The role of HIV-1-specific CD4+ T-cell responses in controlling HIV-1 infection remains unclear. Previous work has suggested that such cells are eliminated in the early stages of infection in most subjects, and thus cannot substantially contribute to host defense against HIV-1. Here, using flow cytometric detection of antigen-induced intracellular cytokines, we show that significant frequencies of gag specific, T-helper-1 CD4+ memory T cells are detectable in most subjects with active/progressive HIV-1 infection (median frequency, 0.12% of memory subset; range, 0-0.66%). Median frequencies of these cells were considerably higher in nonprogressive HIV-1 disease (0.40%), but there was substantial overlap between the two groups (range of nonprogressors, 0.10-1.7%). Continuous HIV-1 suppression with anti-retroviral therapy was associated with a time-dependent reduction in median frequencies of gag-specific CD4+ memory T cells: 0.08% in subjects treated for 4-24 weeks, and 0.03% in subjects treated for 47-112 weeks. Thus, functional HIV-1-specific CD4+ T cells are commonly available for support of anti-HIV-1 effector responses in active disease, but their decline with anti-retroviral therapy indicates that immunologic participation in long-term HIV-1 control will probably require effective vaccination strategies.

Weight regain is a problem among many bariatric surgery patients. Whether a high‐volume exercise program (HVEP), a strategy to limit weight regain, is feasible in these patients is unknown. The feasibility of an HVEP in obese post‐bariatric‐surgery patients was determined by randomizing 33 Roux‐en‐Y gastric bypass (RYGB) and gastric banding (GB) surgery patients with a mean BMI of 41 ± 6 kg/m2 to an HVEP or control group for 12 weeks. The HVEP group was instructed to expend ≥2,000 kcal/week in moderate‐intensity exercise. All patients were counseled to limit energy intake. Treatment effect was assessed by repeated measures analysis. During the last 4 weeks of the study, 53% of the HVEP group expended ≥2,000 kcal/week and 82% expended ≥1,500 kcal/week. Step count, reported time spent and energy expended during moderate physical activity, maximal oxygen consumption relative to weight, and incremental area under the postprandial blood glucose curve were significantly improved over 12 weeks in the HVEP group compared to controls (group‐by‐week effect: P = 0.009–0.03). Both groups reported significant improvement in some quality‐of‐life scales. Changes in weight, energy and macronutrient intake, resting energy expenditure (REE), fasting lipids and glucose, and fasting and postprandial insulin concentrations were not different between the two groups. HVEP is feasible in about 50% of the patients and enhances physical fitness and reduces postprandial blood glucose in bariatric surgery patients.

Metreleptin replacement therapy is equally effective in FPLD patients with both SH and MH in reducing serum and hepatic triglyceride levels, but did not improve hyperglycemia.

Lipodystrophy in HIV-infected (LDHIV) patients receiving protease inhibitors (PIs) is associated with dyslipidaemia. Whether lifestyle factors play a role in dyslipidaemia in LDHIV subjects on PIs is not well characterized. MethodsA total of 45 LDHIV male and six LDHIV female patients on PIs were recruited, and data were collected on smoking, exercise, diet (by 3-day food record), and fasting levels of serum lipids and lipoproteins. The relationships between lifestyle factors and metabolic variables were analysed in male patients by Spearman's correlation test and the significant relationships were further analysed by adjusting for age, PI duration, and waist circumference by Spearman's partial correlation test. ResultsIn men, mean (AE standard deviation) serum concentrations of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), and non-HDL-C were 212 AE 70, 35 AE 7.3, 325 AE 230 and 169 AE 44 mg/dL, respectively. Sixty-seven percent of the men exercised regularly and 31.1% smoked. The reported diet was high in cholesterol (390 AE 212 mg) and percentage energy from saturated (12.2 AE 3.3%) and trans (2.4 AE 1.2%) fats, and low in soluble fibre (6.9 AE 2.3 g) compared with recent dietary guidelines. Following adjustments for the confounding variables, percentage energy intake from total protein and animal protein was positively related to TC (r 5 0.44, Po0.01 and r 5 0.37, Po0.05, respectively), TG (r 5 0.40, Po0.01 and r 5 0.46, Po0.01, respectively) and non-HDL-C (r 5 0.56, Po0.001 and r 5 0.49, Po0.01, respectively), that from trans fat was positively related to TG (r 5 0.34, Po0.05), and soluble fibre was negatively related to non-HDL-C (r 5 À 0.41, Po0.01). Moderate to heavy aerobic exercise tended to be associated with higher HDL-C (r 5 0.30, P 5 0.07) whereas smoking was not associated with any of the metabolic variables. ConclusionsIncreased intake of total protein, animal protein and trans fat, and reduced soluble fibre consumption contribute to dyslipidaemia in LDHIV subjects on PIs.Keywords: diet, dyslipidaemia, exercise, HIV, lipodystrophy, smoking In subjects not infected with HIV, lifestyle factors such as diet, physical activity and smoking contribute significantly to dyslipidaemia [10]. However, there is a paucity of data regarding the role of lifestyle factors in inducing dyslipidaemia in LDHIV individuals on PI-containing HAART. Previous studies [11][12][13] included not only HIV-infected subjects on PI therapy but also PI-naïve subjects. Also, two of these studies [11,12] did not examine or adjust for the role of exercise and smoking in dyslipidaemia. Furthermore, these studies [11][12][13] did not comprehensively examine the relationship between intakes of macronutrients and levels of lipids and lipoproteins. For example, Batterham et al.[11] evaluated only the role of total and saturated fat in dyslipidaemia. Hadigan et al.[12] did not study the role of unsaturated fats such as polyunsaturated, monounsaturated and trans fats. Gavrila et al. [13] did not ...

Metreleptin is safe but may not be efficacious in improving glycemic control in patients with T1DM, although it reduces body weight and daily insulin dose modestly.