Homocysteine-lowering exercise effect is greater in hyperhomocysteinemic people living with HIV: A randomized clinical trial.

Elevated concentration of homocysteine has been identified as an independent risk factor for the development of cardiovascular disease and is frequently associated with oxidative stress. Moreover, studies have shown that people living with HIV (PLHIV) present elevated concentration of homocysteine and oxidative stress compared to people without HIV. Our purpose was to describe blood homocysteine and oxidative stress markers in PLHIV and those without HIV infection, and to examine the effects of a 16-week combined training exercise program (CTE) on oxidative stress and homocysteine concentrations of PLHIV. We included 49 PLHIV (21 men, 28 women) and 33 people without HIV infection (13 men, 20 women). After baseline evaluations, 30 PLHIV were randomized to either CTE (trained group TG, n=18) or the control group (CG, n=12); CTE consisted of aerobic and strength exercise sessions during 16 weeks, three times a week. Plasma homocysteine, oxidative damage markers, folate and vitamin B12 were assessed pre- and post-training and by hyperhomocysteinemia (homocysteine≥15 µmol/L) status. At baseline, PLHIV had higher levels of homocysteine and malondialdehyde, as well as reduced circulating folate when compared to people without HIV infection. CTE resulted in a 32% reduction (p<0.05) in homocysteine concentration and a reduction in lipid hydroperoxide in PLHIV with hyperhomocysteinemia which was not observed in those without hyperhomocysteinemia. Hyperhomocysteinemic participants experienced a 5.6±3.2 µmol/L reduction in homocysteine after CTE. In summary, sixteen weeks of CTE was able to decrease elevated homocysteine concentration and enhance redox balance of PLHIV with hyperhomocysteinemia, which could improve their cardiovascular risk.