Abstract
BackgroundPro-inflammatory cytokines expressed in human immune deficiency virus (HIV) infection, may induce oxidative stress likely to compromise the patency of the airways or damage the lung tissues/cardiac function. However, physical (aerobic and/or resistance) exercise-induced release of heat shock protein, immune function alteration or reduced tissue hypoxia, have been highlighted as possible mechanisms by which increasing physical activity may reduce plasma pro-inflammatory cytokines in uninfected individuals and should be appraised in the literature for evidence of similar benefits in people living with HIV (PLWH). Therefore, we evaluated the effects of physical exercises on 1) inflammatory biomarkers and 2) cardiopulmonary function (VO2 Max) in PLWH.MethodA systematic review was conducted using the Cochrane Collaboration protocol. Searching databases, up to January 2018. Only randomized control trials investigating the effects of either aerobic or resistance or a combination of both exercise types with a control/other intervention(s) for a period of at least 4 weeks among adults living with HIV, were included. Two independent reviewers determined the eligibility of the studies. Data were extracted and risk of bias (ROB) was assessed with the Cochrane Collaboration ROB tool. Meta-analyses were conducted with random effect models using the Review Manager (RevMan) computer software.ResultTwenty-three studies met inclusion criteria (n = 1073 participants at study completion) comprising male and female with age range 18–65 years. Three meta-analyses across three sub-groups comparisons were performed. The result showed no significant change in biomarkers of inflammation (IL-6 and IL-1β) unlike a significant (Z = 3.80, p < 0.0001) improvement in VO2 Max. Overall, the GRADE evidence for this review was of moderate quality.ConclusionThere was evidence that engaging in either aerobic or resistance exercise, or a combination of both exercises, two to five times per week can lead to a significant improvement in cardiopulmonary function but not biomarkers of inflammation (IL-6 and IL-1β). However, this should not be interpreted as “No evidence of effect” because the individual trial studies did not attain sufficient power to detect treatment effects. The moderate grade evidence for this review suggests that further research may likely have an important impact on our confidence in the estimate of effects and may change the estimate.
Highlights
Pro-inflammatory cytokines expressed in human immune deficiency virus (HIV) infection, may induce oxidative stress likely to compromise the patency of the airways or damage the lung tissues/cardiac function
The review question is: What are the effects of physical exercises on cardiopulmonary function and Inflammatory biomarkers in patients living with Human Immunodeficiency Virus (HIV)? To answer the review question, specific review objectives sought to determine the effects of physical exercises on 1) inflammatory biomarkers and 2) cardiopulmonary function in patients living with HIV
Twenty-two trials determining the efficacy of various exercise interventions for improving the level of inflammatory biomarkers and cardiopulmonary functioning in patients living with HIV infection undergoing Antiretroviral therapy (ART) were reviewed
Summary
Pro-inflammatory cytokines expressed in human immune deficiency virus (HIV) infection, may induce oxidative stress likely to compromise the patency of the airways or damage the lung tissues/cardiac function. A reduction in opportunistic diseases was possible through a reduction of HIV-related inflammation/immune activation [7], decreased risk of HIV transmission [8], improved CD4 T-cells/immune response and decreased progression to AIDS [9] All these effects of ART mentioned above account for a remarkable improvement in the life expectancy of the people living with HIV (PLWH) [10]. Despite the benefits of this drug, PLWH are still associated with lactic acidosis, dyslipidemia & lipodystrophy, neuropsychiatric symptoms, liver toxicity, gastrointestinal intolerance, lipid abnormalities [11], increase creatinine kinase level [12] and cardiopulmonary dysfunction [13] Some of these conditions exist as a result of an increased inflammatory response associated with HIV [14, 15] which is not fully suppressed by the use of ART [16,17,18]. Early management of inflammation is essential in tempering HIV/ ART -associated morbidity [20], and can be achieved through improved physical activity level
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