This Week in HIV Research: The Power of 10,000 Steps

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We've strapped on our electronic boots for another trek through the vast, untamed wilderness of peer-reviewed journals. This week, our hike turned up several noteworthy HIV-focused manuscripts, including the following findings of potential clinical relevance:

  • Sedentary people living with HIV have exceptionally low cardiorespiratory fitness, exacerbating inflammation risk -- but a little walking can help.
  • There are plenty of barriers to greater physical activity for people living with HIV -- but also plenty of strategies an HIV care provider can employ to help their patients improve.
  • Although transwomen with HIV aren't at greater risk for metabolic syndrome than cisgender men with HIV, certain metabolic factors may nonetheless be increasing their cardiovascular risk.
  • Failed treatment of precancerous cervical lesions -- as well as lesion recurrence -- occurs more frequently among women living with HIV than their HIV-negative counterparts.

March on ahead with us for more information on each of these study findings. To beat HIV, you have to follow the science!

Barbara Jungwirth is a freelance writer and translator based in New York. Follow Barbara on Twitter: @reliabletran.

Myles Helfand is the executive editor and general manager of TheBody and TheBodyPRO. Follow Myles on Twitter: @MylesatTheBody.

Walking Improves Cardiorespiratory Fitness, Inflammation Among Sedentary People With HIV

Sedentary people living with HIV have "remarkably poor" cardiorespiratory fitness that continues to decline over time and appears to be associated with chronic inflammation, a study published in AIDS found. Although a group intervention did not improve cardiorespiratory fitness, even light physical activity such as walking had a positive effect, study findings indicated.

Researchers measured markers of oxygen consumption, such as VO2 peak, in 107 virally suppressed participants at baseline and again six months later. All participants wore accelerometers that measured their physical activity beyond the research site. Half attended six group sessions on diet and exercise, during which they were advised on how to incorporate lifestyle changes into their own lives. The other half attended a single education session on healthy behaviors.

At study end, VO2 peak had declined among all participants, and the measure did not differ significantly between the arms. However, walking an additional 10,000 steps per day improved VO2 peak in either group. The decline in VO2 peak was associated with Interleukin-6, a marker of inflammation that, in turn, may be related to HIV itself.

Study authors called for more research into this complex relationship. Meanwhile, HIV providers should routinely assess their patients' cardiorespiratory fitness and encourage walking as a simple lifestyle change, the authors recommended.

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Multidisciplinary Team Issues Practical Recommendations for Increasing Physical Activity

A literature review published in AIDS examined barriers to physical activity among people living with HIV and recommended strategies for encouraging exercise. The team of authors represented a wide range of clinical disciplines, including HIV physician care, geriatrics, nursing, physical therapy, and psychiatry.

Barriers to physical activity identified by the authors included physical and mental health challenges associated with the virus, such as lower cardiorespiratory fitness, depression, worries about HIV disclosure and stigma, and concerns about physical safety or body image.

A prescription for physical activity that is developed jointly by the patient and provider and progresses to greater levels of activity over time may be helpful, study authors noted. Other strategies they urged HIV care providers to encourage include: self-monitoring using fitness trackers, apps or diaries; setting goals and planning for exercise; using prompts, cues, or schedules to make physical activity habitual; and social support, including a buddy system or group exercises. "HIV providers have a responsibility to assess and promote [physical activity] in the routine health care of all [people living with HIV]," study authors concluded.

Metabolic Syndrome Prevalence Similar in Transwomen, Cis Men

Among people living with HIV, metabolic syndrome was no more frequent in transwomen than cisgender men, a prospective matched case-control study published in AIDS found. However, transwomen had higher rates of adrenal insufficiency (20%) and sub-clinical hypothyroidism (12%) than the controls (8% and 3%, respectively). Both conditions can cause metabolic and cardiovascular complications.

Researchers matched 100 transgender women with 192 cisgender men. All participants were living with HIV and were attending a clinic in Paris, France. Neither hormones nor silicone injections were risk factors for metabolic syndrome, nor was a negative effect of combining hormone and antiretroviral therapy observed.

Study authors speculated that the high rate of adrenal insufficiency observed in the transwomen was related to the use of corticosteroids to treat silicone inflammations. Hypothyroidism was associated with having started antiretroviral therapy recently and a low CD4 cell count nadir, but not with the hormones used for transitioning or the presence of silicone.

Study authors recommended screening transwomen living with HIV for thyroid and adrenal function and discussing supplements as necessary to prevent cardiovascular problems.

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Women With HIV at Greater Risk of Failing Treatment for Precancerous Cervical Lesions

Women living with HIV are twice as likely as women not living with the virus to fail treatment for precancerous cervical lesions, a 40-study meta-analysis published in Clinical Infectious Diseases found. HIV infection also increased the chances for recurrent or residual lesions after treatment.

In the 10 studies that included data on treatment failure for both study groups, 23.4% of participants with HIV failed treatment for cervical lesions, compared to 9.5% of women without HIV. Failure rates did not differ significantly between excisional (e.g., loop electrosurgical excision procedure) or ablative (e.g., cryotherapy) treatment methods, although data were limited on the latter procedure.

Results are particularly relevant in resource-limited settings, where visual inspection with acetic acid (VIA) is generally used to find cervical lesions, study authors noted. In one of the studies analyzed, VIA had a detection rate of 27%. Because of its high rate of missing lesions, this meta-analysis excluded studies that used only VIA.

Given relatively high HIV rates in many resource-limited countries, appropriate follow-up strategies need to be developed for women who were treated for cervical lesions in these settings, study authors concluded.