title: Relationship of ethnicity and CD4 Count with glucose metabolism among HIV patients on Highly-Active Antiretroviral Therapy (HAART).
abstract: BACKGROUND
  HIV patients on HAART are prone to metabolic abnormalities, including insulin resistance, lipodystrophy and diabetes. This study purports to investigate the relationship of ethnicity and CD4+ T cell count attained after stable highly-active antiretroviral treatment (HAART) with glucose metabolism in hyperrtriglyceridemic HIV patients without a history of diabetes.
  
  
  METHODS
  Demographic, anthropometric, clinical, endocrinologic, energy expenditure and metabolic measures were obtained in 199 multiethnic, healthy but hypertriglyceridemic HIV-infected patients [46% Hispanic, 17% African-American, 37% Non-Hispanic White (NHW)] on stable HAART without a history of diabetes. The relationship of glucose and insulin responses to ethnicity, CD4 strata (low (<300/cc) or moderate-to-high (≥ 300/cc)), and their interaction was determined.
  
  
  RESULTS
  African-Americans had significantly greater impairment of glucose tolerance (P < 0.05) and HbA1c levels (P < .001) than either Hispanics or NHWs. In multivariate models, after adjusting for confounders (age, sex, HIV/HAART duration, smoking, obesity, glucose, insulin and lipids), African-Americans and Hispanics had significantly higher HbA1c and 2-hour glucose levels than NHW's. Demonstrating a significant interaction between ethnicity and CD4 count (P = 0.023), African Americans with CD4 <300/cc and Hispanics with CD4 ≥300/cc had the most impaired glucose response following oral glucose challenge.
  
  
  CONCLUSIONS
  Among hypertriglyceridemic HIV patients on HAART, African-Americans and Hispanics are at increased risk of developing diabetes. Ethnicity also interacts with CD4+ T cell count attained on stable HAART to affect post-challenge glycemic response.
authors.affiliation: Department of Social and Behavioral Sciences, School of Public Health, West Virginia University, Morgantown, USA. ramisra@hsc.wvu.edu.
authors.forename: Ranjita
authors.initials: R
authors.lastname: Misra
authors.forename: Prakash
authors.initials: P
authors.lastname: Chandra
authors.forename: Steven E
authors.initials: SE
authors.lastname: Riechman
authors.forename: Dustin M
authors.initials: DM
authors.lastname: Long
authors.forename: Shivani
authors.initials: S
authors.lastname: Shinde
authors.forename: Henry J
authors.initials: HJ
authors.lastname: Pownall
authors.forename: Ivonne
authors.initials: I
authors.lastname: Coraza
authors.forename: Dorothy E
authors.initials: DE
authors.lastname: Lewis
authors.forename: Rajagopal V
authors.initials: RV
authors.lastname: Sekhar
authors.forename: Ashok
authors.initials: A
authors.lastname: Balasubramanyam