1
|
Buendia JR, Sears S, Griffin E, Mgbere OO. Prevalence and risk factors of type II diabetes mellitus among people living with HIV in Texas. AIDS Care 2021; 34:900-907. [PMID: 33975492 DOI: 10.1080/09540121.2021.1925212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study aimed to determine the prevalence and risk factors associated with type II diabetes mellitus (T2DM) among people living with HIV (PLWH). Cross-sectional data of 989 PLWH in Texas obtained from the 2015-2017 Texas and Houston Medical Monitoring Project were examined. T2DM was identified by formal medical chart diagnosis, insulin/oral hypoglycemic prescriptions, or most recent fasting blood glucose ≥126 mg/dL. T2DM adjusted prevalence ratios and 95% confidence intervals (CIs) were estimated using multiple logistic regression. Participants were mostly male (72%), ≥40 years (68%), overweight (31%) or obese (28%) and virally suppressed (62%). T2DM prevalence was 15% with variations by age, body mass index, education and health insurance (p < 0.05 for all). Compared to PLWH ≥60 years, 18-39-year-olds had significantly lower likelihood of T2DM (p < 0.001). Overweight and obese PLWH were 2.11 (95% CI: 1.23-3.63) and 3.89 times (95% CI: 2.30-6.56) more likely to have T2DM compared to normal weight PLWH. Over 1 in 6 PLWH in Texas had T2DM, with age and BMI as significant predictors. Since DM is a risk factor for cardiovascular disease and PLWH are living longer, increased education and lifestyle modification interventions are warranted to prevent T2DM development among PLWH.
Collapse
Affiliation(s)
| | - Sabeena Sears
- Texas Department of State Health Services, Austin, TX, USA
| | - Elyse Griffin
- Texas Department of State Health Services, Austin, TX, USA
| | | |
Collapse
|
2
|
Seang S, Lake JE, Tian F, Anastos K, Cohen MH, Tien PC. Oral Glucose Tolerance Testing identifies HIV+ infected women with Diabetes Mellitus (DM) not captured by standard DM definition. JOURNAL OF AIDS & CLINICAL RESEARCH 2016; 7:545. [PMID: 27066296 PMCID: PMC4825684 DOI: 10.4172/2155-6113.1000545] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE HIV-infected (HIV+) individuals may have differential risk of diabetes mellitus (DM) compared to the general population, and the optimal diagnostic algorithm for DM in HIV+ persons remains unclear. We aimed to assess the utility of oral glucose tolerance testing (OGTT) for DM diagnosis in a cohort of women with or at risk for HIV infection. METHODS Using American Diabetic Association DM definitions, DM prevalence and incidence were assessed among women enrolled in the Women's Interagency HIV Study. DM was defined by 2-hour OGTT ≥ 200 mg/dL (DM_OGTT) or a clinical definition (DM_C) that included any of the following: (i) anti-diabetic medication use or self-reported DM confirmed by either fasting glucose (FG) ≥126 mg/dL or HbA1c ≥ 6.5%, (ii) FG ≥ 126 mg/dL confirmed by a second FG ≥ 126 mg/dL or HbA1c 6.5%, or (iii) HbA1c 6.5% confirmed by FG ≥ 126 mg/dL cohort. RESULTS Overall, 390 women (285 HIV+, median age 43 years; 105 HIV-, median age 37 years) were enrolled between 2003-2006. Over half of all women were African American. Using DM_C, DM prevalence rates were 5.6% and 2.8% among HIV+ and HIV- women, respectively. Among HIV+ women, adding DM_OGTT to DM_C increased DM prevalence from 5.6% to 7.4%, a 31% increase in the number of diabetes cases diagnosed (p=0.02). In HIV- women, no additional cases were diagnosed by DM-OGTT. CONCLUSION In HIV+ women, OGTT identified DM cases that were not identified by a standardized clinical definition. Further investigation is needed to determine whether OGTT should be considered as an adjunctive tool for DM diagnosis in the setting of HIV infection.
