Effect of Nonnucleoside Reverse Transcriptase Inhibitor–Based Antiretroviral Therapy on Dysglycemia and Insulin Sensitivity in South African HIV-Infected Patients

Dave, Joel A.; Lambert, Estelle V.; Badri, Motasim; West, Sacha; Maartens, Gary; Levitt, Naomi

doi:10.1097/qai.0b013e318221863f

Cited by 76 publications

(92 citation statements)

References 22 publications

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“…The two PIs included were LPV/r and ATV/r ( Some independent risk factors were found to be associated with metabolic alterations; regarding IFG, EFV-containing regimens was the only factor that remained significant; other studies have associated EFV as an independent risk factor for increase glucose [9,10].…”

Section: Discussionmentioning

confidence: 99%

Dyslipidemia and Fasting Glucose Impairment among HIV-Infected Patients 48-Weeks after the First Antiretroviral Regimen

Marín¹

2015

J AIDS Clin Res

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BackgroundWith the increased survival of HIV-infected patients, there have emerged a number of unexpected consequences of chronic illness and drugs adverse events, especially in the form of metabolic disease [1].Available data suggest the presence of an accelerated process of coronary atherosclerosis in this population due to multiple factors, including a higher prevalence (compared with non-HIV-infected patients) of conventional risk factors, emerging risk factors (chronic inflammation, immune activation, and senescence related to HIV infection itself), and the role of antiretroviral therapy (ART), regarding metabolic syndrome as one of the major problems [2]. Some studies have showed that the prevalence of metabolic syndrome was higher among HIV-infected patients on ART than among non-HIV-infected healthy controls (15.8 vs. 3.2%) [3]. A high incidence of diabetes mellitus (DM) and impaired fasting glucose (IFG) has been detected in HIV-infected patients receiving ART [4,5]. Another studies have found relationship between some classes of antiretroviral (ARV) drugs such as protease inhibitors (PIs) and nucleos(t)ide retrotranscriptase inhibitors (NRTIs) with a higher frequency of new-onset DM and IFG [6].Dyslipidemia is particularly frequent and is mostly characterized by hypertriglyceridemia and low HDL-cholesterol concentrations. AbstractBackground: People infected with human immunodeficiency virus (HIV) develop lipid and glucose metabolic alterations, which predisposes them to cardiovascular disease. The aim of this study was to evaluate the cumulative incidence of dyslipidemia and fasting glucose impairment after 48 weeks of initiating the first antiretroviral (ART) regimen and the association with the type of ART regimen.

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Section: Discussionmentioning

confidence: 99%

Dyslipidemia and Fasting Glucose Impairment among HIV-Infected Patients 48-Weeks after the First Antiretroviral Regimen

Marín¹

2015

J AIDS Clin Res

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“…22,23 Participants were ambulatory HIV-infected African black adults who presented for a routine follow-up visit at public-sector antiretroviral clinics in Cape Town. Participants were recruited by convenience sampling between February 2007 and September 2008.…”

Section: Study Design and Participantsmentioning

confidence: 99%

Mitochondrial Genomics and Antiretroviral Therapy-Associated Metabolic Complications in HIV-Infected Black South Africans: A Pilot Study

