Department of Medicine, St. John's Medical College, Bangalore, India.
Int J Gen Med. 2011 Jan 23;4:73-8. doi: 10.2147/IJGM.S15818.
Insulin resistance, diabetes mellitus, and metabolic syndrome in patients with human immunodeficiency virus (HIV) infection are increasingly being reported in the global medical literature. This cross-sectional study was done to describe the occurrence of metabolic syndrome, diabetes mellitus, and insulin resistance in HIV-positive patients in a tertiary referral center in South India. A total of 60 patients who had HIV infection for 12 months or more were enrolled in the study. Of these, 30 patients were antiretroviral therapy (ART)-naïve, and 30 were treated with ART. Biochemical estimations (fasting blood glucose, 75 g oral glucose tolerance test, lipid profile, and fasting insulin) and anthropometric measurements (height, weight, and waist circumference) were performed for each patient. Metabolic syndrome was diagnosed using National Cholesterol Education Program-Adult Treatment Plan III criteria, and insulin resistance was calculated applying the homeostasis model assessment method. Diabetes mellitus, impaired fasting glycemia, and impaired glucose tolerance were diagnosed based on American Diabetes Association criteria. A high prevalence of metabolic syndrome was observed in patients with HIV (16/60), and was more prevalent in the ART-treated group (13/30; P = 0.028). Similarly, insulin resistance was also noted to be high (24/60), and of these patients, 15 were on ART. Seventy-five percent of patients with metabolic syndrome had insulin resistance. Diabetes was diagnosed in one patient who was ART-naïve and in six patients who were on ART. Our observations suggest an increased prevalence of metabolic syndrome, insulin resistance, and diabetes mellitus in ART-treated patients. These warrant attention and substantiation with larger studies. While ART improves survival, it may lead on to cardiovascular morbidity and mortality, especially in the Indian subcontinent where there is a genetic predisposition to cardiovascular risk.
在全球医学文献中，越来越多的报道提到人类免疫缺陷病毒（HIV）感染患者出现胰岛素抵抗、糖尿病和代谢综合征。本横断面研究旨在描述在印度南部一家三级转诊中心的 HIV 阳性患者中代谢综合征、糖尿病和胰岛素抵抗的发生情况。共纳入 60 名 HIV 感染时间达 12 个月或以上的患者。其中，30 名患者为未接受抗逆转录病毒治疗（ART）的初治患者，30 名患者接受了 ART 治疗。对每位患者进行生化指标（空腹血糖、75g 口服葡萄糖耐量试验、血脂谱和空腹胰岛素）和人体测量学指标（身高、体重和腰围）的检测。采用美国国家胆固醇教育计划成人治疗专家组 III 标准诊断代谢综合征，应用稳态模型评估法计算胰岛素抵抗。根据美国糖尿病协会标准诊断糖尿病、空腹血糖受损和糖耐量受损。HIV 患者中代谢综合征的患病率较高（16/60），且在接受 ART 治疗的患者中更为常见（13/30；P=0.028）。同样，也发现胰岛素抵抗的患病率较高（24/60），其中 15 名患者正在接受 ART 治疗。有代谢综合征的患者中有 75%存在胰岛素抵抗。1 名初治患者和 6 名接受 ART 治疗的患者被诊断为糖尿病。我们的观察结果表明，接受 ART 治疗的患者中代谢综合征、胰岛素抵抗和糖尿病的患病率增加。这些需要引起重视，并通过更大规模的研究加以证实。虽然 ART 提高了生存率，但它可能导致心血管发病率和死亡率增加，尤其是在印度次大陆，那里存在心血管风险的遗传易感性。
