title: Intensive lifestyle modification reduces Lp-PLA2 in dyslipidemic HIV/HAART patients.
abstract: OBJECTIVE
  Patients with dyslipidemia associated with HIV-1 infection and highly active antiretroviral therapy (HAART) have elevated levels of Lp-PLA2 and CCL5/regulated on activation, normal T-cell expressed and secreted (RANTES), which may increase the risk of cardiovascular disease.
  
  
  OBJECTIVE
  This study aimed to determine whether an intensive diet and exercise (D/E) program, independently or combined with fenofibrate or niacin, could reduce Lp-PLA2 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-PLA2 and RANTES concentrations were measured in fasting plasma samples at baseline and postintervention. General linear models were used to compare Lp-PLA2 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-PLA2 (388.5 ± 127.5 ng·mL) and RANTES (43.8 ± 25.5 ng·mL) levels were elevated when compared with healthy controls. Posttreatment Lp-PLA2 mass was lower in patients who received D/E only (323.0 ± 27.2 ng·mL), D/E plus fenofibrate (327.2 ± 25.9 ng·mL), and D/E plus niacin (311.1 ± 27.8 ng·mL) when compared with patients receiving usual care (402.2 ± 25.3 ng·mL). RANTES concentrations were not significantly affected by any intervention.
  
  
  CONCLUSIONS
  Elevated plasma Lp-PLA2 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.
authors.affiliation: Division of Atherosclerosis and Vascular Biology, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA.
authors.forename: Joshua S
authors.initials: JS
authors.lastname: Wooten
authors.forename: Preethi
authors.initials: P
authors.lastname: Nambi
authors.forename: Baiba K
authors.initials: BK
authors.lastname: Gillard
authors.forename: Henry J
authors.initials: HJ
authors.lastname: Pownall
authors.forename: Ivonne
authors.initials: I
authors.lastname: Coraza
authors.forename: Lynne W
authors.initials: LW
authors.lastname: Scott
authors.forename: Vijay
authors.initials: V
authors.lastname: Nambi
authors.forename: Christie M
authors.initials: CM
authors.lastname: Ballantyne
authors.forename: Ashok
authors.initials: A
authors.lastname: Balasubramanyam
mesh_terms: D043203:1-Alkyl-2-acetylglycerophosphocholine Esterase / Q000097:blood*; D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D015415:Biomarkers / Q000097:blood; D018946:Chemokine CCL5 / Q000097:blood; D003131:Combined Modality Therapy; D004035:Diet Therapy / Q000379:methods; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005081:Exercise Therapy / Q000379:methods; D005260:Female; D011345:Fenofibrate / Q000627:therapeutic use; D015658:HIV Infections / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D015497:HIV-1; D006801:Humans; D015228:Hypertriglyceridemia / Q000097:blood / Q000209:etiology / Q000628:therapy*; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008019:Life Style; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009525:Niacin / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; C483024:CCL5 protein, human; D018946:Chemokine CCL5; D000960:Hypolipidemic Agents; D009525:Niacin; D043203:1-Alkyl-2-acetylglycerophosphocholine Esterase; D011345:Fenofibrate