Effects of Combined Aerobic and Resistance Exercise on Exercise Capacity, Muscle Strength and Quality of Life in HIV-Infected Patients: A Systematic Review and Meta-Analysis

<div><p>Background</p><p>Many HIV-infected patients demonstrate disability and lower aerobic capacity. The inclusion of resistance training combined with aerobic exercise in a single program is known as combined aerobic and resistance exercise (CARE) and seems to be an effective strategy to improve muscle weakness, as well as aerobic capacity in HIV-infected patients. We performed a meta-analysis to investigate the effects of CARE in HIV-infected patients.</p><p>Methods</p><p>We searched MEDLINE, Cochrane Controlled Trials Register, EMBASE, CINAHL (from the earliest date available to august 2014) for controlled trials that evaluated the effects of CARE in HIV-infected patients. Weighted mean differences (WMD) and 95% confidence intervals (CIs) were calculated, and heterogeneity was assessed using the I² test.</p><p>Results</p><p>Seven studies met the study criteria. CARE resulted in improvement in Peak VO₂ WMD (4.48 mL·kg^-1·min^-1 95% CI: 2.95 to 6.0), muscle strength of the knee extensors WMD (25.06 Kg 95% CI: 10.46 to 39.66) and elbow flexors WMD (4.44 Kg 95% CI: 1.22 to 7.67) compared with no exercise group. The meta-analyses also showed significant improvement in Health status, Energy/Vitality and physical function domains of quality of life for participants in the CARE group compared with no exercise group. A nonsignificant improvement in social function domain of quality of life was found for participants in the CARE group compared with no exercise group.</p><p>Conclusions</p><p>Combined aerobic and resistance exercise may improve peak VO₂, muscle strength and health status, energy and physical function domains of quality of life and should be considered as a component of care of HIV-infected individuals.</p></div

Search and selection of studies for systematic review according PRISMA.

<p>Search and selection of studies for systematic review according PRISMA.</p

Study quality on the PEDro scale.

<p>1: eligibility criteria and source of participants; 2: random allocation; 3: concealed allocation; 4: baseline comparability; 5: blinded participants; 6: blinded therapists;7: blind assessors; 8: adequate follow-up; 9: intention-to-treat analysis; 10: between-group comparisons; 11: point estimates and variability.</p><p>*Item 1 does not contribute to the total score.</p><p>Study quality on the PEDro scale.</p

Combined aerobic and resistance exercise (CARE) versus No Exercise: Peak VO₂.

<p>Review Manager (RevMan). Version 5.2 The Cochrane Collaboration, 2013.</p

Characteristics of the included studies.

<p>HRQoL, Health-related quality-of-life; MOS-HIV, Medical outcomes study HIV health survey; GQL, Globat quality of life; NA, not assessed.</p><p>Characteristics of the included studies.</p

Search strategy MEDLINE via PUBMED.

<p>Search strategy MEDLINE via PUBMED.</p

Predictors of HPV incidence and clearance in a cohort of Brazilian HIV-infected women

<div><p>Persistent infection with high-risk human papillomavirus (HR-HPV) is necessary for the development of precursor lesions and cervical cancer. HPV infection among women living with HIV/AIDS (WLHA) occurs more frequently, presents a higher rate of persistent infections and an earlier progression to cancer. We aimed to evaluate HR-HPV prevalence, incidence and clearance, and its association with HIV viral suppression, immunological response and other risk factors among WLHA followed at an STD/HIV reference center. This was a cohort study conducted at a reference center for STD/AIDS in Northeastern Brazil from September 2013 to September 2015. Follow-up visits were conducted at 6 and 12 months after enrolment, where socio-epidemiological data were obtained. Cervical samples were collected for conventional cytology and HPV DNA research (PCR COBAS® Roche) in addition to blood samples for CD4+ T lymphocyte count and HIV viral load. We prospectively evaluated 333 women. HR-HPV DNA prevalence was 33.3% at baseline. HPV-16 was present in 5.1%, HPV-18 in 3.9% and 29.4% WLHA had other HR-HPV (31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 and 68). The HR-HPV incidence during the follow-up was 10.8%, at the 6-month visit was 7.7% and at the 12-month visit was 3.7%. Variables associated with HR-HPV incidence were: nulliparity, combined oral contraceptive use and detectable HIV viral load. The HR-HPV clearance rate was 41.7% and was associated with age >30 years and lymphocyte T CD4 count >500 cells/mm3 at enrolment. These findings contribute to the knowledge about a group of women that need more careful HPV screening and describe the association between an efficient immunological response and HIV viral suppression with lower incidence and increased clearance of HR-HPV.</p></div

Kaplan-Meier estimates of the incidence and time to clearance of cervical HR-HPV infection in women living with HIV/AIDS by clinical and virological characteristics.

<p>(A) Incidence of HR-HPV by parity. (B) Incidence of HR-HPV by COC pill use. (C) Incidence of HR-HPV by ART use. (D) Clearance of HR-HPV by the presence of multiple HPV infection.</p

Clinical and socio-demographic characteristics of 333 women living with HIV/AIDS followed in a cohort in northeastern Brazil, based on the presence of baseline HPV co-infection.

<p>Clinical and socio-demographic characteristics of 333 women living with HIV/AIDS followed in a cohort in northeastern Brazil, based on the presence of baseline HPV co-infection.</p

Association between oncotic cytology, HPV genotype, virologic suppression of HIV, and immunologic response at baseline in a cohort of women living with HIV/AIDS, northeastern Brazil.

<p>Association between oncotic cytology, HPV genotype, virologic suppression of HIV, and immunologic response at baseline in a cohort of women living with HIV/AIDS, northeastern Brazil.</p