Insulin resistance change and antiretroviral therapy exposure in HIV-infected and uninfected Rwandan women: A longitudinal analysis

Eugene Mutimura, Donald R. Hoover, Qiuhu Shi, Jean Claude Dusingize, Jean D Amour Sinayobye, Mardge Cohen, Kathryn Anastos

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Abstract

Background: We longitudinally assessed predictors of insulin resistance (IR) change among HIV-uninfected and HIV-infected (ART-initiators and ART-non-initiators) Rwandan women. Methodology: HIV-infected (HIV+) and uninfected (HIV-) women provided demographic and clinical measures: age, body mass index (BMI) in Kg/(height in meters)<sup>2</sup>, Fat-Mass (FMI) and Fat-Free-Mass (FFMI) index, fasting serum glucose and insulin. Homeostasis Model Assessment (HOMA) was calculated to estimate IR change over time in log10 transformed HOMA measured at study enrollment or prior to ART initiation in 3 groups: HIV- (n = 194), HIV+ ART-non-initiators (n=95) and HIV+ ART-initiators (n=371). ANCOVA linear regression models of change in log<inf>10</inf>-HOMA were fit with all models included the first log10 HOMA as a predictor. Results: Mean ±SD log<inf>10</inf>-HOMA was -0.18 ±0.39 at the 1<sup>st</sup> and -0.21±0.41 at the 2<sup>nd</sup> measure, with mean change of 0.03±0.44. In the final model (all women) BMI at 1<sup>st</sup> HOMA measure (0.014; 95% CI=0.006-0.021 per kg/m<sup>2</sup>; p<0.001) and change in BMI from 1<sup>st</sup> to 2<sup>nd</sup> measure (0.024; 95% CI=0.013-0.035 per kg/m<sup>2</sup>; p<0.001) predicted HOMA change. When restricted to subjects with FMI measures, FMI at 1<sup>st</sup> HOMA measure (0.020; 95% CI=0.010-0.030 per kg/m<sup>2</sup>; p <0.001) and change in FMI from 1<sup>st</sup> to 2<sup>nd</sup> measure (0.032; 95% CI=0.020-0.043 per kg/m<sup>2</sup>; p<0.0001) predicted change in HOMA. While ART use did not predict change in log<inf>10</inf>-HOMA, untreated HIV+ women had a significant decline in IR over time. Use or duration of AZT, d4T and EFV was not associated with HOMA change in HIV+ women. Conclusions: Baseline BMI and change in BMI, and in particular fat mass and change in fat mass predicted insulin resistance change over ∼3 years in HIV-infected and uninfected Rwandan women. Exposure to specific ART (d4T, AZT, EFV) did not predict insulin resistance change in ART-treated HIV-infected Rwandan women.

Original languageEnglish (US)
Article numbere0123936
JournalPLoS One
Volume10
Issue number4
DOIs
StatePublished - Apr 16 2015

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Implosive Therapy
insulin resistance
Insulin Resistance
HIV
Insulin
homeostasis
therapeutics
Homeostasis
body mass index
Body Mass Index
Fats
lipids
Linear Models
Linear regression
fasting

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

Insulin resistance change and antiretroviral therapy exposure in HIV-infected and uninfected Rwandan women : A longitudinal analysis. / Mutimura, Eugene; Hoover, Donald R.; Shi, Qiuhu; Dusingize, Jean Claude; Sinayobye, Jean D Amour; Cohen, Mardge; Anastos, Kathryn.

In: PLoS One, Vol. 10, No. 4, e0123936, 16.04.2015.

Research output: Contribution to journalArticle

Mutimura, Eugene ; Hoover, Donald R. ; Shi, Qiuhu ; Dusingize, Jean Claude ; Sinayobye, Jean D Amour ; Cohen, Mardge ; Anastos, Kathryn. / Insulin resistance change and antiretroviral therapy exposure in HIV-infected and uninfected Rwandan women : A longitudinal analysis. In: PLoS One. 2015 ; Vol. 10, No. 4.
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abstract = "Background: We longitudinally assessed predictors of insulin resistance (IR) change among HIV-uninfected and HIV-infected (ART-initiators and ART-non-initiators) Rwandan women. Methodology: HIV-infected (HIV+) and uninfected (HIV-) women provided demographic and clinical measures: age, body mass index (BMI) in Kg/(height in meters)2, Fat-Mass (FMI) and Fat-Free-Mass (FFMI) index, fasting serum glucose and insulin. Homeostasis Model Assessment (HOMA) was calculated to estimate IR change over time in log10 transformed HOMA measured at study enrollment or prior to ART initiation in 3 groups: HIV- (n = 194), HIV+ ART-non-initiators (n=95) and HIV+ ART-initiators (n=371). ANCOVA linear regression models of change in log10-HOMA were fit with all models included the first log10 HOMA as a predictor. Results: Mean ±SD log10-HOMA was -0.18 ±0.39 at the 1st and -0.21±0.41 at the 2nd measure, with mean change of 0.03±0.44. In the final model (all women) BMI at 1st HOMA measure (0.014; 95{\%} CI=0.006-0.021 per kg/m2; p<0.001) and change in BMI from 1st to 2nd measure (0.024; 95{\%} CI=0.013-0.035 per kg/m2; p<0.001) predicted HOMA change. When restricted to subjects with FMI measures, FMI at 1st HOMA measure (0.020; 95{\%} CI=0.010-0.030 per kg/m2; p <0.001) and change in FMI from 1st to 2nd measure (0.032; 95{\%} CI=0.020-0.043 per kg/m2; p<0.0001) predicted change in HOMA. While ART use did not predict change in log10-HOMA, untreated HIV+ women had a significant decline in IR over time. Use or duration of AZT, d4T and EFV was not associated with HOMA change in HIV+ women. Conclusions: Baseline BMI and change in BMI, and in particular fat mass and change in fat mass predicted insulin resistance change over ∼3 years in HIV-infected and uninfected Rwandan women. Exposure to specific ART (d4T, AZT, EFV) did not predict insulin resistance change in ART-treated HIV-infected Rwandan women.",
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T1 - Insulin resistance change and antiretroviral therapy exposure in HIV-infected and uninfected Rwandan women

