title: Insulin resistance predicts endothelial dysfunction and cardiovascular risk in HIV-infected persons on long-term highly active antiretroviral therapy.
abstract: OBJECTIVE
  Cardiovascular disease risk among persons with HIV is likely multifactorial, thus testing a variety of available noninvasive vascular ultrasound and other surrogate tests may yield differing results. To address this issue, we assessed multiple metabolic and clinical predictors of endothelial function and carotid intima-media thickness in HIV-infected subjects and compared results with HIV-negative controls.
  
  
  METHODS
  Prospective, cross-sectional study of 50 HIV-infected, healthy adults on stable highly active antiretroviral therapy matched to 50 HIV-negative controls by age, sex, race, and body mass index.
  
  
  METHODS
  Flow-mediated vasodilation of the brachial artery, carotid intima-media thickness, dual energy X-ray absorptiometry (HIV-infected subjects), and fasting insulin, lipids, and oral glucose tolerance tests were performed. Results were compared between HIV-infected and control groups.
  
  
  RESULTS
  Fifty percent of subjects were African-American with 34% women. Among HIV-infected, mean CD4 cell count was 547 cells/microl; 90% had HIV RNA less than 50 copies/ml. There were no significant differences between HIV-infected and control subjects with regard to brachial artery flow-mediated vasodilation or carotid intima-media thickness. In multivariate analyses of the HIV cohort, independent predictors of endothelial dysfunction (lower flow-mediated vasodilation) were increasing insulin resistance, greater alcohol consumption, and higher baseline brachial artery diameter (P < 0.05); predictors of increased carotid intima-media thickness were hypertension, higher trunk/limb fat ratio, and insulin resistance (P < 0.05).
  
  
  CONCLUSIONS
  In this HIV cohort on modern highly active antiretroviral therapy with well controlled HIV, there were no significant differences with regard to preclinical markers of cardiovascular disease. Insulin resistance was a strong predictor of impaired brachial artery flow-mediated vasodilation and increased carotid intima-media thickness, and may be an important cardiovascular disease risk factor in the HIV population.
authors.affiliation: Washington University School of Medicine, St Louis, MO, USA.
authors.forename: Kristin E
authors.initials: KE
authors.lastname: Mondy
authors.forename: Lisa
authors.initials: L
authors.lastname: de las Fuentes
authors.forename: Alan
authors.initials: A
authors.lastname: Waggoner
authors.forename: Nur F
authors.initials: NF
authors.lastname: Onen
authors.forename: Coco S
authors.initials: CS
authors.lastname: Bopp
authors.forename: Sherry
authors.initials: S
authors.lastname: Lassa-Claxton
authors.forename: William G
authors.initials: WG
authors.lastname: Powderly
authors.forename: Victor
authors.initials: V
authors.lastname: Dávila-Román
authors.forename: Kevin E
authors.initials: KE
authors.lastname: Yarasheski
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D001916:Brachial Artery / Q000000981:diagnostic imaging; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000821:virology; D016009:Chi-Square Distribution; D004730:Endothelium, Vascular / Q000000981:diagnostic imaging / Q000503:physiopathology*; D016021:Epidemiologic Studies; D005260:Female; D006678:HIV; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D006801:Humans; D007333:Insulin Resistance; D008297:Male; D012306:Risk; D013995:Time; D014463:Ultrasonography
chemical_list: D019380:Anti-HIV Agents