Insulin resistance and adipokines serum levels in a caucasian cohort of hiv-positive patients undergoing antiretroviral therapy: a cross sectional study

Abstract

BackgroundInsulin resistance is frequent in human immunodeficiency virus (HIV) infection and may be related to antiretroviral therapy. Cytokines secreted by adipose tissue (adipokines) are linked to insulin sensitivity. The present study is aimed to assess the prevalence of insulin resistance (IR) and its association with several adipokines, in a non-diabetic Romanian cohort of men and women with HIV-1 infection, undergoing combination antiretroviral therapy (cART).MethodsA cross-sectional study was conducted in an unselected sample of 89 HIV-1-positive, non-diabetic patients undergoing stable cART for at least 6 months. Metabolic parameters were measured, including fasting plasma insulin, and circulating adiponectin, leptin, resistin, tumor necrosis factor alpha (TNF-alpha) and interleukin-6 (IL-6) levels. Insulin resistance was estimated by measuring the Quantitative Insulin Sensitivity Check Index (QUICKI), using a cut-off value of 0.33. A linear regression model was fitted to QUICKI to test the association of IR and adipokines levels.ResultsA total of 89 patients (aged 18–65, median: 28 years) including 51 men (57.3%) and 38 women (42.7%) were included in the study. Fifty nine patients (66.3%) were diagnosed with IR based on QUICKI values lower than the cut-off point. IR prevalence was 72.5% in men and 57.6% in women. The presence of the IR was not influenced by either the time of the HIV diagnosis or by the duration of cART. Decreased adiponectin and increased serum triglycerides were associated with increased IR in men (R=0.43, p=0.007). Hyperleptinemia in women was demonstrated to be associated with the presence of IR (R=0.33, p=0.03).ConclusionsGiven the significant prevalence of the IR in our young non-diabetic cohort with HIV infection undergoing antiretroviral therapy reported in our study and the consecutive risk of diabetes and cardiovascular events, we suggest that the IR management should be a central component of HIV-infection therapeutic strategy. As adipokines play major roles in regulating glucose homeostasis with levels varying according to the sex, we suggest that further studies investigating adipokines should base their analyses on gender differences.

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

“…Our study, in a large cohort of patients in different lines of therapy, shows that the current prevalence of IR is 21%, lower than previously published, which ranged from 35 to 63% (6,7). The prevalence in our study was similar to that seen in the general population, although there are significant differences by age, as it has been described in non-HIV controls older than 55-60 years (20).…”

“…Indeed, from the beginning of the HIV epidemic, and particularly after the introduction of HAART, the prevalence of IR has been reported in up to 35-63% of patients, much higher than in uninfected control populations (6,7,8,9). 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).…”

“…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).…”

Metabolic complications and selected cytokines in HIV‑infected individuals

“…We did not observe significant differences in TNF-α, IL-6, adiponectin, and FABP4 concentrations, although the leptin concentration was significantly lower in in patients with lipodystrophy as reported by other investigators. 9, 29,30 In contrast to other studies, we did not consider FABP4 as a strong marker of lipodystrophy. However, in HIV-infected ARV-treated patients, FABP4 positively correlated with glucose, insulin, and TG concentration.…”

Maternal post-absorptive leucine kinetics during late pregnancy in US women with HIV taking antiretroviral therapy: A cross-sectional pilot study

“…Based on previous findings of insulin resistance(20, 21) and impaired fatty acid oxidation(22) in non-gravid HIV(+) adults, we hypothesized that maternal leucine utilization (i.e. oxidation rate) during HIV(+) pregnancy would be higher in order to meet maternal energy needs (i.e.…”