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Abstract:
Background:
The management of HIV infection, and subsequent development of AIDS has
evolved since the syndrome was first described. Although the current use of
Highly Active Antiretroviral Therapy (HAART) has decreased the mortality and
morbidity rates of HIV infected persons, it is associated with lipodystrophy
and metabolic dysfunction abnormalities. Patients affected by lipodystrophy
can be identified as HIV+ wherever they are in public areas. This serves
further stigma as the body wasting and skin lesions in the earlier years of
the epidemic. The associated psycho-social problems of low self-esteem and
depression, may influence patients’ decisions to start or continue HIV
medications. Lipodystrophy may also cause musculo-skeletal disorders, such as
neck pain and back pain that may result from fat collections around the neck
and breast enlargement respectively. Lipodystrophy is usually accompanied by
high cholesterols-TC, LDL (HDL decreases), triglycerides and glucose levels.
Metabolic changes alter the function of multiple cell types of endothelium,
smooth muscle and platelets resulting into vaso-constrictions, inflammation
and thrombosis leading to atherogenesis. This predisposes the affected
individuals to premature cardiovascular diseases. There is sufficient evidence
to support the benefits of exercise in adults with HIV infection. However, as
various types of HAART become available in the most HIV/AIDS stricken
developing countries, there are inadequate studies to evaluate and promote
aerobic exercise in alleviating HIV lipodystrophy and the related metabolic
dysfunction. Objectives: (i) To determine the occurrence and severity
of physical changes in body composition associated with lipodystrophy, (ii) To
establish the effect of aerobic exercise on aerobic capacity of patients with
HIV and lipodystrophy, (iii) To assess the effect of aerobic exercise on
lipodystrophy and quality of life in adults with HIV infection, (iv) To
determine the effect of HIV and lipodystrophy on lipid and glucose metabolism,
and (v) To design weekly aerobic exercise programs and monitor anthropometric
measurements, lipid & glucose levels for adults with HIV infection. Design
and subjects: A
randomised controlled trial of four (4) study groups, each with 50
participants (approximating a drop-out rate of 20%) using a power calculation
of 80%. Setting and measurements: After ethical clearance,
participants will be recruited from various HIV/AIDS clinics in
Kigali
City
province,
Kabyayi
Hospital
,
Butare
University
Hospital
, Centre Hospitalier Universitaire de Kigali (CHK-CHUK) and Treatment &
Research AIDS Centre (TRAC). Data analyses: Data analyses will include
descriptive statistics, and associations of various variables will be analysed
using Chi-square and Fisher’ Exact tests. Differences in means
will be given by subtractions of the outcome control from outcome test, using
a 95% confidence interval. An accepted Type 1 error probability of five
percent (p < 0.05) will be used for statistical significance. Significance:
The study will be a contribution to the significance and effect of aerobic
exercises on lipodystrophy syndrome and QOL among HIV individuals. The
findings could be useful indicators of how non-pharmacological agents can be
used for the management of lipodystrophy. Duration and costs: The study
will take 48 weeks of data collection, exercise program, while reporting and
publications will take about 24 weeks. The cost of the study will be thirty
eight millions nine hundred seventy five thousands and five hundred Rwanda
Francs (38975500 Frw),
64,959 US$ dollars (1
US
$ =600 Frw), most of which will be used for purchase of relevant equipments
for the project.
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Eugene
Mutimura is a lecturer at Kigali Health Institute. He completed his BSc (Hons)
degree and MSc degree from
South Africa
in 2001. He started his Doctoral studies in 2004 at the University of the
Witwatersrand (
South Africa
), with which Kigali Health Institute is establishing a partnership. His PhD
studies focus on “Randomised controlled trial of aerobic
capacity on HIV lipodystrophy and metabolic function”, exploring a
possible relationship between aerobic
exercise capacity, anthropometric variables and metabolic dysfunction that may
occur in lipodystrophy syndrome. In response to public health issues,
Eugene
has attended and presented at several regional & international
conferences. He presented papers on HIV/IDS, such as “Response of
Higher Institutions of Learning to the HIV/AIDS Pandemic” and “Psycho-Social
and Economic Impact of HIV/AIDS on Education System”. He is currently
involved in an intervention on “Strategic approaches to HIV/AIDS
Prevention, Care & Rehabilitation of People living with HIV/AIDS”. He
presented research papers in June 2004 at the 14th
International World Confederation for Physical Therapy in
Barcelona
,
Spain
(“The role of caregivers in rehabilitation of their children with
disabilities” and “Health promotion needs of physically disabled
individuals with lower limb amputation in selected areas of
Rwanda
”). In 2003 he presented papers in
Cape Town
on “Public health consequences of
landmines in post war
Rwanda
” and
“Promotion of Health-enhancing programs for physically handicapped
individuals”. Responding to the current public outcry of low back pain
in
Rwanda
, he recently completed a research on ‘Low back pain predictors, its
classification and patient satisfaction with management.”.
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