Physiologic Investigation of the Renin Angiotensin Aldosterone Axis in HIV

• Plasma Renin Activity [ Time Frame: baseline ] [ Designated as safety issue: No ]
• Aldosterone response to Angiotensin II Infusion [ Time Frame: baseline ] [ Designated as safety issue: No ]
• Flow mediated dilation [ Time Frame: baseline ] [ Designated as safety issue: No ]
• Intramyocellular Lipid [ Time Frame: baseline ] [ Designated as safety issue: No ]
• Hepatic fat [ Time Frame: baseline ] [ Designated as safety issue: No ]
• Insulin stimulated glucose uptake [ Time Frame: baseline ] [ Designated as safety issue: No ]

The purpose of this study is to see if individuals with HIV-infection, particularly those with increased belly fat, have abnormalities in the renin angiotensin aldosterone axis. Renin, angiotensin, and aldosterone are hormones that regulate salt and water balance in the body, and they may also have effects on sugar metabolism and cardiovascular health. There is some evidence that individuals with HIV-associated abdominal fat accumulation may have increased aldosterone, which may contribute to abnormalities in sugar metabolism and increased cardiovascular disease seen in HIV. The purpose of this study is the measure renin, angiotensin, and aldosterone activity, as well as other hormonal axes, in people with and without HIV infection, and with and without increased belly fat. The investigators hypothesize that aldosterone will be increased in HIV-infected individuals compared to those without HIV-infection, and that aldosterone will be further increased in HIV-infected individuals with increased abdominal fat compared to those without abdominal fat accumulation.

50 HIV-infected and 50 non-HIV-infected male and female volunteers, ages 18-65 years old.

• HIV-infected Individuals
  Intervention: Drug: Angiotensin II Infusion
• non-HIV-infected Individuals
  Intervention: Drug: Angiotensin II Infusion

Inclusion Criteria:

1. Stable use of antiretroviral therapy for at least 3 months (HIV group)
2. Age ≥ 18 and ≤ 65 years of age

Exclusion Criteria:

1. Antihypertensive use, including angiotensin converting enzyme inhibitors or angiotensin II receptor blocker use, diuretics, beta-blockers, calcium-channel blockers, potassium supplements, and spironolactone; and/or blood pressure (BP) >140/90 at screen
2. Current or recent steroid use within last 2 months.
3. Known diabetes and/or use of antidiabetic medications
4. Creatinine > 1.5 mg/dL
5. Potassium (K) > 5.5 mEq/L
6. Hemoglobin (Hgb) < 11.0 mg/dL
7. Alanine aminotransferase (ALT) > 2.5 x upper limit of normal (ULN)
8. Thyroid disease/abnormal thyroid stimulating hormone (TSH)
9. Significant electrocardiographic abnormalities at screen such as heart block or ischemia
10. History of congestive heart failure, stroke, myocardial infarction, or known coronary artery disease (CAD)
11. For women: Pregnant or actively seeking pregnancy, or breastfeeding
12. Estrogen, progestational derivative, growth hormone (GH), growth hormone releasing hormone (GHRH) or ketoconazole use within 3 months.
13. Current viral, bacterial or other infections (excluding HIV)
14. Current cigarette smoker/use of nicotine (patch/gum) or current active substance abuse