Morgan Kocher

Effects of Antiretroviral Therapy on Autonomic Function in Early HIV Infection: A Preliminary Report

Background: A prospective study was conducted in human immunodeficiency virus (HIV)-infected patients as they undergo alterations in their antiretroviral therapy (ART) to determine the effect of ART on autonomic function. Methods: HIV-infected subjects who were either 1) naïve to ART and initiating ART, or 2) receiving ART and in HIV virologic failure for at least 4 months and were about to switch ART were enrolled in this study. Autonomic function assessment (cardiovagal, adrenergic, and sudomotor tests) was performed prior to and 4 months after initiating the new ART. Changes in clinical autonomic symptoms and virologic assessment were assessed. Results: Twelve subjects completed the study: 92% male; median age (Q1, Q3) was 41.0 (28.0, 48.2) years; and 50% White/Non-Hispanic. Seventy-five percent were ART naïve while 25% were failing their ART regimen. The median CD4 count was 336.5 (245.3, 372.3) cells/mm3. All subjects achieved an undetectable HIV viral load by the 4-month follow-up visit. The majority of naïve subjects were started on an ART regimen of tenofovir / emtricitabine / efavirenz. There were no significant differences in autonomic function assessment, as measured by cardiovagal, adrenergic, and sudomotor tests, with regards to ART initiation. Conclusion: This is the first study to examine the effects of initiating ART on autonomic function in early HIV infection. This study found no appreciable differences of ART on the autonomic nervous system when ART is initiated early in the course of HIV disease. ART may not contribute to short-term changes in autonomic function.

Reliability of clinically feasible dual-task tests: Expanded timed get up and go test as a motor task on young healthy individuals

Dual-Task testing has been reported to have a higher sensitivity to deficits associated with concussion; however, the feasibility as a clinical or field test is questionable due to the requirements of laboratory-based equipment. With an overarching goal of exploration of clinically feasible Dual-Task testing options, the specific aims of this study were 1) to evaluate the reliability of Dual-Task testing methods using the Expanded Timed Get-Up-and-Go (ETGUG) paired with Backward Digit Recall (BDR), Serial Seven (SS), and Auditory Pure Switch Task (APST), and 2) to determine the effects of Dual-Task testing on motor and cognitive performance in healthy college-aged individuals. Fifty-four healthy young adults completed two separate testing sessions, which consisted of Single-Task tests in a randomized order followed by 3 pairs of Dual-Task tests in a randomized order. Test-retest reliability for ETGUG time to completion was excellent for all Single- and Dual-Task conditions (ICC 0.89-0.92); however, ETGUGBDR and ETGUGSS were associated with learning effects (p=0.002 and 0.007, respectively). Test-retest reliability for Response Rate of the cognitive tasks was lower than those of motor task and all outcomes were associated with learning effects. The completion time of the ETGUGAPST pair indicated excellent reliability with no learning effect. Performance level declined in all tasks under Dual-Task conditions compared to Single-Task; however, motor tasks showed larger deficits indicating the prioritization of the cognitive task compared to the motor task.