Collapse
Affiliation(s)
- Sophie Seang
- Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, California, USA
| | - Jordan E Lake
- Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, California, USA
| | | | - Kathryn Anastos
- Department of Medicine and Epidemiology and Population Health, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
| | - Mardge H Cohen
- Departments of Medicine, Cook County Health & Hospital System, and Rush University, Chicago, Illinois, USA
| | - Phyllis C Tien
- Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, California, USA
| |
Collapse
|
3
|
Mutimura E, Hoover DR, Shi Q, Dusingize JC, Sinayobye JD, Cohen M, Anastos K. Insulin resistance change and antiretroviral therapy exposure in HIV-infected and uninfected Rwandan women: a longitudinal analysis. PLoS One 2015; 10:e0123936. [PMID: 25880634 PMCID: PMC4400132 DOI: 10.1371/journal.pone.0123936] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 03/09/2015] [Indexed: 01/16/2023] Open
Abstract
Background We longitudinally assessed predictors of insulin resistance (IR) change among HIV-uninfected and HIV-infected (ART-initiators and ART-non-initiators) Rwandan women. Methodology HIV-infected (HIV+) and uninfected (HIV-) women provided demographic and clinical measures: age, body mass index (BMI) in Kg/(height in meters)2, Fat-Mass (FMI) and Fat-Free-Mass (FFMI) index, fasting serum glucose and insulin. Homeostasis Model Assessment (HOMA) was calculated to estimate IR change over time in log10 transformed HOMA measured at study enrollment or prior to ART initiation in 3 groups: HIV- (n = 194), HIV+ ART-non-initiators (n=95) and HIV+ ART-initiators (n=371). ANCOVA linear regression models of change in log10-HOMA were fit with all models included the first log10 HOMA as a predictor. Results Mean±SD log10-HOMA was -0.18±0.39 at the 1st and -0.21±0.41 at the 2nd measure, with mean change of 0.03±0.44. In the final model (all women) BMI at 1st HOMA measure (0.014; 95% CI=0.006-0.021 per kg/m2; p<0.001) and change in BMI from 1st to 2nd measure (0.024; 95% CI=0.013-0.035 per kg/m2; p<0.001) predicted HOMA change. When restricted to subjects with FMI measures, FMI at 1st HOMA measure (0.020; 95% CI=0.010-0.030 per kg/m2; p<0.001) and change in FMI from 1st to 2nd measure (0.032; 95% CI=0.020-0.043 per kg/m2; p<0.0001) predicted change in HOMA. While ART use did not predict change in log10-HOMA, untreated HIV+ women had a significant decline in IR over time. Use or duration of AZT, d4T and EFV was not associated with HOMA change in HIV+ women. Conclusions Baseline BMI and change in BMI, and in particular fat mass and change in fat mass predicted insulin resistance change over ~3 years in HIV-infected and uninfected Rwandan women. Exposure to specific ART (d4T, AZT, EFV) did not predict insulin resistance change in ART-treated HIV-infected Rwandan women.
