Yoga for the Management of HIV-Metabolic Syndromes

Exclusion Criteria

• •Chronic hepatitis B infection (HB surface antigen positive). Active hepatitis C infection (detectable Hep C RNA). Those who have cleared hepatitis B or C infection are eligible.
• •Diabetes \[fasting glucose \>140 mg/dL, or fasting insulin \>45 µU/mL, or 2-hr glucose \>200mg/dL\].
• •Gestational diabetes, pregnancy, or nursing mothers. Menstruating women must have a negative urine pregnancy test within 14 days prior to DEXA testing (minor radiation exposure from DEXA). To control for potential metabolic effects of alterations in female hormones during the menstrual cycle, all menstruating women will be tested during the follicular phase.
• •Hypogonadism \[total testosterone \<200ng/dL (men) or \<15ng/dL (women)\]; thyroid disorder \[TSH \<0.2 or \>12µIU/mL\]; hypercortisolemia \[morning cortisol \>22µg/dL\]. Replacement testosterone or thyroid hormones or human growth hormone to normalize abnormal levels is acceptable, as long as treatment has been stable, and blood testosterone, TSH or IGF-1 levels are within the normal range.
• •Unwilling or unable to attend supervised yoga sessions 3days/wk provided by Brentwood Center for Health at the Connectcare Clinic. Any condition that might be contraindicated for yoga therapy (disabling neuromuscular or musculoskeletal injury/disorder)
• •History of serious cardiovascular disease; MI, unstable angina, heart failure, congenital heart disease, coronary artery disease, resting ST-segment depression \>1mm, coronary artery bypass graft, stroke, sinus tachycardia, arrhythmias, premature atrial or ventricular contractions, claudication. Bundle branch block is exclusionary because it limits the interpretability of the resting/exercise ECG. Cardiovascular contraindications to maximal exercise testing
• •Anticipated change in anti-HIV medications or other medications that affect metabolism, within the next 4months
• •Well-trained athletes (defined as \>3 exercise training exposures/week; \>30min regimented exercise/exposure maintained for at least the prior 4 weeks)
• •Active substance abuse (eg, alcoholism, cocaine, heroin, crack, methamphetamine, phencyclidine)
• •Active secondary infection or a significant change in chronic suppressive therapy for an opportunistic infection during 1 month prior to enrollment
• •New serious systemic infection during the 3 weeks prior to enrollment
• •Recent episode of hyperlactatemia or lactic acidosis, esp. with rapid weight loss
• •Chronic renal insufficiency/failure or other comorbid conditions (eg. cancer, COPD) that alter metabolism
• •Pancreatitis, celiac disease, or cirrhosis
• •Inadequate macronutrient or energy intake, or malabsorptive disorder as determined by the research dietician
• •Dementia or any condition that would prevent voluntary informed consent or compliance
• •Other compounds or blinded investigational new drugs that might affect metabolism or confound data interpretation (eg. RU486, interleukin therapy, or cytokine-receptor antagonist)
• •Oral glucocorticoid or corticosteroid use within the previous 3 months