title: Type B insulin resistance syndrome associated with an immune reconstitution inflammatory syndrome in an HIV-infected woman.
abstract: BACKGROUND
  Type B insulin resistance syndrome is a rare condition characterized by the presence of autoantibodies directed against the insulin receptor. It has been reported in association with autoimmune diseases such as systemic lupus erythematosus.
  
  
  OBJECTIVE
  We report a case of type B insulin resistance syndrome in a patient with HIV infection on highly active antiretroviral therapy (HAART).
  
  
  METHODS
  A 27-yr-old African woman with ketosis-prone diabetes and HIV infection developed severe insulin resistance after the initiation of HAART. Standard oral glucose tolerance tests using 75 g of glucose performed 1, 2, and 3 months after the initiation of HAART showed severe hyperinsulinemia and hypoglycemia. Six months later, she developed symptomatic hyperglycemia resistant to high-dose insulin therapy. To determine the cause of insulin resistance, we assayed the titer of insulin receptor autoantibodies in the serum of the patient.
  
  
  RESULTS
  Plasma insulin receptor autoantibodies were present at the time of marked hyperglycemia and insulin resistance, confirming the diagnosis of type B insulin resistance syndrome. Simultaneously the diagnosis of immune reconstitution inflammatory syndrome was established according to increased CD4 T cell count, decreased plasma HIV1-RNA level, and tuberculosis reactivation, shortly after institution of HAART. Corticosteroid therapy improved insulin resistance and hyperglycemia.
  
  
  CONCLUSIONS
  We report the first case of type B insulin resistance syndrome associated with immune reconstitution inflammatory syndrome in an HIV-infected patient.
authors.affiliation: Groupe Hospitalier Bichat-Claude-Bernard, Assistance Publique-Hôpitaux de Paris, Service d'Endocrinologie, Diabétologie, et Nutrition, 46 Rue Henri Huchard, 75877 Paris, France. kmmohammedi@yahoo.fr
authors.forename: Kamel
authors.initials: K
authors.lastname: Mohammedi
authors.forename: Ronan
authors.initials: R
authors.lastname: Roussel
authors.forename: Oussaima
authors.initials: O
authors.lastname: El Dbouni
authors.forename: Louis
authors.initials: L
authors.lastname: Potier
authors.forename: Charbel
authors.initials: C
authors.lastname: Abi Khalil
authors.forename: Emilie
authors.initials: E
authors.lastname: Capel
authors.forename: Corinne
authors.initials: C
authors.lastname: Vigouroux
authors.forename: Martine
authors.initials: M
authors.lastname: Caron-Debarle
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Capeau
authors.forename: Michel
authors.initials: M
authors.lastname: Marre
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D016883:Diabetic Ketoacidosis / Q000150:complications / Q000276:immunology; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000150:complications*; D024821:Metabolic Syndrome / Q000139:chemically induced / Q000145:classification / Q000150:complications* / Q000276:immunology; D011972:Receptor, Insulin / Q000276:immunology
chemical_list: D011972:Receptor, Insulin