Collapse
Affiliation(s)
- Eugene Mutimura
- Regional Alliance for Sustainable Development (RASD Rwanda) Kigali, Rwanda
- * E-mail:
| | - Donald R. Hoover
- The State University of New Jersey, New Brunswick, New Jersey, United States of America
| | - Qiuhu Shi
- School of Health Sciences and Practice, New York Medical College, New York, New York, United States of America
| | | | | | - Mardge Cohen
- Department of Medicine, Stroger Hospital, Chicago, Illinois, United States of America
| | - Kathryn Anastos
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, United States of America
| |
Collapse
|
4
|
Gerena Y, Menéndez-Delmestre R, Skolasky RL, Hechavarria RM, Pérez S, Hilera C, González C, Nath A, Wojna V. Soluble insulin receptor as a source of insulin resistance and cognitive impairment in HIV-seropositive women. J Neurovirol 2015; 21:113-9. [PMID: 25604495 DOI: 10.1007/s13365-014-0310-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 12/08/2014] [Accepted: 12/22/2014] [Indexed: 01/06/2023]
Abstract
Insulin resistance occurs in HIV-infected individuals and is associated with HIV-associated neurocognitive disorders (HAND). However, the mechanisms involved are not well understood. Previously, we showed a correlation between soluble insulin receptor (sIR) and HAND. Here, we investigated if binding of free insulin to sIR and soluble insulin-like growth factor-1 receptor (sIGF1-R) levels are associated with sIR in HAND. Thirty-four (34) HIV-seropositive women stratified by cognitive status and five HIV-seronegative women were evaluated. In a subgroup of 20 HIV positive and 5 donors, binding of plasma insulin to sIR was determined by ELISA assay of residual insulin levels in plasma immuno-depleted with anti-IR-monoclonal antibody-Sepharose beads. sIR and sIGF1-R levels were determined by ELISA. Nonparametric statistics were used. Higher percentages of insulin bound to sIR significantly correlated with sIR levels and were associated with HAND status. Higher levels of plasma sIGF1-R had a positive correlation with sIR levels (p = 0.011) and were associated with HAND (p = 0.006). No correlations were observed with age, viral-immune profile, antiretroviral therapy, or TNF. This study suggests that changes in sIGF1-R levels and insulin binding to sIR may contribute to HAND.
Collapse
Affiliation(s)
- Yamil Gerena
- Department of Pharmaceutical Sciences, School of Pharmacy and NeuroAIDS Program, Specialized Neuroscience Research Program (SNRP), University of Puerto Rico, Medical Sciences Campus, PO Box 365067, San Juan, PR, 00936-5067, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Messina J, McCall J, Barron A. Overweight and obesity status in an urban Canadian HIV outpatient population. J Assoc Nurses AIDS Care 2014; 25:652-6. [PMID: 24840252 DOI: 10.1016/j.jana.2014.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 04/11/2014] [Indexed: 10/25/2022]
|
6
|
Rasmussen LD, Mathiesen ER, Kronborg G, Pedersen C, Gerstoft J, Obel N. Risk of diabetes mellitus in persons with and without HIV: a Danish nationwide population-based cohort study. PLoS One 2012; 7:e44575. [PMID: 22984529 PMCID: PMC3440341 DOI: 10.1371/journal.pone.0044575] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 08/09/2012] [Indexed: 11/19/2022] Open
Abstract
Objective In a nationwide, population-based cohort study we assessed the risk of diabetes mellitus (DM) in HIV-infected individuals compared with the general population, and evaluated the impact of risk factors for DM in HIV-infected individuals. Methods We identified 4,984 Danish-born HIV-infected individuals from the Danish HIV Cohort Study and a Danish born population-based age- and gender-matched comparison cohort of 19,936 individuals (study period: 1996–2009). Data on DM was obtained from the Danish National Hospital Registry and the Danish National Prescription Registry. Incidence rate ratios (IRR) and impact of risk factors including exposure to Highly Active Antiretroviral Therapy (HAART) and antiretroviral drugs were estimated by Poisson regression analyses. Results In the period 1996–1999 risk of DM was higher in HIV-infected individuals compared to the comparison cohort (adjusted IRR: 2.83; 95%CI: 1.57–5.09), both before (adjusted IRR: 2.40; 95%CI: 1.03–5.62) and after HAART initiation (adjusted IRR: 3.24; 95% CI: 1.42–7.39). In the period 1999–2010 the risk of DM in HIV-infected individuals did not differ from that of the comparison cohort (adjusted IRR: 0.90; 95% CI: 0.72–1.13), although the risk was decreased before HAART-initiation (adjusted IRR: 0.45; 95%CI: 0.21–0.96). Increasing age, BMI and the presence of lipoatrophy increased the risk of DM, as did exposure to indinavir, saquinavir, stavudine and didanosine. Conclusion Native HIV–infected individuals do not have an increased risk of developing DM compared to a native background population after year 1998. Some antiretroviral drugs, not used in modern antiretroviral treatment, seem to increase the risk of DM.