Sinxadi

Dave

Samuels

et al. 2013

AIDS Research and Human Retroviruses

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Studies suggest that mitochondrial DNA (mtDNA) haplogroups are associated with antiretroviral therapy (ART)-related metabolic complications and distal sensory polyneuropathy (DSP), but there have been few studies in persons of African descent. We explored such associations in South African adults. Clinical and laboratory data and DNA specimens from a cross-sectional study were used. Sequencing and Phylotree determined African mtDNA subhaplogroups. Wilcoxon and regression analyses determined associations between mtDNA subhaplogroups and ART-related complications. The 171 participants represented six major haplogroups: L0 (n=78), L1 (n=3), L2 (n=30), L3 (n=53), L4 (n=1), and L5 (n=6). Analyses were restricted to 161 participants representing L0, L2, and L3: 78% were female; the median age was 36 years. All had been exposed to thymidine analogues, 42% were on lopinavir/ritonavir (lopinavir/r), and 58% were on either efavirenz or nevirapine. Median (IQR) ART duration was 22 (14-36) months. Median fasting triglycerides were 1.60 (1.13-1.75) and 1.04 (0.83-1.45) mmol/liter among L3e1 (n=22) and other subhaplogroups, respectively (p=0.003). Subhaplogroup L3e1 [adjusted OR (aOR) 3.16 (95% CI: 1.11-8.96); p=0.03] and exposure to lopinavir/r [aOR 2.98 (95% CI: 1.02-8.96); p=0.05] were independently associated with hypertriglyceridemia, after adjusting for age, sex, and ART duration. There were no significant associations between mtDNA haplogroups and cholesterol, dysglycemia, hyperlactatemia, or lipoatrophy, or DSP. Subhaplogroup L3e1 and lopinavir/r exposure were independently associated with hypertriglyceridemia in black South Africans on ART. This is the first report to link an African mtDNA variant with hypertriglyceridemia. If replicated, these findings may provide new insights into host factors affecting metabolic complications.

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“…IR in HIV patients has been associated with an increased risk of cardiovascular risk and mortality, and particularly with the development of DM, several folds higher in case of IR (5,6,7). This high prevalence in a younger population has been attributed to the presence of additional risk factors, such as HIV itself, vitamin D deficiency, coinfection with hepatitis C virus (HCV), and particularly as a possible adverse effect of different antiretroviral drugs (4,10,11,12,13). This fact is particularly important as the HIV therapeutic arsenal continues to change with the development of newer drug classes and agents within existing drug classes, and therefore, the use of drugs with a lower causal role could change the prevalence and consequences of this complication.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of insulin resistance and risk of diabetes mellitus in HIV-infected patients receiving current antiretroviral drugs

Araújo

Bañón

Machuca

et al. 2014

European Journal of Endocrinology

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Objective: HIV-infected patients had a higher prevalence of insulin resistance (IR) and risk of diabetes mellitus (DM) than that observed in healthy controls, but there are no data about the current prevalence considering the changes in HIV presentation and the use of newer antiretroviral drugs. Design: Longitudinal study which involved 265 HIV patients without DM, receiving first (nZ71) and advanced lines of antiretroviral therapy (nZ194). Methods: Prevalence of IR according to clinical and anthropometric variables, including dual X-ray absorptiometry (DXA) scan evaluation. IR was defined as homeostasis model assessment of IR R3.8. Incident DM was assessed during the follow-up. Results: First-line patients had a short time of HIV infection, less hepatitis C virus coinfection, and received mainly an efavirenz-based regimen. Overall, the prevalence of IR was 21% (55 patients, 6% in first-line, 27% in pretreated). In a logistic regression analysis, significant associations were found between the waist/hip circumference ratio (RR 10; 95% CI 1.66-16; P!0.01, per unit), and central fat in percentage (RR 1.08; 95% CI 1.01-1.17; PZ0.04, per unit) as evaluated by DXA, and IR. During 770.8 patient-years, DM was diagnosed in 8% (22 patients), mostly in pretreated patients (10 vs 4%; PZ0.1). Thus, the overall rate of incident DM was 2.85 per 100 person-years, mostly in previous IR (10.39 vs 0.82/100 person-years; PZ0.01). Conclusions: A lower prevalence of IR is observed in the current HIV-infected patients with fewer risk factors and receiving newer antiretroviral drugs. IR continues to identify patients at high risk for developing DM in the short term.

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Effect of Nonnucleoside Reverse Transcriptase Inhibitor–Based Antiretroviral Therapy on Dysglycemia and Insulin Sensitivity in South African HIV-Infected Patients

Cited by 76 publications

References 22 publications

Dyslipidemia and Fasting Glucose Impairment among HIV-Infected Patients 48-Weeks after the First Antiretroviral Regimen

Dyslipidemia and Fasting Glucose Impairment among HIV-Infected Patients 48-Weeks after the First Antiretroviral Regimen

Mitochondrial Genomics and Antiretroviral Therapy-Associated Metabolic Complications in HIV-Infected Black South Africans: A Pilot Study

Prevalence of insulin resistance and risk of diabetes mellitus in HIV-infected patients receiving current antiretroviral drugs

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