Efeitos do treinamento físico combinado periodizado e estatina em pessoas vivendo com HIV com dislipidemia: ensaio clínico randomizado, duplo-cego e placebo-controlado

Abstract

Introduction: Previous studies have suggested that exercise training (ET) along with the use of statin provides reduction of mortality as well as improvement of the lipid and inflammatory profile in the general population. However, such responses remain scarce in people living with HIV (PLHIV). Purpose: To evaluate the effects of periodized combined ET and the use of statins in PLHIV with dyslipidemia. Methods: This is a randomized, double-blind, placebo-controlled clinical study conducted between February 2016 and September 2016 with PLHIV of both genders, sedentary and dyslipidemic. We randomly assigned 83 participants to four groups: placebo (PL, n=21), statin (STA, n=21), placebo + ET (PLET, n = 20) and STA + ET (STAET; n=21). Participants received and were instructed to take one pill per day, and in the STA and STAET groups contained 10 mg of rosuvastatin calcium while in the PL and PLET groups contained 10 mg of placebo. The PLET and STAET groups performed combined periodized ET three times a week on nonconsecutive days. We evaluate before and after 12 weeks the systolic and diastolic blood pressure (SBP, DBP), heart rate (HR), fasting glucose (GJ), glycated hemoglobin (HbA1c), homeostatic model for insulin resistance (HOMA- IR), insulin, total cholesterol (TC), triglycerides (TG), low density lipoprotein (LDL-c), high density lipoprotein (HDL-c), muscle creatine kinase (CK), lactate, C-reative protein (CRP), fibrinogen, interleukin (IL) -1β, IL-6, IL-8, IL-10, tumor necrosis factor (TNF)-α, adiponectin, CD4+ and CD8+ cells, body mass (BM), body mass index (BMI), muscle mass (MM), fat body mass (FBM), body fat percentage (BF%), left and right carotid media-intimal thickness (CMIT), peak-systolic velocity (PSV), end-diastolic velocity (EDV), wall-shear rate (WSR), muscle strength and cardiorespiratory capacity. We used Δ values (post – pre) and performed a covariance analysis with Bonferroni post-hoc test using the pre-intervention value as covariate. Results: We found significant reductions in SBP, HR, GJ, HbA1c, HOMA-IR, insulin, CK, lactate, MG and% GC in the PLET and STAET groups compared to the PL and STA groups. The STAET group showed higher reductions in TC, TG, LDL-c, IL-1β, IL-6 left CMIT and increase in HDL-c compared to STA, PLET and PL groups and, in addition, all groups significantly decreased the concentration CRP and fibrinogen compared to the PL group. The PLET and STAET groups increased IL-10 and reduced right CIMT compared to the STA and PL groups. There were increases in adiponectin, CD4+ and CD8+ cells, PSV, EDV, WSR, MM as well as muscle strength and aerobic capacity in the PLET and STAET groups compared to the PL and STA groups. Conclusion: We conclude that ET along with statin use improves anthropometric, metabolic, lipid, inflammatory, immune profile, carotid doppler ultrasound parameters and the physical capacities of PLHIV.