Immune deficiency could be an early risk factor for altered insulin sensitivity in antiretroviral-naive HIV-1-infected patients: the ANRS COPANA cohort.

Abstract

BACKGROUND:

The relationships between immunovirological status, inflammatory markers, insulin resistance and fat distribution have not been studied in recently diagnosed (<1 year) antiretroviral-naive HIV-1-infected patients.

METHODS:

We studied 214 antiretroviral-naive patients at enrolment in the metabolic substudy of the ANRS COPANA cohort. We measured clinical, immunovirological and inflammatory parameters, glucose/insulin during oral glucose tolerance test (OGTT), adipokines, subcutaneous and visceral fat surfaces (subcutaneous adipose tissue [SAT] and visceral adipose tissue [VAT], assessed by computed tomography) and the body fat distribution based on dual-energy X-ray absorptiometry (DEXA).

RESULTS:

Median age was 36 years; 28% of the patients were female and 35% of sub-Saharan origin; 20% had low CD4(+) T-cell counts (≤200/mm(3)). Patients with low CD4(+) T-cell counts were older and more frequently of sub-Saharan Africa origin, had lower body mass index (BMI) but no different SAT/VAT ratio and fat distribution than other patients. They also had lower total, low-density lipoprotein and high-density lipoprotein cholesterolaemia, higher triglyceridaemia and post-OGTT glycaemia, higher markers of insulin resistance (insulin during OGTT and homeostasis model assessment of insulin resistance) and of inflammation (high-sensitivity C-reactive protein, IL-6, tumour necrosis factor (TNF)-α, sTNFR1 and sTNFR2). After adjustment for age, sex, geographic origin, BMI and waist circumference, increased insulin resistance was not related to any inflammatory marker. In multivariate analysis, low CD4(+) T-cell count was an independent risk factor for altered insulin sensitivity (β-coefficient for HOMA-IR: +0.90; P=0.001; CD4(+) T-cell count >500/mm(3) as the reference), in addition to older age (β: +0.26 for a 10-year increase; P=0.01) and higher BMI (β: +0.07 for a 1-kg/m(2) increase; P=0.003).

CONCLUSIONS:

In ART-naive patients, severe immune deficiency but not inflammation could be an early risk factor for altered insulin sensitivity.

• Authors: Faroudy Boufassa, Cécile Goujard, Jean-Paul Viard, Robert Carlier, Bénédicte Lefebvre, Patrick Yeni, Olivier Bouchaud, Jacqueline Capeau, Laurence Meyer, Corinne Vigouroux, ANRS COPANA Cohort Study Group
• Journal: Antiviral therapy (Antivir Ther) Vol. 17 Issue 1 Pg. 91-100 ( 2012) ISSN: 2040-2058 [Electronic] England
• PMID: 22267473 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Chemical References

• Adipokines
• Blood Glucose
• Cytokines
• Insulin
• Lipoproteins
• RNA, Viral
• C-Reactive Protein

Topics

• Adipokines (blood)
• Adult
• Africa South of the Sahara (ethnology)
• Blood Glucose (analysis)
• Body Fat Distribution
• Body Mass Index
• C-Reactive Protein (analysis)
• CD4 Lymphocyte Count
• Cohort Studies
• Cytokines (blood)
• Female
• France (epidemiology)
• Glucose Tolerance Test
• HIV Infections (blood, ethnology, immunology, virology)
• Humans
• Insulin (blood)
• Insulin Resistance (immunology)
• Lipoproteins (blood)
• Male
• RNA, Viral (analysis)
• Risk Factors
• White People