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1.
Am J Physiol Endocrinol Metab ; 300(1): E243-51, 2011 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-20959530

RESUMEN

The prevalence and incidence of insulin resistance and type 2 diabetes mellitus (DM) are higher in people treated for human immunodeficiency virus-1 (HIV) infection than in the general population. Identifying safe and effective interventions is a high priority. We evaluated whether the peroxisome proliferator-activated receptor-γ agonist pioglitazone with exercise training improves central and peripheral insulin sensitivity more than pioglitazone alone in HIV-infected adults with insulin resistance and central adiposity. Forty-four HIV-infected adults with baseline insulin resistance and central adiposity were randomly assigned to 4 mo of pioglitazone (30 mg/day) with or without supervised, progressive aerobic, and resistance exercise training (1.5-2 h/day, 3 days/wk). The hyperinsulinemic euglycemic clamp was used to evaluate alterations in central and peripheral insulin sensitivity. Thirty-nine participants completed the study. Hepatic insulin sensitivity improved similarly in both groups. Exercise training augmented the beneficial effects of pioglitazone on peripheral insulin sensitivity. Greater improvements in peripheral insulin sensitivity were associated with reductions in total body and limb adipose content rather than increases in limb adiposity or pioglitazone-induced increases in adiponectin concentration. We conclude that supplementing pioglitazone with increased physical activity improved insulin sensitivity more effectively than pioglitazone alone in HIV-infected adults with insulin resistance and central adiposity. Pioglitazone alone did not significantly increase limb adipose content. Potential cardiovascular benefits of these interventions in HIV need investigation.


Asunto(s)
Diabetes Mellitus Tipo 2/prevención & control , Ejercicio Físico/fisiología , Infecciones por VIH/complicaciones , Resistencia a la Insulina/fisiología , Obesidad Abdominal/terapia , PPAR gamma/agonistas , Tiazolidinedionas/uso terapéutico , Adiposidad , Adolescente , Adulto , Terapia Combinada , Diabetes Mellitus Tipo 2/complicaciones , Femenino , Técnica de Clampeo de la Glucosa , Infecciones por VIH/tratamiento farmacológico , Humanos , Hipoglucemiantes/efectos adversos , Hipoglucemiantes/uso terapéutico , Hígado/efectos de los fármacos , Hígado/metabolismo , Masculino , Persona de Mediana Edad , Obesidad Abdominal/sangre , Obesidad Abdominal/complicaciones , Obesidad Abdominal/tratamiento farmacológico , Pioglitazona , Entrenamiento de Fuerza , Tiazolidinedionas/efectos adversos , Adulto Joven
2.
AIDS ; 26(16): 2053-8, 2012 Oct 23.
Artículo en Inglés | MEDLINE | ID: mdl-22874520

RESUMEN

OBJECTIVE: Abnormalities in left ventricular morphology and function have been reported in HIV-negative infants exposed to antiretroviral therapy (ART) in utero that persists throughout preschool age. The objective of this study was to determine if these abnormalities persist, resolve, or worsen during preadolescence. DESIGN: Cross-sectional observation study. METHODS: Thirty HIV-negative children born to HIV-positive women and exposed to ART in utero (mean age 8 ± 2 years, 37% female, 74% African-American) and 30 HIV-negative children born to HIV-negative women (mean age 8 ± 3 years, 37% female, 76% African-American) underwent two-dimensional Doppler, tissue Doppler, and strain echocardiography to evaluate left ventricular systolic and diastolic function. RESULTS: Weight, body surface area, heart rate and blood pressure were similar between groups. For the ART-exposed group, left ventricular mass index was lower (60 ± 9 vs. 67 ± 12 g/m, P < 0.02) and early diastolic annular velocity was lower (15.0 ± 2.2 vs. 16.3 ± 2.5 cm/s, P < 0.03) compared to controls. Left ventricular systolic function did not differ between groups. Lower maternal third trimester CD4 count was associated with lower early diastolic annular velocity; other non-HIV-related variables including cocaine use and increased maternal age correlated with lower left ventricular mass index. CONCLUSIONS: Abnormalities in left ventricular systolic performance previously reported in HIV-negative infants and preschool aged children exposed to ART in utero were not apparent in preadolescent children. Left ventricular diastolic relaxation was reduced compared with controls suggesting residual effects of ART exposure on left ventricular diastolic function. Larger, longitudinal studies are necessary to confirm these observations.


Asunto(s)
Fármacos Anti-VIH/efectos adversos , Diástole/efectos de los fármacos , Seronegatividad para VIH , Seropositividad para VIH/tratamiento farmacológico , Contracción Miocárdica/efectos de los fármacos , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Efectos Tardíos de la Exposición Prenatal/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Función Ventricular Izquierda/efectos de los fármacos , Fármacos Anti-VIH/administración & dosificación , Niño , Estudios Transversales , Ecocardiografía Doppler , Femenino , Estudios de Seguimiento , Frecuencia Cardíaca , Humanos , Masculino , Edad Materna , Tamaño de los Órganos , Embarazo , Complicaciones Infecciosas del Embarazo/virología
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