2249. Insulin Resistance is Associated with higher viral loads among HIV-1-infected patients initiated on 12 months of first-line antiretroviral therapy
Session: Poster Abstract Session: HIV: Metabolic, Cardiovascular, and Renal Complications
Saturday, October 6, 2018
Room: S Poster Hall
Posters
  • Poster ID WEEK 2018 _ Insulin Resistance is Associated with Higher Plasma Viral Load Among HIV-Positive Adults Receiving Longer-Term (1 Year) Combination Antiretroviral Therapy (ART) .pdf (1.5 MB)
  • Poster ID WEEK 2018 _ Insulin Resistance is Associated with Higher Plasma Viral Load Among HIV-Positive Adults Receiving Longer-Term (1 Year) Combination Antiretroviral Therapy (ART) .pdf
  • Background: As HIV infected patients are living longer due to ART and decreasing mortality, the burden of non-communicable diseases (NCDs) is expected to rise. With the implication of Insulin resistance (IR) and inflammation in the pathogenesis of Diabetes Mellitus (DM), DM is likely to be increasing in the HIV infected patients in the Sub-Saharan Africa (SSA). HIV is characterized with systemic inflammation and markers which quickly decrease with ART initiation regardless of type of ARV regimen though they do not normalize. We thus assessed the relationship between IR and Virologic treatment failure among HIV-1 infected individuals at 12 months of first line ART in the Zambian ART program.
    Methods: We conducted a cross sectional survey among HIV-1 infected individuals at 12 months (± 3 months) of first line ART. Systematic sampling was performed and 20 clinics were selected based on the random starting-point, sampling interval and cumulative population size giving a sample size of 460. Eligible patients had their fasting blood specimens collected for VL, Insulin, Blood glucose, high sensitive c-reactive protein (hsCRP), tumour necrosis factor alfa (TNFa) and Lipogram. Anthropometric indices were also measured including visceral fat. Insulin resistance (IR) was determined using Homeostatic model assessment (HOMA). Proportions for each outcome at linearized standard error 95% confidence interval and summary estimates were determined. Viral Load suppression (VLS) was defined according to the detection threshold which was <20copies/mL and Treatment failure was defined as VL>1000 copies/mL.

    Results: Of the 473 patients enrolled, 142 (30%): 95%CI (26%, 34%) had IR. 19% of Individuals with IR had treatment failure compared to 5.7% with treatment failure and without IR (P-value <.0001). Treatment success was associated with less likelihood of IR (OR 0.26 (0.14, 0.48), P-value <0.0001. Among individuals with VLS, 82, out of 142 (58%) 95% CI (0.54%, 0.70%) had IR compared to 232 out of 331, (70%) 95% CI (65%, 75%) who did not have IR (p-value=0.042)

    Conclusion: Patients with poor virological outcomes at 12 months of first line ART had increased likelihood of insulin resistance compared to those with treatment success. There was good evidence to suggest that the proportion of those with VLS and IR was less than those with VLS and no IR.

    Lloyd Mulenga, MBChB, MMED, Infectious Diseases, University of Zambia, School of Medicine, University Teaching Hospital, Division of Infectious Diseases, Lusaka, Zambia, University of Zambia School of Medicine, Internal Medicine, Lusaka, Zambia, Lusaka, Zambia, Patrick Musonda, PHD, University of Zambia School of Medicine, Adult Infectious Disease Centre/Internal Medicine, Lusaka, Zambia, University Teaching Hospital, Division of Infectious Diseases, Lusaka, Lusaka, Zambia, Lameck Chirwa, MSc, University Teaching Hospital, Division of Infectious Diseases, Lusaka, Zambia, Lusaka, Zambia, Mpanji Siwingwa, MSc, University of Zambia School of Medicine, Adult Infectious Disease Centre/Internal Medicine, Lusaka, Zambia, University Teaching Hospital, Division of Infectious Diseases, Lusaka, Zambia, Lusaka, Zambia and Henry Phiri, MSc, Ministry of Health, Ndeke House, Lusaka, Zambia, Lusaka, Zambia

    Disclosures:

    L. Mulenga, None

    P. Musonda, None

    L. Chirwa, None

    M. Siwingwa, None

    H. Phiri, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.