title: High Molecular Weight (HMW): total adiponectin ratio is low in hiv-infected women receiving protease inhibitors.
abstract: BACKGROUND
  At the time of the study, the HIV-treatment policy in South Africa included highly active antiretroviral therapy (HAART) regimens 1 (nucleotide reverse transcriptase inhibitors (NRTIs) only), and 2 (protease inhibitors (PI) and NRTIs). HAART is associated with the lipodystrophy syndrome, insulin resistance and reduced total adiponectin (TA) levels. The high molecular weight (HMW):TA ratio is a superior marker of insulin resistance. The aim of this study was to establish whether HMW:TA ratios are low in patients on PIs and whether they correlate with insulin resistance.
  
  
  METHODS
  This was a cross-sectional study undertaken in an antiretroviral clinic at a tertiary hospital. The participants were 66 HIV-infected females: 22 were on regimen 2 (PI group), 22 on regimen 1 (non-PI) and 22 treatment naïve (TN), matched for BMI and age. Patients with a history of diabetes or impaired glucose tolerance were excluded. Serum adiponectin multimers were analysed using the AlpcoTM Adiponectin (Multimeric) enzyme immunoassay. Waist hip ratios (WHR), glucose and insulin levels were assessed, and HOMA-IR and QUICKI calculated. Data were analysed non-parametrically and multivariate analysis was performed.
  
  
  RESULTS
  TA and HMW levels were lower in the treatment groups than in the TN group. HMW:TA was lower in the PI than in the non-PI and TN groups, and in the non-PI than in the TN groups. HMW:TA correlated negatively with waist, insulin and HOMA-IR, independently of BMI and duration of therapy. HOMA-IR and QUICKI did not differ among the groups.
  
  
  CONCLUSIONS
  HMW:TA is significantly decreased with HAART (particularly with PIs, but also with non-PIs) and may be a more sensitive marker of insulin resistance in these patients than conventional markers or HMW and total adiponectin individually.
authors.affiliation: Division of Chemical Pathology, C17 NHLS, Groote Schuur Hospital, University of Cape Town, Anzio Road Observatory, Cape Town, 7925 South Africa.
authors.forename: Fierdoz
authors.initials: F
authors.lastname: Omar
authors.affiliation: Division of Diabetic Medicine and Endocrinology, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa.
authors.forename: Joel A
authors.initials: JA
authors.lastname: Dave
authors.affiliation: Division of Chemical Pathology, C17 NHLS, Groote Schuur Hospital, University of Cape Town, Anzio Road Observatory, Cape Town, 7925 South Africa.
authors.forename: Judy A
authors.initials: JA
authors.lastname: King
authors.affiliation: Division of Diabetic Medicine and Endocrinology, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa.
authors.forename: Naomi S
authors.initials: NS
authors.lastname: Levitt
authors.affiliation: Division of Chemical Pathology, C17 NHLS, Groote Schuur Hospital, University of Cape Town, Anzio Road Observatory, Cape Town, 7925 South Africa ; Department of Chemical Pathology, University of Pretoria and NHLS Tshwane Academic Division/Steve Biko Academic Hospital, Tshwane, South Africa.
authors.forename: Tahir S
authors.initials: TS
authors.lastname: Pillay
keywords: HMW adiponectin; HMW: adiponectin ratio; Insulin resistance; Lipodystrophy syndrome; Protease inhibitors