Allometric Grip Strength Norms for Children of Hawaiian Lineage

Abstract Kocher, MH, Romine, RK, Stickley, CD, Morgan, CF, Resnick, PB, and Hetzler, RK. Allometric grip strength norms for children of Hawaiian lineage. J Strength Cond Res 31(10): 2794–2807, 2017—The purpose of the study was to determine allometric exponents for scaling grip strength in children that effectively control for body mass (BM) and stature (Ht) and to develop normative grip strength data for Hawaiian children. One thousand, four hundred thirty-seven students (754 boys) from a rural community in Hawaii participated in this 5-year study, resulting in 2,567 data points. Handgrip strength, BM, and Ht were collected every year. Multiple log-linear regression was used to determine allometric exponents for BM and Ht. Appropriateness of the allometric model was assessed through regression diagnostics, including normality of residuals and homoscedasticity. Allometrically scaled, ratio-scaled, and unscaled grip strength were then correlated with BM and Ht to examine the effectiveness of the procedure in controlling for body size. Allometric exponents for BM and Ht were calculated separately for each age group of boys and girls to satisfy the common exponent and group difference principles described by Vanderburgh. Unscaled grip strength had moderate to strong positive correlations with BM and Ht (p ⩽ 0.05 for all) for all age groups. Ratio-scaled handgrip strength had significant moderate to strong negative correlations with BM (p ⩽ 0.05 for all) and, to a lesser extent, Ht (p ⩽ 0.05 for 8- to 12-year-old boys; p ⩽ 0.05 for 8- to 12- and 14-year-old girls). Correlations between allometrically scaled handgrip strength and BM and Ht were not significant and approached zero. This study was the first to allometrically scale handgrip strength for BM and Ht in Hawaiian children. Allometric scaling applied to grip strength provides a useful expression of grip strength free of the confounding influence of body size.

HIV Patient Systemic Mitochondrial Respiration Improves with Exercise

In HIV-infected individuals, impaired mitochondrial function may contribute to cardiometabolic disease as well as to fatigue and frailty. Aerobic exercise improves total body energy reserves; however, its impact at the cellular level is unknown. We assessed alterations in cellular bioenergetics in peripheral blood mononuclear cells (PBMC) before and after a 12-week aerobic exercise study in sedentary HIV-infected subjects on stable antiretroviral therapy who successfully completed a 12-week aerobic exercise program. In this prospective study, participants underwent supervised 20-40 min of light aerobic exercise (walking or jogging) performed three times per week for 12 weeks, gradually increasing to maintain an intensity of 50%-80% of heart rate reserve. Maximal aerobic capacity (VO2MAX) was assessed by a graded exercise test on a cycle ergometer before and after completion of the study. PBMC from compliant subjects (attended at least 70% of exercise sessions) were assessed for mitochondrial respiration using the Seahorse XF24 Bio-Analyzer. Seven of 24 enrolled subjects were compliant with the exercise regimen. In these individuals, a significant increase (p = .04) in VO2MAX over 12 weeks was found with a median increase of 14%. During the same interval, a 2.45-fold increase in PBMC mitochondrial respiratory capacity (p = .04), a 5.65-fold increase in spare respiratory capacity (p = .01), and a 3.15-fold (p = .04) increase in nonmitochondrial respiration was observed. Aerobic exercise improves respiration at the cellular level. The diagnostic and prognostic value of such improved cellular respiration in the setting of chronic HIV warrants further investigation.

Symptoms of Autonomic Dysfunction in Human Immunodeficiency Virus: Figure 1.

This retrospective study evaluated the frequencies of symptoms associated with autonomic dysfunction in human immunodeficiency virus (HIV)-infected patients on stable combined antiretroviral therapy. Patients infected with HIV reported higher frequencies of dysautonomia symptoms compared with HIV-negative patients, particularly in the autonomic domains related to urinary, sleep, gastroparesis, secretomotor, pupillomotor, and male sexual dysfunction.

Symptoms of Autonomic Dysfunction in HIV

This retrospective study evaluated the frequencies of symptoms associated with autonomic dysfunction in human immunodeficiency virus (HIV)-infected patients on stable combined antiretroviral therapy. Patients infected with HIV reported higher frequencies of dysautonomia symptoms compared with HIV-negative patients, particularly in the autonomic domains related to urinary, sleep, gastroparesis, secretomotor, pupillomotor, and male sexual dysfunction.

Symptoms of Autonomic Dysfunction in Human Immunodeficiency Virus.

This retrospective study evaluated the frequencies of symptoms associated with autonomic dysfunction in human immunodeficiency virus (HIV)-infected patients on stable combined antiretroviral therapy. Patients infected with HIV reported higher frequencies of dysautonomia symptoms compared with HIV-negative patients, particularly in the autonomic domains related to urinary, sleep, gastroparesis, secretomotor, pupillomotor, and male sexual dysfunction.