Endocrine Abstracts

Introduction: Although the importance of disorders in glucose metabolism is well recognized in human immunodeficiency virus (HIV) infected patients; the clinical relevance of prediabetes in this population has been little studied. The aims of this observational study were to determine the prevalence of prediabetes in a cohort of HIV-infected patients on long term highly active antiretroviral therapy (HAART) and to assess whether this condition involves the appearance of particular clinical and metabolic features.

Methods/design: One hundred and five HIV-positive individuals (85.7% men, mean age: 46±6.5 years) were enrolled. Prediabetes was defined using established ADA criteria. Data related to HIV infection, HCV co-infection and anthropometric and metabolic parameters were recorded. Fasting plasma glucose (FPG), fasting insulin levels and homeostatic model assessment-insulin resistance (HOMA-IR) were determined.

Results: Prevalence of prediabetes was higher (43.1%) among HCV/HIV as compared to 38.3% among those with HIV alone. When compared to normoglycemic controls, patients with prediabetes had significantly (P<0.05) higher waist-to-hip-ratio (0.96±0.1 vs 0.91±0.1); higher FPG levels (99.4±9.9 vs 90.4±9.6 mg/dl), higher basal insulin (14.1±11.5 vs 8.6±5.1 μIU/l) and higher HOMA-IR (4.4±0.9 vs 1.9±1.2). HCV/HIV with prediabetes were mostly men (100 vs 61%; P=0.001) and had significantly (P<0.001) lower LDLc levels (113.2±27.2 vs 139.9±37.7 mg/dl) and lower total cholesterol (180.41 ±34.7 vs 213.89±44.6 mg/dl) as compared to prediabetic HIV group. Although FPG levels and HOMA-IR were higher in prediabetic HCV/HIV patients, the difference was not significantly.

Conclusions: HIV patients on long-term HAART are at risk to develop prediabetes, especially if abdominal obesity is present thus, measurements of HOMA-index and waist-to-hip ratio should be routinely done. The worst lipidic profile in prediabetic HIV alone suggests that this parameter deserves special attention in these individuals.