title: Immune deficiency could be an early risk factor for altered insulin sensitivity in antiretroviral-naive HIV-1-infected patients: the ANRS COPANA cohort.
abstract: BACKGROUND
  The relationships between immunovirological status, inflammatory markers, insulin resistance and fat distribution have not been studied in recently diagnosed (<1 year) antiretroviral-naive HIV-1-infected patients.
  
  
  METHODS
  We studied 214 antiretroviral-naive patients at enrolment in the metabolic substudy of the ANRS COPANA cohort. We measured clinical, immunovirological and inflammatory parameters, glucose/insulin during oral glucose tolerance test (OGTT), adipokines, subcutaneous and visceral fat surfaces (subcutaneous adipose tissue [SAT] and visceral adipose tissue [VAT], assessed by computed tomography) and the body fat distribution based on dual-energy X-ray absorptiometry (DEXA).
  
  
  RESULTS
  Median age was 36 years; 28% of the patients were female and 35% of sub-Saharan origin; 20% had low CD4(+) T-cell counts (≤200/mm(3)). Patients with low CD4(+) T-cell counts were older and more frequently of sub-Saharan Africa origin, had lower body mass index (BMI) but no different SAT/VAT ratio and fat distribution than other patients. They also had lower total, low-density lipoprotein and high-density lipoprotein cholesterolaemia, higher triglyceridaemia and post-OGTT glycaemia, higher markers of insulin resistance (insulin during OGTT and homeostasis model assessment of insulin resistance) and of inflammation (high-sensitivity C-reactive protein, IL-6, tumour necrosis factor (TNF)-α, sTNFR1 and sTNFR2). After adjustment for age, sex, geographic origin, BMI and waist circumference, increased insulin resistance was not related to any inflammatory marker. In multivariate analysis, low CD4(+) T-cell count was an independent risk factor for altered insulin sensitivity (β-coefficient for HOMA-IR: +0.90; P=0.001; CD4(+) T-cell count >500/mm(3) as the reference), in addition to older age (β: +0.26 for a 10-year increase; P=0.01) and higher BMI (β: +0.07 for a 1-kg/m(2) increase; P=0.003).
  
  
  CONCLUSIONS
  In ART-naive patients, severe immune deficiency but not inflammation could be an early risk factor for altered insulin sensitivity.
authors.affiliation: Equipe VIH et IST, Centre de Recherche en Epidémiologie et Santé des Populations, INSERM U1018, Le Kremlin Bicêtre, France.
authors.forename: Faroudy
authors.initials: F
authors.lastname: Boufassa
authors.forename: Cécile
authors.initials: C
authors.lastname: Goujard
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Viard
authors.forename: Robert
authors.initials: R
authors.lastname: Carlier
authors.forename: Bénédicte
authors.initials: B
authors.lastname: Lefebvre
authors.forename: Patrick
authors.initials: P
authors.lastname: Yeni
authors.forename: Olivier
authors.initials: O
authors.lastname: Bouchaud
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Capeau
authors.forename: Laurence
authors.initials: L
authors.lastname: Meyer
authors.forename: Corinne
authors.initials: C
authors.lastname: Vigouroux
mesh_terms: D054392:Adipokines / Q000097:blood; D000328:Adult; D017954:Africa South of the Sahara / Q000208:ethnology; D001786:Blood Glucose / Q000032:analysis; D050218:Body Fat Distribution; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000032:analysis; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D016207:Cytokines / Q000097:blood; D005260:Female; D005602:France / Q000453:epidemiology; D005951:Glucose Tolerance Test; D015658:HIV Infections / Q000097:blood* / Q000208:ethnology / Q000276:immunology / Q000821:virology; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance / Q000276:immunology*; D008074:Lipoproteins / Q000097:blood; D008297:Male; D012367:RNA, Viral / Q000032:analysis; D012307:Risk Factors; D044465:White People
chemical_list: D054392:Adipokines; D001786:Blood Glucose; D016207:Cytokines; D007328:Insulin; D008074:Lipoproteins; D012367:RNA, Viral; D002097:C-Reactive Protein