Collapse
Affiliation(s)
- Line D Rasmussen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.
| | | | | | | | | | | |
Collapse
|
7
|
Gerena Y, Skolasky RL, Velez JM, Toro-Nieves D, Mayo R, Nath A, Wojna V. Soluble and cell-associated insulin receptor dysfunction correlates with severity of HAND in HIV-infected women. PLoS One 2012; 7:e37358. [PMID: 22629383 PMCID: PMC3358319 DOI: 10.1371/journal.pone.0037358] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Accepted: 04/19/2012] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Blood sugar metabolism abnormalities have been identified in HIV-infected individuals and associated with HIV-associated neurocognitive disorders (HAND). These abnormalities may occur as a result of chronic HIV infection, long-term use of combined antiretroviral treatment (CART), aging, genetic predisposition, or a combination of these factors, and may increase morbidity and mortality in this population. OBJECTIVE To determine if changes in soluble and cell-associated insulin receptor (IR) levels, IR substrate-1 (IRS-1) levels, and IRS-1 tyrosine phosphorylation are associated with the presence and severity of HAND in a cohort of HIV-seropositive women. METHODS AND RESULTS This is a retrospective cross-sectional study using patient database information and stored samples from 34 HIV-seropositive women and 10 controls without history of diabetes from the Hispanic-Latino Longitudinal Cohort of Women. Soluble IR subunits [sIR, ectodomain (α) and full-length or intact (αβ)] were assayed in plasma and CSF samples by ELISA. Membrane IR levels, IRS-1 levels, and IRS-1 tyrosine phosphorylation were analyzed in CSF white cell pellets (WCP) using flow cytometry. HIV-seropositive women had significantly increased levels of intact or full-length sIR in plasma (p<0.001) and CSF (p<0.005) relative to controls. Stratified by HAND, increased levels of full-length sIR in plasma were associated with the presence (p<0.001) and severity (p<0.005) of HAND. A significant decrease in IRS-1 tyrosine-phosphorylation in the WCP was also associated with the presence (p<0.02) and severity (p<0.02) of HAND. CONCLUSIONS This study provides evidence that IR secretion is increased in HIV-seropositive women, and increased IR secretion is associated with cognitive impairment in these women. Thus, IR dysfunction may have a role in the progression of HAND and could represent a biomarker for the presence and severity of HAND.
Collapse
Affiliation(s)
- Yamil Gerena
- NeuroAIDS Specialized Neuroscience Research Program, University of Puerto Rico, San Juan, Puerto Rico, United States of America
- School of Pharmacy, University of Puerto Rico, San Juan, Puerto Rico, United States of America
| | - Richard L. Skolasky
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Joyce M. Velez
- NeuroAIDS Specialized Neuroscience Research Program, University of Puerto Rico, San Juan, Puerto Rico, United States of America
| | - Dianedis Toro-Nieves
- NeuroAIDS Specialized Neuroscience Research Program, University of Puerto Rico, San Juan, Puerto Rico, United States of America
| | - Raul Mayo
- NeuroAIDS Specialized Neuroscience Research Program, University of Puerto Rico, San Juan, Puerto Rico, United States of America
- Departments of Physical Medicine and Rehabilitation, University of Puerto Rico, San Juan, Puerto Rico, United States of America
| | - Avindra Nath
- Section of Infections of the Nervous System, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Valerie Wojna
- NeuroAIDS Specialized Neuroscience Research Program, University of Puerto Rico, San Juan, Puerto Rico, United States of America
- Internal Medicine Neurology Division, University of Puerto Rico, San Juan, Puerto Rico, United States of America
| |
Collapse
|
8
|
