Abstract
Objective: The present study evaluated the influence of the duration of antiretroviral therapy on insulin resistance among people living with HIV with lipodystrophic syndrome. Methods: The study assessed 36 subjects of both sexes between 22 and 60 years old split into three groups: 1) HIV-positive using antiretroviral with lipodystrophy syndrome (HIV+LIPO+); 2) HIV-positive using antiretroviral therapy with no lipodystrophy syndrome (HIV+LIPO-); and 3) HIV-negative and healthy (Control). The data were collected at the Special Unit for the Treatment of Infectious Diseases (Unidade Especial de Tratamento para Doenças Infecciosas - UETDI) of the Dyslipidemia Outpatient Clinic (Ambulatório de Dislipidemia - ADIS) of the General Hospital of the Medical School of Ribeirão Preto (HC-FMRP). The biochemical assessment used laboratory kits when the results were not available in the volunteer's records. Results: Higher HOMA-IR values were observed for the group 1: HIV+LIPO+ (1,61 ± 1,17 ) compared to group 2: HIV+LIPO- (0,79 ± 0,87) and group 3: Control (0,46 ± 0,72 ) and such values were positively correlated with the time of antiretroviral medication use (r=0,41). Conclusions: The time of infection by HIV and the use of antiretrovirals impact the glucose metabolism with changes in serum insulin levels and consequent insulin resistance and increased risk for the development of diabetes and diseases related to carbohydrate metabolism.
Highlights
As previously described, HIV has tropism for T-cells that express CD4 and macrophages, which leads to a reduction in the number of lymphocyte cells responsible for recognizing antigens foreign to the organism
The nutritional status assessment showed that all groups had average body mass index (BMI) below 24.9 kg/ m2, i.e., within the limits to be classified as eutrophic
The HIV+LIPO+ group had the highest mean age (46.7±8.9 years). It had the longest time of HIV infection, time under antiretroviral therapy, and highest CD4+ cell count, with a difference
Summary
HIV has tropism for T-cells that express CD4 and macrophages, which leads to a reduction in the number of lymphocyte cells responsible for recognizing antigens foreign to the organism Drug therapy for those patients began in 1987 with the use of Zidovudine (AZT)[1]. That enabled a change in the disease profile, which was culturally associated with death but that, as treatment advanced, acquired a chronic character[3,4] This treatment improves the morbidity rate and well-being of patients, its continuous use may cause severe metabolic alterations such as HIV-associated lipodystrophy (redistribution of body fat with peripheral lipoatrophy and central lipohypertrophy) alone or accompanied by hyperlipidemia, hyperglycemia, dyslipidemia, and insulin resistance[5,6]
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