title: Factors associated with insulin resistance among children and adolescents perinatally infected with HIV-1 in the pediatric HIV/AIDS cohort study.
abstract: OBJECTIVE
  Because of prior inconsistent findings, we studied a large cohort of HIV-infected children to determine: (1) prevalence of insulin resistance (IR); (2) anthropometric and clinical correlates of IR, and (3) concomitant abnormalities of glucose tolerance.
  
  
  METHODS
  The study population consisted of 451 children from the Pediatric HIV/AIDS Cohort Study. The outcome of interest was HOMA-IR. Covariates included demographic, metabolic, growth, body composition, HIV laboratory tests, and treatment characteristics. Children meeting triggers for IR underwent oral glucose tolerance tests and hemoglobin A1c (HbA1c) measurements.
  
  
  RESULTS
  Among 402 children with glucose and insulin measurements, 15.2% had IR of whom 79% were pubertal. IR was associated with higher alanine aminotransferase, body mass index, and nadir CD4%, Tanner stage 5, and ever having received amprenavir. Of those with IR, three had impaired fasting glucose (IFG), three impaired glucose tolerance (IGT), one IFG and IGT, none diabetic glucose tolerance, and three HbA1c between 6.1 and 6.5%.
  
  
  CONCLUSIONS
  In our cohort of HIV-infected adolescents, we observed a 15.2% prevalence of IR more closely linked to obesity than any other variable. This finding mirrors the high prevalence of obesity-mediated IR in American youth. However, associations with CD4 count and use of protease inhibitors may indicate some effect of HIV and/or its treatment.
authors: Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, Calif., USA. mgeffner@chla.usc.edu
authors: Mitchell E
authors: ME
authors: Geffner
authors: Kunjal
authors: K
authors: Patel
authors: Tracie L
authors: TL
authors: Miller
authors: Rohan
authors: R
authors: Hazra
authors: Margarita
authors: M
authors: Silio
authors: Russell B
authors: RB
authors: Van Dyke
authors: William
authors: W
authors: Borkowsky
authors: Carol
authors: C
authors: Worrell
authors: Linda A
authors: LA
authors: DiMeglio
authors: Denise L
authors: DL
authors: Jacobson
mesh_terms: D000293:Adolescent; D015992:Body Mass Index; D018791:CD4 Lymphocyte Count; D002219:Carbamates / Q000627:therapeutic use; D002648:Child; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D005663:Furans; D018149:Glucose Intolerance / Q000150:complications / Q000453:epidemiology*; D015658:HIV Infections / Q000150:complications* / Q000151:congenital / Q000378:metabolism* / Q000821:virology; D017320:HIV Protease Inhibitors / Q000627:therapeutic use; D015497:HIV-1; D006801:Humans; D007333:Insulin Resistance; D008297:Male; D009765:Obesity / Q000150:complications; D015995:Prevalence; D011446:Prospective Studies; D011627:Puberty; D013449:Sulfonamides / Q000627:therapeutic use; D014481:United States / Q000453:epidemiology
chemical_list: D002219:Carbamates; D005663:Furans; D017320:HIV Protease Inhibitors; D013449:Sulfonamides; C095108:amprenavir