Effect of Nonnucleoside Reverse Transcriptase Inhibitor–Based Antiretroviral Therapy on Dysglycemia and Insulin Sensitivity in South African HIV-Infected Patients

• Published in: Journal of acquired immune deficiency syndromes (1999) Vol. 57; no. 4; pp. 284 - 289
• Main Authors: Dave, Joel A, Lambert, Estelle V, Badri, Motasim, West, Sacha, Maartens, Gary, Levitt, Naomi S
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins, Inc 01-08-2011; Lippincott Williams & Wilkins; Lippincott Williams & Wilkins Ovid Technologies
• Subjects: Adult; AIDS/HIV; Anti-HIV Agents - adverse effects; Anti-HIV Agents - therapeutic use; Antiretroviral drugs; Biological and medical sciences; Blood Glucose - drug effects; Diabetes; Drug therapy; Female; Fundamental and applied biological sciences. Psychology; HIV; HIV Infections - drug therapy; HIV Infections - epidemiology; Human immunodeficiency virus; Human viral diseases; Humans; Hyperglycemia - chemically induced; Hyperglycemia - epidemiology; Infectious diseases; Insulin; Insulin Resistance; Male; Medical sciences; Microbiology; Miscellaneous; Multivariate Analysis; Prevalence; Reverse Transcriptase Inhibitors - adverse effects; Reverse Transcriptase Inhibitors - therapeutic use; Risk Factors; South Africa - epidemiology; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Virology; South Africa; Endocrinopathy; Pancreatic hormone; Antiretroviral agent; antiretroviral therapy; Glucose; dysglycemia; Enzymopathy; Reverse transcriptase inhibitor; impaired glucose metabolism; Antiviral; Aminoacid disorder; Immunopathology; Nervous system diseases; human immunodeficiency virus (HIV); Diabetes mellitus; Retroviridae; Metabolic diseases; AIDS; Hypoglycemia; Metabolism; Immune deficiency; Lentivirus; Insulin; Genetic disease; Infection; Virus; Sensitivity; Treatment; Viral disease; Hyperglycinemia; Human immunodeficiency virus; diabetes
• ISSN: 1525-4135; 1944-7884
• DOI: 10.1097/QAI.0b013e318221863f

BACKGROUND:Data on the prevalence of the complications of antiretroviral therapy (ART) (diabetes, central fat accumulation, peripheral fat wasting, and dyslipidemia) in sub-Saharan Africa are sparse. We examined the prevalence and associated risk factors of dysglycemia and insulin sensitivity in HIV-infected South Africans.
METHODS:HIV-infected patients, on nonnucleoside reverse transcriptase inhibitor-based ART or ART-naive, had oral glucose tolerance tests and clinical anthropometry. Insulin sensitivity and β-cell function were assessed.
RESULTS:The prevalence of dysglycemia in 406 ART-naive patients and 443 patients on ART was 25.7% and 21.9% (P = 0.193), respectively. Dysglycemic patients on ART had a similar body mass index (P = 0.440), greater waist circumference (P = 0.047), and smaller calf skinfold thickness (P = 0.015) than dysglycemic ART-naive patients but no difference in β-cell function or insulin sensitivity. Normoglycemic patients on ART had a greater body mass index (P = 0.0009), waist circumference (P = 0.0001), and abdominal skinfold thickness (P = 0.040), similar calf skinfold thickness (P = 0.079), and reduced β-cell function [lower insulinogenic index (P = 0.027) and oral disposition index (Do, P = 0.020)] compared with normoglycemic ART-naive patients. In multivariate analysis, older age [odds ratio (OR)1.04, 95% confidence interval (CI)1.02 to 1.06], male gender (OR1.96, 95% CI1.28 to 2.99), higher CD4 count (OR1.0, 95% CI1.00 to 1.02) and use of efavirenz (OR1.70, 95% CI1.19 to 2.45) were associated with dysglycemia.
CONCLUSIONS:The prevalence of dysglycemia in ART-naive and ART patients was similar. Peripheral fat wasting was more common in dysglycemic patients on ART. The association of efavirenz with dysglycemia is important because first-line ART regimens in the developing world include nonnucleoside reverse transcriptase inhibitors, and increasingly, efavirenz is selected because of its perceived lower toxicity than nevirapine.