Ageing, nondiabetic HIV-positive individuals prone to insulin resistance
Ageing, nondiabetic, HIV-positive individuals may have a greater tendency to develop insulin resistance than HIV-negative individuals, although their body mass index (BMI) and body fat levels were lower than that of HIV-negative individuals, a study from Thailand found.
The cross-sectional study conducted in Bangkok, Thailand involved 383 participants aged ≥50 years without overt type 2 diabetes (median age 54.4 years, 60 percent male), 297 and 86 of whom were HIV-positive and HIV-negative, respectively. Participants who were HIV-positive had been on antiretroviral therapy for a median 16.1 years.
Compared with HIV-negative participants, HIV-positive participants had lower BMI (median, 22.8 vs 24.6 kg/m2; p<0.001), percentage of body fat (23 percent vs 25.4 percent; p=0.01), and high visceral fat rating (25.77 percent vs 43.91 percent), but a higher rate of hepatitis C co-infection (10.10 percent vs 2.33 percent; p=0.02) and prevalence of hypertension (37.04 percent vs 20.93 percent; p=0.005).
Prevalence of insulin resistance (HOMA-IR* >2) was higher among HIV-positive participants compared with HIV-negative ones (29 percent vs 16 percent). While multivariate analysis showed that HIV-positive status was associated with a significantly increased risk for insulin resistance (adjusted odds ratio** [adjOR], 5.22, 95 percent confidence interval [CI], 1.91–14.24; p=0.001), use of antiretroviral therapy did not affect this risk. [AIDS International Conference 2018 (AIDS 2018), abstract TUPEB119]
Other factors that influenced insulin resistance were hypertension (adjOR, 2.80, 95 percent CI, 1.48–5.28; p=0.002), high-sensitivity C-reactive protein (hs-CRP) >3 mg/L (adjOR, 2.35, 95 percent CI, 1.15–4.79; p=0.019), high visceral fat score (adjOR, 3.87, 95 percent CI, 1.81–8.29; p=0.001), and liver stiffness (adjOR, 1.08, 95 percent CI, 1.002–1.17; p=0.045).
“Insulin resistance, a risk factor for type 2 diabetes and cardiovascular disease, is increasingly seen in HIV-infected patients. Asians typically have higher visceral fat compared with non-Asians at the same BMI,” said study author Dr Tanakorn Apornpong from the HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT) and Thai Red Cross AIDS Research Centre in Bangkok, Thailand, who presented the results as a poster at AIDS 2018.
“Despite having lower BMI and body fat, ageing HIV-infected patients had a significantly higher prevalence of insulin resistance compared with HIV-negative controls,” he said.
“Apart from HIV infection, insulin resistance in our cohort was associated with hypertension, high hs-CRP as a marker of immune activation, high degrees of visceral fat, and liver fibrosis, all [of which] are associated with a higher risk of atherosclerotic cardiovascular disease [ASCVD],” said Apornpong.