title: Quantification of insulin-mediated glucose disposal in HIV-infected individuals: comparison of patients treated and untreated with protease inhibitors.
abstract: To describe the distribution of insulin sensitivity and glucose tolerance in HIV-infected patients, the authors measured insulin-mediated glucose disposal (IMGD) in 51 subjects (24 protease inhibitor (PI)-treated subjects and 27 non-PI-treated subjects). IMGD was determined by measuring the steady-state plasma glucose (SSPG) concentration during the last 30 minutes of a 180-minute intravenous infusion of octreotide, glucose, and insulin. In addition, oral glucose tolerance testing was performed. SSPG concentrations varied six-fold in both groups, and the mean values +/- SEM did not differ between PI-treated and non-PI-treated groups (8.7 +/- 0.9 vs. 8.0 +/- 0.7 mmol/L, respectively). The mean fasting plasma glucose concentration +/- SEM was higher in the PI-treated subjects than in the non-PI-treated subjects (5.44 +/- 0.11 vs. 5.05 +/- 0.11 mmol/L, respectively; p =.01), whereas fasting plasma insulin concentrations did not differ. PI-treated patients also had significantly higher plasma glucose (p =.001) and insulin (p =.03) responses to the oral glucose challenge. However, whereas the incremental plasma glucose response during the first 30 minutes was significantly higher in PI-treated patients, the incremental insulin response in the two groups was identical. In conclusion, insulin sensitivity varies widely in HIV-infected patients irrespective of PI treatment, and the adverse effect of PIs on insulin sensitivity is likely to be of modest magnitude. Finally, PI treatment may have an inhibitory effect on insulin secretion.
authors.affiliation: Department of Medicine, University of California San Francisco, San Francisco General Hospital, San Francisco, California 94110, USA. gbeatty@php.ucsf.edu
authors.forename: George
authors.initials: G
authors.lastname: Beatty
authors.forename: Mandana
authors.initials: M
authors.lastname: Khalili
authors.forename: Fahim
authors.initials: F
authors.lastname: Abbasi
authors.forename: James
authors.initials: J
authors.lastname: Chu
authors.forename: Gerald M
authors.initials: GM
authors.lastname: Reaven
authors.forename: Alan
authors.initials: A
authors.lastname: Rosen
authors.forename: Jamey M
authors.initials: JM
authors.lastname: Schmidt
authors.forename: John
authors.initials: J
authors.lastname: Stansell
authors.forename: Johannes
authors.initials: J
authors.lastname: Koch
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000032:analysis / Q000378:metabolism*; D005260:Female; D005947:Glucose / Q000008:administration & dosage / Q000494:pharmacology; D005951:Glucose Tolerance Test; D015658:HIV Infections / Q000188:drug therapy / Q000378:metabolism*; D017320:HIV Protease Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D039682:HIV-Associated Lipodystrophy Syndrome / Q000139:chemically induced; D006801:Humans; D007328:Insulin / Q000378:metabolism*; D008297:Male; D008875:Middle Aged
chemical_list: D001786:Blood Glucose; D017320:HIV Protease Inhibitors; D007328:Insulin; D005947:Glucose