Clinical Review
Homelessness, HIV, and HCV
The homeless and people without stable housing are shown to have higher rates of HIV and hepatitis C infection and low medication adherence rates...
Targeting insulin resistance (IR) may be an important strategy to reduce cardiovascular events in patients infected with HIV, say researchers from Johns Hopkins University in Baltimore, Maryland, and Northwestern University in Chicago, Illinois.
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To find out whether IR was greater in men infected with HIV and, consequently, whether coronary artery disease would be amplified in those patients, the researchers analyzed data collected over 10 years from 448 men infected with HIV and 306 uninfected men in the Multicenter AIDS Cohort Study. They measured fasting serum insulin and glucose and computed the homeostatic model assessment of IR. At the end of the study, they assessed atherosclerotic disease with computed tomographic angiography (CTA).
Insulin resistance was higher in men infected with HIV when averaged over the course of the study and when measured with CTA. The prevalence of coronary stenosis ≥ 50% was similar between both groups. Men with mean IR values in the highest tertile had nearly 3 times the odds of coronary stenosis than men in the lowest tertile.
Men infected with HIV (of whom about 11% also had hepatitis C infection) were more insulin resistant than those without HIV. Insulin resistance was associated in all the study participants with common cardiovascular disease (CVD) risk factors, such as hypertension, but also with hepatitis C infection. The association between IR and coronary artery stenosis remained after adjustment for multiple CVD risk factors as well as HIV-related variables. That may mean the association is independent of the severity of immune suppression or HIV control.
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Coronary artery stenosis was associated with IR in both groups, particularly when IR values were assessed over the 10 years rather than at the time of the angiography. The researchers say this suggests that long-standing IR is an important contributor to CVD in patients infected with HIV.
Source: Brener MI, Post WS, Haberlen SA, et al. Am J Cardiol. 2016;117(6):993-1000.doi: 10.1016/j.amjcard.2015.12.037.