HIV-1, Exercise and Endothelial Function

描述（由申请人提供）：心血管疾病（CVD）是人类免疫缺陷病毒(HIV)-1感染成人的新问题，包括接受抗逆转录病毒治疗（ART）的患者。前瞻性和回顾性研究表明，与hiv -1血清阴性个体相比，接受抗逆转录病毒治疗的hiv -1感染者发生动脉粥样硬化和心肌梗死的风险增加。在hiv -1感染人群中，与动脉粥样硬化加速相关的许多风险与传统的风险因素无关，其背后的机制尚不完全清楚。此外，尚未确定有效的非药物干预策略，以预防和/或降低接受抗逆转录病毒治疗的hiv -1感染成人动脉粥样硬化性血管疾病的风险。越来越多的证据表明，抗逆转录病毒治疗的hiv -1感染个体具有以血管舒缩和纤溶调节受损为特征的促动脉粥样硬化内皮表型。有规律的有氧运动被广泛认为是心血管疾病一级和二级预防最有效的非药物干预措施。迄今为止，关于有氧运动训练对hiv -1血清阳性成人的影响的研究主要集中在心肺和代谢适应方面。目前尚不清楚有氧运动训练是否能改善接受抗逆转录病毒治疗的hiv -1感染成人的内皮功能。因此，本提案的具体目标1和2将是确定定期有氧运动计划是否改善：1)血管内皮依赖性一氧化氮介导的血管舒张；2)血管内皮释放组织型纤溶酶原激活剂（t-PA）的能力，在先前久坐的hiv -1感染的成年人中，没有冠状动脉疾病的传统心脏代谢危险因素，正在接受抗逆转录病毒治疗。具体目标3将确定在接受抗逆转录病毒治疗的hiv -1感染成人中，运动诱导的内皮血管扩张剂和纤溶功能的增加是否至少部分是由于氧化应激和炎症的减少。为了实现这些目标，将对80名年龄在30-50岁之间的hiv -1血清阳性成人进行研究，他们接受了第一次ART治疗方案，该方案由替诺福韦和恩曲他滨联合依非韦伦或利托那韦增强的阿扎那韦组成。受试者将被随机分配到有氧运动训练组或注意力对照组，为期24周。内皮依赖性血管舒张、内皮t-PA释放和氧化应激对各功能特征的影响将在24周干预前后通过离体前臂模型进行测定。本研究的结果将为hiv -1感染个体加速动脉粥样硬化的机制提供见解，并支持在这一高度易感人群中使用定期有氧运动作为辅助治疗来减少和预防心血管疾病。

DESCRIPTION (provided by applicant): Cardiovascular disease (CVD) is an emerging problem in human immunodeficiency virus (HIV)-1-infected adults, including those treated with antiretroviral therapy (ART). Prospective and retrospective studies have indicated that HIV-1-infected individuals on ART are at increased risk of atherosclerosis and myocardial infarction compared with HIV-1-seronegative individuals. Much of the risk associated with accelerated atherosclerosis in the HIV-1-infected population is independent of traditional risk factors, and the mechanisms underlying this are not completely understood. Furthermore, effective non-pharmacological intervention strategies to prevent and/or reduce the risk of atherosclerotic vascular disease in HIV-1-infected adults receiving ART have not been established. There is increasing evidence that ART-treated HIV-1-infected individuals have a proatherogenic endothelial phenotype characterized by impaired vasomotor and fibrinolytic regulation. Regular aerobic exercise is widely regarded as the most effective non-pharmacological intervention for both primary and secondary prevention of CVD. To date, studies on the effects of aerobic exercise training in HIV-1-seropositive adults have focused on cardiorespiratory and metabolic adaptations. It is currently unknown whether aerobic exercise training can improve endothelial function in HIV-1-infected adults receiving ART. Accordingly, specific aims 1 and 2 of the present proposal will be to determine if a program of regular aerobic exercise improves: 1) vascular endothelium-dependent nitric oxide-mediated vasodilation; and 2) the capacity of the vascular endothelium to release tissue-type plasminogen activator (t-PA) in previously sedentary HIV-1-infected adults without traditional cardiometabolic risk factors for coronary artery disease who are receiving antiretroviral therapy. Specific aim 3 will determine if the exercise-induced increase in endothelial vasodilator and fibrinolytic function in HIV-1-infected adults receiving antiretroviral therapy is due, at least in part, to reduced oxidative stress and inflammation. To address these aims, 80 HIV-1-seropositive adults, ranging in age from 30-50 years, receiving their first ART regimen consisting of tenofovir and emtricitabine combined with either efavirenz or atazanavir boosted with ritonavir will be studied. Subjects will be randomly assigned to either an aerobic exercise training group or an attention control group for 24 weeks. Endothelium- dependent vasodilation, endothelial t-PA release and the effects of oxidative stress on each functional characteristic will be determined before and after the 24-week intervention period using an isolated forearm model. The results of the present study will provide mechanistic insight into the accelerated atherosclerosis seen in HIV-1-infected individuals and support use of regular aerobic exercise as adjunctive therapy to reduce and prevent cardiovascular disease in this highly susceptible population.