Mulligan K, Harris DR, Monte D, Stoszek S, Emmanuel P, Hardin DS, Kapogiannis BG, Worrell C, Meyer WA, Sleasman J, Wilson CM, Aldrovandi GM. Obesity and dyslipidemia in behaviorally HIV-infected young women: Adolescent Trials Network study 021. Clin Infect Dis 2010; 50:106-14. [PMID: 19947855 DOI: 10.1086/648728] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The goal of this study was to determine the nature and prevalence of abnormalities in lipids, glucose metabolism, and body composition in behaviorally human immunodeficiency virus (HIV)-infected young women and the relationship of these abnormalities to different classes of antiretroviral therapy regimens. METHODS We conducted a cross-sectional, multicenter study involving 173 behaviorally HIV-infected women aged 14-24 years and 61 HIV-seronegative control subjects. HIV-infected women were categorized as follows: antiretroviral therapy naive (n=85), receiving a regimen containing a nonnucleoside reverse-transcriptase inhibitor (NNRTI; n=33), receiving a regimen containing a protease inhibitor (PI; n=36), or receiving a regimen not containing an NNRTI or a PI (n=19). Measurements included fasting lipid levels, glucose and insulin levels before and 2 hours after an oral glucose challenge, high-sensitivity C-reactive protein (hsCRP) levels, anthropometry, fat distribution (measured by dual energy X-ray absorptiometry), and antiretroviral therapy and medical histories. Race-adjusted results were compared across groups and within HIV-infected groups. RESULTS The median age of participants was 20 years. Of HIV-infected subjects, 77% were African American, 35% smoked cigarettes, and 32% reported exercising regularly. More than 40% had a body mass index > or =25. Triglycerides; total, high-density lipoprotein (HDL), and non-HDL cholesterol; and hsCRP levels differed significantly among groups, with higher levels being most common among those receiving antiretroviral therapy. Indices of glucose metabolism did not differ among groups. In general, cholesterol levels, hsCRP levels, and indices of glucose metabolism worsened as body mass index increased. CONCLUSIONS Obesity, dyslipidemia, and inflammation were prominent among HIV-infected adolescent women and, coupled with other risk factors, may accelerate the lifetime risk of cardiovascular disease and other adverse events. These results underscore the need for a multifaceted approach to addressing risk reduction in this population.
Collapse
Affiliation(s)
- Kathleen Mulligan
- University of California, San Francisco, San Francisco General Hospital Div. of Endocrinology, Bldg. 30, Rm. 3501K, 1001 Potrero Ave., San Francisco, CA 94110, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
González-Tomé MI, Ramos Amador JT, Guillen S, Solís I, Fernández-Ibieta M, Muñoz E, Almeda J, Rojano X, Rojo P, Nieto O. Gestational diabetes mellitus in a cohort of HIV-1 infected women. HIV Med 2009; 9:868-74. [PMID: 18983478 DOI: 10.1111/j.1468-1293.2008.00639.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES We undertook a prospective study to estimate the prevalence of gestational diabetes mellitus (GDM) and associated risk factors in a cohort of 669 HIV-1 infected women. METHODS The O'Sullivan and glucose tolerance tests were performed during regular visits of 609 mothers. RESULTS The median age of the cohort was 30.7 years (range 16-44), with most women having had heterosexual contact (67%). The majority were in Centers for Disease Control (CDC) category A (71%) and 53% exhibited hepatitis C co-infection. Median viral load and CD4 count at third trimester were 545 cells/microL (range 139-1690 cells/microL) and 1.9 log (range 1.7-5.4), respectively. Seventy-four per cent of the patients were treated with highly active antiretroviral therapy (HAART), of whom 41% received a protease inhibitor (PI). An above-average prevalence of 7% [95% confidence interval (CI) 5.2-9.5] for positive GDM diagnosis was found. Risk factors associated with GDM in univariate analysis included older age, hepatitis C co-infection, stavudine and PI exposure. However, only older age [adjusted odds ratio (AOR) 1.09, 95% CI 1-1.1] and PI exposure (AOR 2.4, 95% CI 1-5.3) remained as independent risk factors for GDM development in multivariate analysis. CONCLUSIONS In our cohort, the prevalence of GDM appears to be increased, with older age and PI exposure contributing as significant independent risk factors.
