HIV infection does not prevent the metabolic benefits of diet‐induced weight loss in women with obesity

Abstract

Objective To test the hypothesis that HIV infection impairs the beneficial effects of weight-loss on insulin-sensitivity and adipose-tissue inflammation and endoplasmic reticulum (ER) stress. Methods A prospective clinical trial to evaluate the effects of moderate diet-induced weight-loss on body-composition, metabolic function and adipose-tissue biology in women with obesity who were HIV-seronegative (HIV−) or HIV-positive (HIV+). Body-composition, multi-organ insulin-sensitivity (assessed by using a 2-stage hyperinsulinemic-euglycemic clamp procedure with stable isotopically-labeled tracer infusions), and adipose-tissue expression of markers of inflammation, autophagy and ER stress were evaluated in 8 HIV− and 20 HIV+ women with obesity before and after 6%–8% diet-induced weight-loss. Results Although weight-loss was not different between groups (~7.5%), the decrease in fat-free-mass was greater in HIV+ than HIV− subjects (−4.4±0.7 % vs −1.7±1.0%, P < 0.05). Weight loss improved insulin-sensitivity in adipose-tissue (suppression of palmitate rate of appearance [Ra]), liver (suppression of glucose Ra) and muscle (glucose disposal) similarly in both groups. Weight-loss did not affect adipose-tissue expression of markers of inflammation or ER stress in either group. Conclusions Moderate diet-induced weight-loss improves multi-organ insulin-sensitivity in HIV+ women to the same extent as women who are HIV−. However, weight loss causes a greater decline in FFM in HIV+ than HIV− women.

The Fat of the Matter: Obesity and Visceral Adiposity in Treated HIV Infection

“…A complete review of therapeutic options for obesity and visceral adiposity in treated HIV infection is beyond the scope of this article, although a consensus guideline has recent been published[102]. To date, data on the efficacy of weight loss and dietary interventions in HIV are mixed, although structured exercise with or without dietary intervention reduces abdominal obesity in most studies[103–107], and disproportionate SAT loss has not been observed, eliminating fear of worsening of lipoatrophy in persons with mixed lipodystrophy. Based on available data, ≥30 minutes of moderate-intensity physical activity most days of the week plus reduction of caloric intake at least 500 kcal/day below usual intake is generally recommended to attain and sustain significant (≥5%) weight loss[108, 102].…”

Obesity and diabetes in people of African ancestry with HIV

“…Intensive lifestyle modification may result in 8% weight reduction, although this is rarely achieved in clinical practice and the interventions required to achieve this may be difficult to sustain. Lifestyle interventions may also be slightly less effective in black populations [57], but seem to confer similar benefits to people with and without HIV [58,59].…”

Weight Gain and Metabolic Syndrome in Human Immunodeficiency Virus Patients

“…However, Fitch et al reported that intensive lifestyle modification significantly improved important cardiovascular risk indices in PLWH with MetS and suggested that lifestyle modification might be a useful strategy to decrease cardiovascular risk in PLWH [ 75 ]. A prospective clinical trial evaluated the effect of moderate diet-induced weight loss in obese HIV-positive women and showed that moderate diet-induced weight loss improves multi-organ insulin sensitivity in HIV-positive women to the same extent as in HIV-negative women [ 76 ].…”