Evaluation of insulin resistance in a cohort of HIV-infected youth.
OBJECTIVE
Metabolic abnormalities, including impairment of glucose homeostasis, have been well characterized in HIV-infected patients. In contrast to adults, insulin resistance and diabetes mellitus appear to be relatively uncommon finding in youth.


METHODS
We assessed insulin resistance, and associated risk factors, in a population of vertically HIV-infected children and young adults, when compared with a control population of healthy children.


METHODS
At the time of enrolment, weeks of pregnancy, birth weight, sex, age, weight, height, body mass index (BMI), pubertal stages, CDC classification, blood pressure, clinical lipodystrophy, hepatitis B or C co-infection, antiretroviral therapy, CD4 T lymphocyte counts, and HIV-RNA levels were recorded. Fasting plasma glucose and insulin levels and homeostatic model assessment-insulin resistance (HOMA-IR) were determined. These parameters were compared between HIV patients and healthy controls with multivariate analyses.


RESULTS
Fasting insulin levels (OR=1.21, P<0.001) and glycemia (OR=0.89, P<0.001) were significantly different between HIV-infected patients and controls. Antiretroviral therapy duration (r=0.281, P<0.05), triglyceride levels (r=0.286, P<0.05), age (r=0.299, P<0.05), and BMI SDS (r=0.485, P<0.001) were significant predictor variables of insulin resistance, expressed as HOMA-IR. Moreover, clinical lipodystrophy seems to be strongly correlated to glycemia (P<0.05), triglyceride levels (P<0.05), serum insulin levels (P<0.001), HOMA-IR (P<0.05), and also with therapy duration (P<0.05).


CONCLUSIONS
Both HIV infection and antiretroviral therapy demonstrate differential effects on glucose metabolism in HIV-infected children. Targeted prevention of insulin resistance and diabetes mellitus in HIV-infected children and young adults is needed in order to avoid the associated long-term complications that would otherwise occur, given the improvement in life expectancy of HIV-infected individuals.
Rosso
Raffaella
R
Department of Infectious Diseases, San Martino Hospital, University of Genoa, Largo R. Benzi 10, 16132 Genoa, Italy. raffaella.rosso@unige.it
Parodi
Arianna
A
d'Annunzio
Giuseppe
G
Ginocchio
Francesca
F
Nicolini
Laura
L
Torrisi
Chiara
C
Sormani
Maria Pia
MP
Lorini
Renata
R
Viscoli
Claudio
C
Vignolo
Marina
M
D000293:Adolescent; D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000097:blood / Q000517:prevention & control; D005260:Female; D015658:HIV Infections / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D018445:Infectious Disease Transmission, Vertical; D007333:Insulin Resistance / Q000502:physiology*; D008297:Male
D001786:Blood Glucose