Collapse
Affiliation(s)
- M I González-Tomé
- Department of Immunodeficiencies, Hospital 12 de Octubre, Madrid, Spain.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Keithley JK, Duloy AM, Swanson B, Zeller JM. HIV Infection and Obesity: A Review of the Evidence. J Assoc Nurses AIDS Care 2009; 20:260-74. [DOI: 10.1016/j.jana.2009.02.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Accepted: 02/11/2009] [Indexed: 10/20/2022]
|
11
|
|
12
|
Longenberger A, Lim JY, Orchard T, Brooks MM, Brach J, Mertz K, Kingsley LA. Self-reported low physical function is associated with diabetes mellitus and insulin resistance in HIV-positive and HIV-negative men. ACTA ACUST UNITED AC 2008; 2:539-549. [PMID: 23805164 DOI: 10.2217/17469600.2.6.539] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
AIM To investigate the association between self-reported physical function (as a surrogate for physical activity) and diabetes mellitus (DM) and insulin resistance (IR) among HIV-positive and -negative men. METHOD A total of 384 HIV-negative and 274 HIV-positive men from the Pitt Men's Study contributed data. DM was defined by fasting serum glucose levels. IR was calculated using the homeostasis model assessment. The Physical Functioning 10 Scale from the Short Form-36 Health Survey measured physical function. Multivariate logistic regression assessed the independent association between physical function and DM and IR. RESULTS Physical function, older age and Black race were associated with DM in multivariate analyses. Physical function/HIV interaction, older age, higher body mass index, HIV infection and Black race were associated with IR in multivariate analyses. CONCLUSION Self-reported low physical function is associated with DM and IR in HIV-negative and -positive men.
Collapse
Affiliation(s)
- Allison Longenberger
- Graduate School of Public Health, Department of Epidemiology, University of Pittsburgh, Fifth Avenue and Desoto Street, Pittsburgh, PA 15261, USA
| | | | | | | | | | | | | |
Collapse
|
13
|
Anastos K, Lu D, Shi Q, Tien PC, Kaplan RC, Hessol NA, Cole S, Vigen C, Cohen M, Young M, Justman J. Association of serum lipid levels with HIV serostatus, specific antiretroviral agents, and treatment regimens. J Acquir Immune Defic Syndr 2007; 45:34-42. [PMID: 17460470 DOI: 10.1097/qai.0b013e318042d5fe] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The effects of HIV infection, highly active antiretroviral therapy (HAART), and specific antiretroviral agents on lipoproteins in women are not well described. METHODS In a cross-sectional substudy of the Women's Interagency HIV Study with 623 HIV-negative and 1556 HIV-positive women (636 untreated, 419 on non-protease inhibitor [PI] HAART, and 501 on PI-containing HAART), we performed multivariate analyses of associations among fasting lipoprotein levels, HIV infection, and HAART. RESULTS Untreated HIV-positive women had lower high-density lipoprotein cholesterol (HDL-C) and higher triglycerides (TGs) but not lower low-density lipoprotein cholesterol (LDL-C) than HIV-negative women and were the most likely to have unfavorable HDL-C by National Cholesterol Education Program (NCEP) guidelines. PI HAART users had higher LDL-C than untreated HIV-infected women (107 vs. 100 mg/dL, P = 0.0006) and were the most likely to have unfavorable LDL-C and TGs by NCEP guidelines. HIV-negative women and non-PI HAART users had similar HDL-C levels (55 and 53 mg/dL, respectively), which were higher than those in untreated HIV-infected women and PI HAART users (42 and 49 mg/dL, respectively; P < 0.001 for all). Lamivudine, didanosine, nevirapine, and efavirenz were independently associated with higher HDL-C (P < 0.001 for all). Ritonavir, indinavir/ritonavir, and nelfinavir were associated with higher LDL-C (P < 0.01 for all). Stavudine, abacavir, and all ritonavir-containing regimens were associated with higher TGs (P < 0.05 for all), and tenofovir was associated with lower TGs (P = 0.009). CONCLUSIONS A dyslipidemic pattern was associated with HIV infection itself, was more severe in users of PI-containing HAART, but was not present in women taking non-PI HAART.
