifestyle factors such as regular exercise may provide benefits to HIV+ individuals. Few studies have shown definitive benefit of aerobic exercise (AE) to HIV+ cognitive status, and none have used MRI. In this study we determine if a history of AE is beneficial to brain integrity and neurocognitive test scores in a cohort of HIV+ individuals.

Methods: A cross-sectional cohort of 70 HIV+ individuals (19-82 age range) had neuropsychological performance (NP) testing, neuroimaging, and completed an extensive self-report AE questionnaire that split the cohort into physically active (n=22) and sedentary (n=48) groups. Student’s t-tests were used to analyze demographics. Analysis of variance (ANOVA) was used to study main effects of exercise on a brief NP battery, which consisted of the following tests: Trail Making Tests A and B, Hopkins Verbal Learning Test, Digit-Symbol Coding, F-A-S and Verbal Fluency. NP tests were grouped by executive and motor function for analysis. ANOVAs were also used to study the effects of exercise upon brain volumes. This included brain volumes affected by HIV, such as the caudate and putamen, regions affected by exercise, such as the hippocampus, and general brain regions like total gray and total white matter

Results: Active and sedentary HIV+ individuals were similar for age, sex, education, and laboratory values. Physically active HIV+ patients performed significantly better than sedentary HIV+ participants on NP tests of executive (p=.04, mean Z scores of -0.654 and -0.956 respectively, [95% CI, 0.27, 0.72]) but not motor function (p=.13, mean Z scores of -0.331 and -0.827, respectively). Additionally, physically active HIV+ individuals had a significantly larger putamen (p=0.028) across the lifespan compared to the sedentary cohort.

Conclusions: Across a range of ages, AE may maintain healthy brain volumetrics in HIV+ individuals and led to improved cognitive performance. Future studies should consider exercise as an adjunctive therapy to HAART for HIV+ individuals.

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HIV Lipodystrophy Update: Interview with Researcher Dr. Grace McComsey

HIV Lipodystrophy Update: Interview with Researcher Dr. Grace McComsey

Dr. Grace McComsey has been involved in HIV research for 16 years, 12 of those as an NIH-funded principal investigator. Her work has focused on the investigations on lipodystrophy and metabolic complications in HIV. Her work was paramount in showing the link between nucleoside inhibitor-induced mitochondrial toxicity and lipoatrophy in HIV-infected people. Her work was recognized by the HIV Medical Association of the Infectious Diseases Society of America, with the HIVMA Leader in HIV Research Award. Specifically in recognition for her work in advancing our understanding of lipodystrophy. She has personally led a number of studies, including several multi-center investigating different means to prevent and treat fat alterations in HIV, including uridine supplements, rosiglitazone, statins, and modulation of antiviral therapy dose and type. She has also led several SDG studies showing that central fat accumulation continues to be a major problem threatening the success of current HIV treatment. We’re going to talk about that today. That’s our focus.

In the last 12 years, she has led Case HIV Metabolic Center, which is recognized for clinical and translational studies highlighting the pathogenesis and management of metabolic and cardiovascular complications in HIV. Over the last few years, she has been focusing on elucidating the role of inflammation and immune activation related to co-morbidities in HIV.