Incidence of and risk factors for insulin resistance in treatment-naive HIV-infected patients 48 weeks after starting highly active antiretroviral therapy.
OBJECTIVE
to assess the incidence and risk factors for insulin resistance (IR) in a cohort of naive HIV-infected patients 48 weeks after starting highly active antiretroviral therapy (HAART).


METHODS
prospective, two centre, observational, cohort study.


METHODS
One-hundred and thirty-seven patients who started HAART and maintained the same regimen for 48 weeks were included. IR was determined by the homeostasis model assessment (HOMA-IR) method. Individuals with a HOMA-IR value >3.8 were defined as insulin resistant. Independent associations with the development of IR at 48 weeks were evaluated.


RESULTS
Seventeen (12.4%) individuals showed a HOMA-IR value >3.8 at baseline and were excluded for incidence analyses. Fifteen patients developed IR at 48 weeks of HAART, giving an incidence of 13%. Independent predictors of the development or IR were indinavir exposure (beta-coefficient 5.45, 95% confidence interval [CI] 1.30-22.8; P=0.02), and hepatitis C virus (HCV) antibody positivity (beta-coefficient 5.22, 95% CI 1.34-20.33; P=0.01). The appearance of IR was associated with a higher BMI (beta-coefficient 1.72 for each 2 kg/m2 increase, 95% CI 1.54-1.94; P=0.02) and with the presence of lipodystrophy at 48 weeks (beta-coefficient 5.59, 95% CI 1.45-21.5; P=0.01).


CONCLUSIONS
HAART induces the development of IR in previously naive non-insulin-resistant HIV-infected individuals, with an incidence of 13% in the first year of therapy. Indinavir exposure, and HCV coinfection are associated with an increased risk of developing IR.
Palacios
Rosario
R
Unidad de Enfermedades Infecciosas, Hosp. Virgen de la Victoria, Málaga, Spain.
Merchante
Nicolás
N
Macias
Juan
J
González
Mercedes
M
Castillo
Jesús
J
Ruiz
Josefa
J
Márquez
Manuel
M
Gómez-Mateos
Jesús
J
Pineda
Juan A
JA
Santos
Jesús
J
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D017320:HIV Protease Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D039682:HIV-Associated Lipodystrophy Syndrome / Q000150:complications; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D015994:Incidence; D019469:Indinavir / Q000008:administration & dosage / Q000009:adverse effects; D007333:Insulin Resistance; D008297:Male; D012307:Risk Factors
D017320:HIV Protease Inhibitors; D019469:Indinavir