Collapse
Affiliation(s)
- Kathryn Anastos
- Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY 10467, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Howard AA, Lo Y, Floris-Moore M, Klein RS, Fleischer N, Schoenbaum EE. Hepatitis C virus infection is associated with insulin resistance among older adults with or at risk of HIV infection. AIDS 2007; 21:633-41. [PMID: 17314526 PMCID: PMC2423380 DOI: 10.1097/qad.0b013e3280464db7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To determine the associations of hepatitis C virus (HCV) infection with insulin resistance and abnormal glucose tolerance in a cohort of older adults with or at risk of HIV infection. DESIGN A cross-sectional study of 267 HIV-infected and 179 at-risk-uninfected adults without a history of diabetes mellitus. METHODS HCV antibody assays and RNA levels were performed to assess HCV status. Antiretroviral use, family history of diabetes, sedentary behavior, and sociodemographic data were obtained using standardized interviews. Fasting insulin levels and oral glucose tolerance tests were performed to assess two outcomes, the homeostasis model assessment of insulin resistance and abnormal glucose tolerance [impaired glucose tolerance (IGT) or diabetes]. RESULTS Of 446 participants, 265 (59%) were HCV seropositive; of these, 199 (75%) had detectable HCV-RNA levels. Insulin resistance was greater among HCV-seropositive compared with seronegative participants, adjusting for body mass index, Hispanic ethnicity, age greater than 55 years, sedentary behavior (watching television > 4 h/day), HIV status, HAART, and protease inhibitor (PI) use. Ninety-eight participants (22%) had abnormal glucose tolerance (69 with IGT and 29 with diabetes). Among HIV-infected participants, 25% were on non-PI HAART and 52% were on PI HAART, but HAART and PI use were not associated with insulin resistance or abnormal glucose tolerance. Among obese participants, abnormal glucose tolerance was more common in HCV-seropositive than seronegative individuals, whereas among non-obese participants there was no association. CONCLUSION The potential impact of HCV co-infection and obesity on glucose metabolism should be recognized in clinical care, and addressed in future research studies of HIV-infected individuals.
Collapse
Affiliation(s)
- Andrea A Howard
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York 10467, USA.
| | | | | | | | | | | |
Collapse
|
15
|
Gallagher DM. Current Clinical Issues Impacting the Lives of Patients Living With HIV/AIDS. J Assoc Nurses AIDS Care 2007; 18:S11-6. [PMID: 17275717 DOI: 10.1016/j.jana.2006.11.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
By significantly delaying the onset of AIDS, highly active antiretroviral therapy (HAART) decreases the high rates of mortality and morbidity previously associated with HIV type 1 infection. However, to gain the therapeutic benefits of HAART, patients must commit to lifelong therapy, which carries an increased risk of multiple metabolic comorbidities, including dyslipidemia and hyperglycemia. Hyperlipidemia associated with HAART can be accompanied by abnormal accumulation of adipose tissue in the abdominal and dorsocervical regions, collectively known as lipodystrophy. Additionally, hyperglycemia associated with HAART causes development of type 2 diabetes mellitus. Moreover, patients experiencing adverse metabolic effects associated with HAART have an increased risk for developing cardiovascular disease. Currently, metabolic comorbidities in patients infected with HIV are managed by interventional pharmacotherapy. However, because HAART regimens already have such high pill burdens, treatment of comorbidities with additional drugs may lead to nonadherence. This article will review the differential metabolic effects of various HAART regimens and the clinical implications for patients living with HIV/AIDS.
