title: RAAS Activation Is Associated With Visceral Adiposity and Insulin Resistance Among HIV-infected Patients.
abstract: BACKGROUND
  Little is known about renin-angiotensin-aldosterone system (RAAS) activation in relationship to visceral adipose tissue (VAT) accumulation in HIV-infected patients, a population at significant risk for insulin resistance and other metabolic disease.
  
  
  METHODS
  Twenty HIV and 10 non-HIV-infected subjects consumed a standardized low sodium or liberal sodium diet to stimulate or suppress the RAAS, respectively. RAAS parameters were evaluated in response to each diet and a graded angiotensin II infusion. Further analyses were performed after groups were substratified by median VAT measured by magnetic resonance imaging.
  
  
  RESULTS
  Aldosterone concentrations during the low-sodium diet were higher in HIV than non-HIV-infected subjects [13.8 (9.7, 30.9) vs 9.2 (7.6, 13.6) ng/dL, P = .03] and increased across groups stratified by visceral adipose tissue (VAT) [8.5 (7.1, 12.8), 9.2 (8.1, 21.5), 11.4 (9.4, 13.8), and 27.2 (13.0, 36.9) ng/dL in non-HIV-infected without increased VAT, non-HIV-infected with increased VAT, HIV-infected without increased VAT, HIV-infected with increased VAT, respectively, overall trend P = .02]. Under this condition, plasma renin activity [3.50 (2.58, 4.65) vs 1.45 (0.58, 2.33) ng/mL · h, P = .002] was higher among the HIV-infected subjects with vs without increased VAT. Differences in the suppressibility of plasma renin activity by graded angiotensin infusion were seen stratifying by VAT among the HIV-infected group (P < .02 at each dose). In addition, aldosterone (P = .007) was an independent predictor of insulin resistance in multivariate modeling, controlling for VAT and adiponectin.
  
  
  CONCLUSIONS
  These data suggest excess RAAS activation in relationship to visceral adiposity in HIV-infected patients that may independently contribute to insulin resistance. Mineralocorticoid blockade may have therapeutic potential to reduce metabolic complications in HIV-infected patients with increased visceral adiposity.
authors.affiliation: Program in Nutritional Metabolism (S.S., K.V.F., K.W., T.S., J.L., S.K.G.) and Division of Musculoskeletal Imaging and Intervention (M.T.), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114; and Division of Endocrinology, Diabetes, and Hypertension (C.M., G.K.A.), Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115.
authors.forename: Suman
authors.initials: S
authors.lastname: Srinivasa
authors.affiliation: Program in Nutritional Metabolism (S.S., K.V.F., K.W., T.S., J.L., S.K.G.) and Division of Musculoskeletal Imaging and Intervention (M.T.), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114; and Division of Endocrinology, Diabetes, and Hypertension (C.M., G.K.A.), Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115.
authors.forename: Kathleen V
authors.initials: KV
authors.lastname: Fitch
authors.affiliation: Program in Nutritional Metabolism (S.S., K.V.F., K.W., T.S., J.L., S.K.G.) and Division of Musculoskeletal Imaging and Intervention (M.T.), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114; and Division of Endocrinology, Diabetes, and Hypertension (C.M., G.K.A.), Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Wong
authors.affiliation: Program in Nutritional Metabolism (S.S., K.V.F., K.W., T.S., J.L., S.K.G.) and Division of Musculoskeletal Imaging and Intervention (M.T.), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114; and Division of Endocrinology, Diabetes, and Hypertension (C.M., G.K.A.), Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115.
authors.forename: Martin
authors.initials: M
authors.lastname: Torriani
authors.affiliation: Program in Nutritional Metabolism (S.S., K.V.F., K.W., T.S., J.L., S.K.G.) and Division of Musculoskeletal Imaging and Intervention (M.T.), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114; and Division of Endocrinology, Diabetes, and Hypertension (C.M., G.K.A.), Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115.
authors.forename: Caitlin
authors.initials: C
authors.lastname: Mayhew
authors.affiliation: Program in Nutritional Metabolism (S.S., K.V.F., K.W., T.S., J.L., S.K.G.) and Division of Musculoskeletal Imaging and Intervention (M.T.), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114; and Division of Endocrinology, Diabetes, and Hypertension (C.M., G.K.A.), Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115.
authors.forename: Takara
authors.initials: T
authors.lastname: Stanley
authors.affiliation: Program in Nutritional Metabolism (S.S., K.V.F., K.W., T.S., J.L., S.K.G.) and Division of Musculoskeletal Imaging and Intervention (M.T.), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114; and Division of Endocrinology, Diabetes, and Hypertension (C.M., G.K.A.), Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115.
authors.forename: Janet
authors.initials: J
authors.lastname: Lo
authors.affiliation: Program in Nutritional Metabolism (S.S., K.V.F., K.W., T.S., J.L., S.K.G.) and Division of Musculoskeletal Imaging and Intervention (M.T.), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114; and Division of Endocrinology, Diabetes, and Hypertension (C.M., G.K.A.), Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115.
authors.forename: Gail K
authors.initials: GK
authors.lastname: Adler
authors.affiliation: Program in Nutritional Metabolism (S.S., K.V.F., K.W., T.S., J.L., S.K.G.) and Division of Musculoskeletal Imaging and Intervention (M.T.), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114; and Division of Endocrinology, Diabetes, and Hypertension (C.M., G.K.A.), Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115.
authors.forename: Steven K
authors.initials: SK
authors.lastname: Grinspoon
mesh_terms: D050154:Adiposity / Q000502:physiology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000378:metabolism; D000804:Angiotensin II / Q000494:pharmacology; D004039:Diet, Sodium-Restricted; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000378:metabolism* / Q000473:pathology / Q000503:physiopathology; D015497:HIV-1; D006801:Humans; D007249:Inflammation / Q000150:complications / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology; D007333:Insulin Resistance / Q000502:physiology*; D050152:Intra-Abdominal Fat / Q000187:drug effects / Q000378:metabolism / Q000473:pathology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D056128:Obesity, Abdominal / Q000150:complications / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology; D012084:Renin-Angiotensin System / Q000187:drug effects / Q000502:physiology*; D055815:Young Adult
chemical_list: D000804:Angiotensin II; D000450:Aldosterone