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.
L. Chirwa, None
M. Siwingwa, None
H. Phiri, None
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