Randomized Clinical Trial of High Intensity Exercise in People with HIV: Effects on Muscle Composition and Inflammation.

Abstract

Background: Myosteatosis affects muscle strength and mobility function, and further is associated with inflammation, yet there is limited work examining the effects of exercise training in people with HIV (PWH).

Methods: We conducted a randomized trial of 16-weeks aerobic exercise and resistance training (AEX+RT) compared to standard of care control in PWH ≥50 years of age. Muscle area, intramuscular adipose tissue (IMAT), and muscle density (Hounsfield units) of the mid-thigh was determined by computed tomography. Inflammatory markers included IL-6, hsCRP, TNF-α, and IL-18.

Results: Among participants randomized to AEX+RT (N=17) or control (N=16), the mean (SD) age was 60.1(6.7) years, and the majority identified as black (70%) and men (91%). Significant between-group differences were found for muscle area (+7.5% vs. -3.1%, p<0.01), muscle density (+5.2% vs. -0.3%, p<0.01), and leg strength (+51.8% vs. +1.3%, (p<0.001). The decrease in IMAT after AEX+RT did not reach significance (-6.7%, p=0.07). There was no change in body weight or abdominal adiposity. At baseline, muscle density significantly correlated inversely with TNF-α and IL-6. There was a significant correlation between IMAT and inflammatory markers except IL-18. There were no significant between-group differences in changes in inflammatory markers. Percent change in inflammatory measures did not correlate with change in muscle measures.

Conclusion: Combined AEX+RT increased thigh muscle density, size, and strength in older PWH. Baseline association of muscle density and IMAT with inflammation underscores the need for further work in larger, more diverse populations to target underlying mechanisms for improvements in muscle quality in PWH.