Abstract
IntroductionCombined antiretroviral therapy (cART) in the treatment of HIV-1 infection has been associated with complications, including lipodystrophy, hyperlipidaemia, insulin resistance (IR) and diabetes.AimsTo compare the prevalence of glucose homeostasis disturbances and IR in HIV patients on cART according to the presence of lipodystrophy (defined clinically and by Fat Mass Ratio) and different patterns of fat distribution and to establish their associations.DesignCross-sectional cohort study.MethodsWe evaluated body composition and IR and insulin sensitivity indexes in 345 HIV-infected adults.ResultsPatients with clinical lipodystrophy (CL) had higher plasma glucose levels than patients without CL, without significant differences in plasma insulin levels, A1c, HOMA-IR, HOMA-B, QUICKI, or MATSUDA index. Patients with lipodystrophy defined by FMR had higher plasma glucose and insulin levels, A1c, HOMA-IR, QUICKI and MATSUDA than patients without lipodystrophy, without differences in HOMA-B. Higher insulin resistance (HOMA-IR ≥ 4) was present in patients with FMR-defined lipodystrophy. Patients with FMR-defined lipodystrophy had a higher prevalence of IFG, IGT and DM than patients without lipodystrophy. Significant associations between HOMA-IR and total, central and central/peripheral fat evaluated by CT at abdominal level were found and no association between HOMA-IR and peripheral fat. Association between HOMA-IR and total and trunk fat but no association with leg and arm fat (evaluated by DXA) was found.ConclusionsIR and glucose disturbances were significantly increased in patients with FMR-defined lipodystrophy. FMR lipodystrophy definition seems to be a more sensitive determinant of insulin resistance and glucose disturbances than clinical definition.
Highlights
Combined antiretroviral therapy in the treatment of HIV-1 infection has been associated with complications, including lipodystrophy, hyperlipidaemia, insulin resistance (IR) and diabetes
Patients with lipodystrophy defined by fat mass ratio (FMR) had higher plasma glucose and insulin levels, A1c, homeostasis model assessment of insulin resistance (HOMA)-IR, quantitative insulin sensitivity check index (QUICKI) and MATSUDA than patients without lipodystrophy, without differences in HOMA-B
IR and glucose disturbances were significantly increased in patients with FMR-defined lipodystrophy
Summary
Combined antiretroviral therapy (cART) in the treatment of HIV-1 infection has been associated with complications, including lipodystrophy, hyperlipidaemia, insulin resistance (IR) and diabetes. Combined antiretroviral therapy (cART) in the treatment of HIV-1 infection confers significant survival benefit and has altered the natural history of this disease [1]. CART has been associated with metabolic complications, including hyperlipidemia, insulin resistance (IR), diabetes mellitus (DM) and lipodystrophy, with resultant increased risk of cardiovascular disease [2]. Diabetes is associated with IR, and IR among treated HIV-infected patients is multifactorial: in addition to the common contributors to IR (e.g. obesity, physical inactivity and genetic influences), antiretroviral drugs and lipodystrophy or alterations in body fat distribution are involved [5]. Lipodystrophy related to HIV-infected patients is associated with IR and overt DM [12,14,15]
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