Collapse
Affiliation(s)
- Donna M Gallagher
- New England AIDS Education and Traning Center, Boston, Massachusetts, USA
| |
Collapse
|
16
|
Brown TT, Cofrancesco J. Metabolic abnormalities in HIV-infected patients: An update. Curr Infect Dis Rep 2006; 8:497-504. [PMID: 17064644 DOI: 10.1007/s11908-006-0025-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
In recent years, substantial progress has been made in our understanding of the pathogenesis, risk factors, and treatment of glucose and lipid abnormalities in HIV-infected patients. Newer antiretrovirals, such as abacavir and tenofovir in the nucleoside reverse transcriptase class and atazanavir in the protease inhibitor class, have been shown to improve metabolic profiles compared to other medications. In addition, new information regarding the efficacy of glucose and lipid-lowering medications in HIV-infected patients has become available. It has also been demonstrated that aggressive risk factor modification can reduce the burden of cardiovascular disease in this population. This article reviews these recent advances in order to help providers respond to these important clinical challenges.
Collapse
Affiliation(s)
- Todd T Brown
- 1830 East Monument Street, Suite 333, Baltimore, MD 21287, USA.
| | | |
Collapse
|
17
|
Howard AA, Floris-Moore M, Lo Y, Arnsten JH, Fleischer N, Klein RS. Abnormal glucose metabolism among older men with or at risk of HIV infection. HIV Med 2006; 7:389-96. [PMID: 16903984 PMCID: PMC2104626 DOI: 10.1111/j.1468-1293.2006.00398.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To determine factors associated with diabetes, insulin resistance, and abnormal glucose tolerance in older men with or at risk of HIV infection. METHODS Diabetes was assessed by self-report in 643 men >or=49 years old with or at risk of HIV infection. In a subset of 216 men without previously diagnosed diabetes [including 90 HIV-uninfected men, 28 HIV-infected, antiretroviral-naive men, 28 HIV-infected men taking non-protease inhibitor (PI)-containing highly active antiretroviral therapy (HAART), and 70 HIV-infected men taking PI-containing HAART], an oral glucose tolerance test with insulin levels was performed. HIV serology, CD4 cell count, weight, height and waist circumference were measured. Antiretroviral use, drug use, family history of diabetes, physical activity and sociodemographic data were obtained using standardized interviews. RESULTS Of 643 participants, 116 (18%) had previously diagnosed diabetes. With the oral glucose tolerance test, 15 of 216 men (7%) were found to have undiagnosed diabetes and 40 (18%) impaired glucose tolerance. Factors independently associated with previously diagnosed diabetes included use of non-PI-containing HAART, methadone treatment, positive CAGE test for alcoholism, obesity and family history of diabetes. Factors independently associated with greater insulin resistance included waist circumference and heroin use. Factors independently associated with abnormal glucose tolerance (impaired glucose tolerance or diabetes) included age >or=55 years and Hispanic ethnicity. CONCLUSIONS HIV-infected men with diabetes risk factors should undergo screening for diabetes regardless of HAART use. Interventions targeting modifiable risk factors, including overweight and physical inactivity, are warranted. The potential impact of opiate and alcohol abuse on glucose metabolism should be recognized in clinical care, and addressed in future research studies of HIV-infected persons.
Collapse
Affiliation(s)
- A A Howard
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY 10467, USA.
| | | | | | | | | | | |
Collapse
|
18
|
Abstract
The transformation of HIV infection into a chronically managed illness through the widespread use of highly active antiretroviral therapy has brought with it comorbid conditions such as increased risk of cardiovascular disease. Diabetes and insulin resistance have emerged as important comorbidities associated with HIV infection and the use of antiretroviral therapy. Significant inroads have been made towards understanding the etiology of insulin resistance and diabetes in association with HIV and highly active antiretroviral therapy, and there are also emerging data on the prevalence and incidence of this problem. The recognition and management of diabetes mellitus, insulin resistance, and related complications will be an important part of long-term health maintenance for HIV-infected patients.
Collapse
Affiliation(s)
- Colleen Hadigan
- Harvard Medical School, Program in Nutritional Metabolism, Massachusetts General Hospital, 55 Fruit Street, LON 207, Boston 02114, USA.
| |
Collapse
|