title: Hepatitis C virus infection is associated with insulin resistance among older adults with or at risk of HIV infection.
abstract: OBJECTIVE
  To determine the associations of hepatitis C virus (HCV) infection with insulin resistance and abnormal glucose tolerance in a cohort of older adults with or at risk of HIV infection.
  
  
  METHODS
  A cross-sectional study of 267 HIV-infected and 179 at-risk-uninfected adults without a history of diabetes mellitus.
  
  
  METHODS
  HCV antibody assays and RNA levels were performed to assess HCV status. Antiretroviral use, family history of diabetes, sedentary behavior, and sociodemographic data were obtained using standardized interviews. Fasting insulin levels and oral glucose tolerance tests were performed to assess two outcomes, the homeostasis model assessment of insulin resistance and abnormal glucose tolerance [impaired glucose tolerance (IGT) or diabetes].
  
  
  RESULTS
  Of 446 participants, 265 (59%) were HCV seropositive; of these, 199 (75%) had detectable HCV-RNA levels. Insulin resistance was greater among HCV-seropositive compared with seronegative participants, adjusting for body mass index, Hispanic ethnicity, age greater than 55 years, sedentary behavior (watching television > 4 h/day), HIV status, HAART, and protease inhibitor (PI) use. Ninety-eight participants (22%) had abnormal glucose tolerance (69 with IGT and 29 with diabetes). Among HIV-infected participants, 25% were on non-PI HAART and 52% were on PI HAART, but HAART and PI use were not associated with insulin resistance or abnormal glucose tolerance. Among obese participants, abnormal glucose tolerance was more common in HCV-seropositive than seronegative individuals, whereas among non-obese participants there was no association.
  
  
  CONCLUSIONS
  The potential impact of HCV co-infection and obesity on glucose metabolism should be recognized in clinical care, and addressed in future research studies of HIV-infected individuals.
authors.affiliation: Department of Epidemiology and Population Health, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York 10467, USA. ahoward@montefiore.org
authors.forename: Andrea A
authors.initials: AA
authors.lastname: Howard
authors.forename: Yungtai
authors.initials: Y
authors.lastname: Lo
authors.forename: Michelle
authors.initials: M
authors.lastname: Floris-Moore
authors.forename: Robert S
authors.initials: RS
authors.lastname: Klein
authors.forename: Norman
authors.initials: N
authors.lastname: Fleischer
authors.forename: Ellie E
authors.initials: EE
authors.lastname: Schoenbaum
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D018791:CD4 Lymphocyte Count; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000503:physiopathology; D005260:Female; D005951:Glucose Tolerance Test; D015658:HIV Infections / Q000097:blood / Q000150:complications / Q000276:immunology / Q000503:physiopathology*; D019698:Hepatitis C, Chronic / Q000097:blood / Q000150:complications / Q000503:physiopathology*; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000503:physiopathology
chemical_list: D001786:Blood Glucose; D007328:Insulin