HIV-Positive Inflammatory Activity Monitoring Correlated to Peripheral Insulin Resistance - Hire Study

Abstract

Introduction: Insulin resistance and diabetes mellitus are important metabolic complications of HIV-infected patients' therapy, since an increased survival occurred after HAART [1,2]. HIV-infected patients have an increased risk of hyperglycaemia associated with inflammatory activity and medications, and this can implicate directly in survival and life quality [3]. Inflammatory status related to these patients can also be responsible for increases risk of hospitalization and bad prognosis [4]. Materials and methods: This study was a retrospective analysis of a multicentre cohort proposed to evaluate impact and risk factors for insulin resistance in HIV outpatients of Unichristus Center University and Hospital Geral De Fortaleza, including sociodemographic issues, hospitalization data, comorbidities and laboratory data. Results: A total of 218 patients were included, 73.9% male, median age of 37 years, median HIV diagnosis of 24 months and median follow-up period of 21 months. CD4/CD8 rate before ART 0.38+/-0.29 and final 0.62+/-0.4, initial CD4 count mean 400 cells/mm3 and final 570 cells/mm3, 97.3% had suppressed viral load in final visit. Only 2.8% of patients had diabetes mellitus before HIV diagnosis. There was a significant increase in glucose levels after HAART initiation (18.5% vs. 36.7%, p=0.0025). Fasting glucose elevation was detected as a risk factor to develop symptoms during follow-up (RR 1.35; 95% CI 1.01-1.80; p=0.002). A higher monocyte/ lymphocyte ratio was associated with hospitalization during the follow-up before (p=0.011) and after (p=0.033) introduction of ART. After introduction of HAART, there was an increase in Castelli index for hyperglycaemic patients, but significant difference did not remain during follow-up. Castelli index was 4.5+/-1.2 before ART, 4.8+/-1.4 after 12 months, 5.4+/-1.8 after 24 months and 5.3+/-1.8 after 36 months. Conclusion: Antiretroviral therapy is an important factor associated with higher glucose levels, and causes insulin resistance associated with uncontrolled lipid levels. Perhaps, HIV treatment is essential to control chronic inflammation and its consequences. Monocyte/ lymphocyte ratio can be an easy marker for inflammation activation monitoring and could be associated with higher risk for hospitalization.