T2 - A longitudinal analysis

AU - Mutimura, Eugene

AU - Hoover, Donald R.

AU - Shi, Qiuhu

AU - Dusingize, Jean Claude

AU - Sinayobye, Jean D Amour

AU - Cohen, Mardge

AU - Anastos, Kathryn

PY - 2015/4/16

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N2 - Background: We longitudinally assessed predictors of insulin resistance (IR) change among HIV-uninfected and HIV-infected (ART-initiators and ART-non-initiators) Rwandan women. Methodology: HIV-infected (HIV+) and uninfected (HIV-) women provided demographic and clinical measures: age, body mass index (BMI) in Kg/(height in meters)2, Fat-Mass (FMI) and Fat-Free-Mass (FFMI) index, fasting serum glucose and insulin. Homeostasis Model Assessment (HOMA) was calculated to estimate IR change over time in log10 transformed HOMA measured at study enrollment or prior to ART initiation in 3 groups: HIV- (n = 194), HIV+ ART-non-initiators (n=95) and HIV+ ART-initiators (n=371). ANCOVA linear regression models of change in log10-HOMA were fit with all models included the first log10 HOMA as a predictor. Results: Mean ±SD log10-HOMA was -0.18 ±0.39 at the 1st and -0.21±0.41 at the 2nd measure, with mean change of 0.03±0.44. In the final model (all women) BMI at 1st HOMA measure (0.014; 95% CI=0.006-0.021 per kg/m2; p<0.001) and change in BMI from 1st to 2nd measure (0.024; 95% CI=0.013-0.035 per kg/m2; p<0.001) predicted HOMA change. When restricted to subjects with FMI measures, FMI at 1st HOMA measure (0.020; 95% CI=0.010-0.030 per kg/m2; p <0.001) and change in FMI from 1st to 2nd measure (0.032; 95% CI=0.020-0.043 per kg/m2; p<0.0001) predicted change in HOMA. While ART use did not predict change in log10-HOMA, untreated HIV+ women had a significant decline in IR over time. Use or duration of AZT, d4T and EFV was not associated with HOMA change in HIV+ women. Conclusions: Baseline BMI and change in BMI, and in particular fat mass and change in fat mass predicted insulin resistance change over ∼3 years in HIV-infected and uninfected Rwandan women. Exposure to specific ART (d4T, AZT, EFV) did not predict insulin resistance change in ART-treated HIV-infected Rwandan women.

AB - Background: We longitudinally assessed predictors of insulin resistance (IR) change among HIV-uninfected and HIV-infected (ART-initiators and ART-non-initiators) Rwandan women. Methodology: HIV-infected (HIV+) and uninfected (HIV-) women provided demographic and clinical measures: age, body mass index (BMI) in Kg/(height in meters)2, Fat-Mass (FMI) and Fat-Free-Mass (FFMI) index, fasting serum glucose and insulin. Homeostasis Model Assessment (HOMA) was calculated to estimate IR change over time in log10 transformed HOMA measured at study enrollment or prior to ART initiation in 3 groups: HIV- (n = 194), HIV+ ART-non-initiators (n=95) and HIV+ ART-initiators (n=371). ANCOVA linear regression models of change in log10-HOMA were fit with all models included the first log10 HOMA as a predictor. Results: Mean ±SD log10-HOMA was -0.18 ±0.39 at the 1st and -0.21±0.41 at the 2nd measure, with mean change of 0.03±0.44. In the final model (all women) BMI at 1st HOMA measure (0.014; 95% CI=0.006-0.021 per kg/m2; p<0.001) and change in BMI from 1st to 2nd measure (0.024; 95% CI=0.013-0.035 per kg/m2; p<0.001) predicted HOMA change. When restricted to subjects with FMI measures, FMI at 1st HOMA measure (0.020; 95% CI=0.010-0.030 per kg/m2; p <0.001) and change in FMI from 1st to 2nd measure (0.032; 95% CI=0.020-0.043 per kg/m2; p<0.0001) predicted change in HOMA. While ART use did not predict change in log10-HOMA, untreated HIV+ women had a significant decline in IR over time. Use or duration of AZT, d4T and EFV was not associated with HOMA change in HIV+ women. Conclusions: Baseline BMI and change in BMI, and in particular fat mass and change in fat mass predicted insulin resistance change over ∼3 years in HIV-infected and uninfected Rwandan women. Exposure to specific ART (d4T, AZT, EFV) did not predict insulin resistance change in ART-treated HIV-infected Rwandan women.

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