Antiretroviral therapy exposure and insulin resistance in the women's interagency HIV study

Phyllis C. Tien, Michael F. Schneider, Stephen R. Cole, Alexandra M. Levine, Mardge Cohen, Jack DeHovitz, Mary Young, Jessica E. Justman

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Evidence suggesting an increased risk of cardiovascular disease in HIV-infected individuals has heightened the need to understand the relation of HIV infection, antiretroviral therapy use, and non-HIV-related factors with insulin resistance (IR). Methods: Prospective study of 1614 HIV-infected and 604 HIV-uninfected participants from the Women's Interagency HIV Study between October 2000 and March 2007. Homeostasis model assessment (HOMA)-estimated IR at 11,019 semiannual visits. Results: HIV-infected women reporting highly active antiretroviral therapy (HAART) had higher median HOMA than HIV-uninfected women {1.20 [95% confidence interval (CI): 1.11 to 1.30] times higher for those reporting protease inhibitor-containing HAART; 1.10 (95% CI: 1.01 to 1.20) times higher for those reporting non-protease inhibitor-containing HAART}. Among HIV-infected, cumulative exposure to nucleoside reverse transcriptase inhibitors (NRTIs) of >3 years was associated with HOMA 1.13 (95% CI: 1.02 to 1.25) times higher than the HOMA without any cumulative NRTI exposure. Cumulative exposure to the NRTI stavudine of >1 year was associated with HOMA 1.15 (95% CI: 1.05 to 1.27) times higher than the HOMA without any cumulative stavudine use. Family history of diabetes, hepatitis C virus seropositivity, higher body mass index, or reporting menopause was associated with higher HOMA. Conclusions: Longer cumulative exposure to NRTI; in particular, stavudine is associated with greater IR in HIV-infected women.

Original languageEnglish (US)
Pages (from-to)369-376
Number of pages8
JournalJournal of acquired immune deficiency syndromes
Volume49
Issue number4
DOIs
StatePublished - Dec 1 2008

Keywords

  • Antiretroviral therapy
  • HIV
  • HOMA
  • Insulin resistance
  • Nucleoside reverse transcriptase inhibitor
  • Protease inhibitor

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

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