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Interscience Conference on Antimicrobal Agents and Chemotherapy
December 16-19, 2005 Washington DC
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13% Insulin Resistance in ART-Naive; Nevirapine is Only drug associated with Not causing insulin resistance development
  Reported by Jules Levin
ICAAC Dec 17, 2005 Wash DC
Spanish researchers (Palacios et al) reported that insulin resistance developed in 13% of ART-naive patients 48 weeks after starting HAART. HOMA >3.8 was defined as insulin resistance. The development of insulin resistance was associated with BMI, HCV coinfection, indinavir use and lipodystrophy development. 65% of the patients in this study were smokers. 95%+ were adherent to HAART.
Of note, nevirapine was associated with NOT having insulin resistance. It was the only ART drug associated with NOT having insulin resistance. Indinavir was the only drug associated with insulin resistance. 13% Insulin Resistance in ART-Naive; Nevirapine is Only drug NOT associated with insulin resistance development
"Nevirapine: 0 patients on NVP developed insulin resistance. 19 patients were on NVP & did not develop IR (18%) (0.05).
Indinavir: 5 (33%) patients taking IDV developed IR, 11 taking IDV did not developed IR (10.4%) (0.03)."
HAART is associated with the lipodystrophy syndrome, which includes abnormal fat redistribution, dyslipidemia, and glucose metabolism disorders. Cross-sectional studies have reported a prevalence of diabetes mellitus (DM) of 2-7% among HIV-infected patients on HAART, and an additional 35% have imoaired glucose tolerance (1-6). Insulin resistance (IR) has been reported in 61% of HIV-infected patients on protease inhibitors (PI) (7), however, no prospective studies have analyzed the incidence of IR in HIV population. Most data on the development of glucose disorders in HIV-infected patients are from population-based studies (4,5,8) and the pathogenesis of these disorders remains to be defined (9). Awareness of the incidence and risk factors for IR in these patients would aid in the prevention and management of glucose disorders.
198 patients started HAART, 137 satisfied inclusion criteria for this analysis, and 120 were analyzed. This was a prospective, observational study of a cohort of HIV patients from 2 institutions starting HAART & maintaining the same regimen during the followup. Patients who stopped or switched HAART regimen were excluded. Exclusion criteria: pregnant & breatfeeding women, alcohol or illegal drugs abuse, current OIs, and treatment with drugs which modify glucose metabolism. Fasting samples were collected at entry, and at 48 weeks. Patients with baseline insulin resistance were excluded for analysis.
Anthropometrical evaluations were conducted at the start of HAART & week 48.
17 patients (12.4%) had insulin resistance at baseline. Mean age was 38, 91 of the 120 patients were men. 47 had AIDS; 43 patients had HCV coinfection. Baseline mean BMI was 23.1 kg/m2; CD4 was 219; and HIV VL was 5.15 log copies/ml.
44 patients used a PI regimen, 65 a NNRTI regimen, and 11 NRTIs only regimen. Only patients remaining on the same regimen throughout were included in this analysis.
15 patients (13%) developed insulin resistance at 48 weeks of HAART.
In the multivariate analysis, insulin resistance was associated with:
--higher BMI (p=0.008)
--HCV coinfection (p=0.049)
--indinavir use, but NOT PI (p=0.008)
--lipodystrophy development (p=0.031)
Triglycerides were 214 in patients with insulin resistance and 147 mg/dl in patients who did not develop insulin resistance (p=0.04).