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Factors Associated With Insulin Resistance in Adults With HIV Receiving Contemporary Antiretroviral Therapy: a Brief Update

  • Complications of Antiretroviral Therapy (GA McComsey, Section Editor)
  • Published:
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Abstract

Purpose of Review

This narrative review summarizes recent data on factors associated with insulin resistance (IR) in adults with HIV, including contemporary antiretroviral therapy (ART).

Recent Findings

IR remains common in persons with HIV, even those receiving contemporary ART. Generalized and abdominal obesity and ectopic fat are correlates of IR, and emerging data have identified associations with biomarkers of inflammation and immune activation. Small studies suggest associations between mitochondria and IR. In ART-naïve individuals, IR increased within 4 weeks of starting ART in persons receiving contemporary boosted protease inhibitors or an integrase inhibitor.

Summary

The importance of IR in non-diabetic persons with HIV will continue to grow as the population ages and obesity increases. Non-invasive estimates of IR appear to perform well in persons with HIV, but clinically relevant cutoffs are uncertain. Unexpected metabolic effects of newer HIV integrase inhibitors have been reported; thus, careful observation for and studies of IR are still warranted.

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Acknowledgements

The author is supported by NIH/NIDDK (R21 DK101342), the NIH-funded Tennessee Center for AIDS Research (P30 AI110527), and the Tennessee Valley Veterans Health System. The author would like to acknowledge John Koethe, MD, MSCI, for reviewing a draft of this manuscript, and the providers, staff, and patients of the Vanderbilt Comprehensive Care Clinic and the Tennessee Valley/Nashville VA ID Clinics for always learning and teaching.

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  1. Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Tennessee Valley Veterans Health System/Nashville Veterans Affairs Hospital, A2200 MCN, 1161 21st Ave S, Nashville, TN, 37232, USA

    Todd Hulgan

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Hulgan, T. Factors Associated With Insulin Resistance in Adults With HIV Receiving Contemporary Antiretroviral Therapy: a Brief Update. Curr HIV/AIDS Rep 15, 223–232 (2018). https://doi.org/10.1007/s11904-018-0399-7

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