Insulin resistance predicts endothelial dysfunction and cardiovascular risk in HIV-infected persons on long-term highly active antiretroviral therapy

• Published in: AIDS (London) Vol. 22; no. 7; pp. 849 - 856
• Main Authors: MONDY, Kristin E, DE LAS FUENTES, Lisa, WAGGONER, Alan, ONEN, Nur F, BOPP, Coco S, LASSA-CLAXTON, Sherry, POWDERLY, William G, DAVILA-ROMAN, Victor, YARASHESKI, Kevin E
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 23-04-2008
• Subjects: Adult; Anti-HIV Agents - therapeutic use; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antiretroviral Therapy, Highly Active; Antiviral agents; Biological and medical sciences; Brachial Artery - diagnostic imaging; Cardiovascular Diseases - diagnostic imaging; Cardiovascular Diseases - physiopathology; Cardiovascular Diseases - virology; Chi-Square Distribution; Endothelium, Vascular - diagnostic imaging; Endothelium, Vascular - physiopathology; Epidemiologic Studies; Female; HIV; HIV Infections - complications; HIV Infections - drug therapy; HIV Infections - physiopathology; Human immunodeficiency virus; Human viral diseases; Humans; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunopathology; Infectious diseases; Insulin Resistance; Male; Medical sciences; Pharmacology. Drug treatments; Risk; Time; Ultrasonography; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Africa; Endocrinopathy; Immunopathology; Retroviridae; Metabolic diseases; Cardiovascular disease; AIDS; Immune deficiency; Lentivirus; Insulin; Long term; Endothelium; Infection; Virus; Target tissue resistance; Chemotherapy; Treatment; HIV; Viral disease; Cardiovascular risk; Endothelial dysfunction; Antiviral; Insulin resistance; Human immunodeficiency virus; Predictive factor
• ISSN: 0269-9370; 1473-5571
• DOI: 10.1097/QAD.0b013e3282f70694

Cardiovascular disease risk among persons with HIV is likely multifactorial, thus testing a variety of available noninvasive vascular ultrasound and other surrogate tests may yield differing results. To address this issue, we assessed multiple metabolic and clinical predictors of endothelial function and carotid intima-media thickness in HIV-infected subjects and compared results with HIV-negative controls.
Prospective, cross-sectional study of 50 HIV-infected, healthy adults on stable highly active antiretroviral therapy matched to 50 HIV-negative controls by age, sex, race, and body mass index.
Flow-mediated vasodilation of the brachial artery, carotid intima-media thickness, dual energy X-ray absorptiometry (HIV-infected subjects), and fasting insulin, lipids, and oral glucose tolerance tests were performed. Results were compared between HIV-infected and control groups.
Fifty percent of subjects were African-American with 34% women. Among HIV-infected, mean CD4 cell count was 547 cells/microl; 90% had HIV RNA less than 50 copies/ml. There were no significant differences between HIV-infected and control subjects with regard to brachial artery flow-mediated vasodilation or carotid intima-media thickness. In multivariate analyses of the HIV cohort, independent predictors of endothelial dysfunction (lower flow-mediated vasodilation) were increasing insulin resistance, greater alcohol consumption, and higher baseline brachial artery diameter (P < 0.05); predictors of increased carotid intima-media thickness were hypertension, higher trunk/limb fat ratio, and insulin resistance (P < 0.05).
In this HIV cohort on modern highly active antiretroviral therapy with well controlled HIV, there were no significant differences with regard to preclinical markers of cardiovascular disease. Insulin resistance was a strong predictor of impaired brachial artery flow-mediated vasodilation and increased carotid intima-media thickness, and may be an important cardiovascular disease risk factor in the HIV population.