Diabetes mellitus, insulin resistance, and metabolic syndrome in HIV-positive patients in South India

Abstract

Insulin resistance, diabetes mellitus, and metabolic syndrome in patients with human immunodeficiency virus (HIV) infection are increasingly being reported in the global medical literature. This cross-sectional study was done to describe the occurrence of metabolic syndrome, diabetes mellitus, and insulin resistance in HIV-positive patients in a tertiary referral center in South India. A total of 60 patients who had HIV infection for 12 months or more were enrolled in the study. Of these, 30 patients were antiretroviral therapy (ART)-naïve, and 30 were treated with ART. Biochemical estimations (fasting blood glucose, 75 g oral glucose tolerance test, lipid profile, and fasting insulin) and anthropometric measurements (height, weight, and waist circumference) were performed for each patient. Metabolic syndrome was diagnosed using National Cholesterol Education Program–Adult Treatment Plan III criteria, and insulin resistance was calculated applying the homeostasis model assessment method. Diabetes mellitus, impaired fasting glycemia, and impaired glucose tolerance were diagnosed based on American Diabetes Association criteria. A high prevalence of metabolic syndrome was observed in patients with HIV (16/60), and was more prevalent in the ART-treated group (13/30; P = 0.028). Similarly, insulin resistance was also noted to be high (24/60), and of these patients, 15 were on ART. Seventy-five percent of patients with metabolic syndrome had insulin resistance. Diabetes was diagnosed in one patient who was ART-naïve and in six patients who were on ART. Our observations suggest an increased prevalence of metabolic syndrome, insulin resistance, and diabetes mellitus in ART-treated patients. These warrant attention and substantiation with larger studies. While ART improves survival, it may lead on to cardiovascular morbidity and mortality, especially in the Indian subcontinent where there is a genetic predisposition to cardiovascular risk.

Metabolic abnormalities in adult HIV infected population on antiretroviral medication in Malaysia: a cross-sectional survey

“…Some studies in Thailand reported a similar rate of dyslipidemia at 53.6% and 88% [38,50]. Other studies from other developing countries showed similar results oh high prevalence lipid abnormalities rate of more than 76% [35] from Tanzania, 82.3% [19] from Southern Ethiopia, 20-100% from India [7,41]. …”

Nadir CD4+, religion, antiretroviral therapy, incidence of type 2 diabetes mellitus, and increasing rates of obesity among black Africans with HIV disease

“…There was a significant association between abdominal obesity (a surrogate for clinical insulin resistance in this ethnic group), peripheral obesity, and exposure to ART. Although the mechanisms of action by which protease inhibitors and nucleoside analogs trigger diabetes is not fully understood, most of the hypothesized pathophysiology implicates the insulin resistance pathway16,17 rather than insulin secretion 38…”

“…However, older age, HIV infection itself, antiretroviral therapy (ART), HIV-related inflammation, current CD4 T cell count, nadir CD4 T cell count < 350 cells/mm 3 , and traditional risk factors for cardiovascular disease (smoking, obesity, physical inactivity, excess alcohol intake) substantially increase the risk of cardiovascular disease, including hypertension, stroke, coronary artery disease, peripheral artery disease, dyslipidemia, diabetes mellitus, metabolic syndrome, and lipodystrophy 5–17…”

Metabolic Abnormalities in HIV-Infected Populations without or with Antiretroviral Therapy (ART)

“…Also, early reports in 2000 on the side effects of PIs highlighted the incidence of high concentrations of the lipid profile as being close to 80% [77][78][79] in various global populations, mostly from I. In Asia, in particular Southeast Asia, Thailand [91][92][93][94][95], and India [96][97][98], HIV-associated serum lipid complication rates are in the range of 5-60% for high TC, high LDL-c, high TG, and low HDL among ART receivers. Fewer studies have been conducted in some regions in South America and Asia on the relationship between metabolic disorders and ART.…”