Association of Gut Intestinal Integrity and Inflammation with Insulin Resistance in Adults Living with HIV in Uganda
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Date
2019
Journal Title
Journal ISSN
Volume Title
Publisher
AIDS Patient Care and STDs
Abstract
We conducted a cross-sectional study of 148 HIV+ on HIV antiretroviral therapy and 149 HIV- adults in
Mbarara, Uganda, to estimate the association between HIV infection and homeostasis model assessment of
insulin resistance (HOMA-IR) using multivariable regression analysis. In addition, we evaluated whether
intestinal fatty acid-binding protein (I-FABP), monocyte activation markers soluble (s)CD14 and sCD163, and
proinflammatory cytokine interleukin 6 (IL-6) mediated this association. HOMA-IR was greater among HIV+
than HIV- adults [median (interquartile range): 1.3 (0.7–2.5) vs. 0.9 (0.5–2.4); p = 0.008]. In models adjusted
for sociodemographic variables, diet, hypertension, and smoking history, HIV infection was associated with
37% [95% confidence intervals (95% CIs): 5–77] greater HOMA-IR compared with HIV- participants. The
magnitude of association was greater when I-FABP was included as a covariate although the additive effect was
modest (40% CI: 8–82). By contrast adding sCD14 to the model was associated with greater HOMA-IR (59%;
95% CI: 21–109) among HIV+ participants compared with HIV- participants. Among HIV+ participants,
greater CD4 nadir was non-significantly associated with greater HOMA-IR (22%; 95% CI: -2 to 52). Each
5-unit increase in body mass index (BMI; 49% greater HOMA-IR; 95% CI: 18–87) and female sex (71%; 95%
CI: 17–150) remained associated in adjusted models. In this study of mainly normal-weight Ugandan adults,
HIV infection, female sex, and greater BMI were all associated with greater insulin resistance (IR). This
association was strengthened modestly after adjustment for sCD14, suggesting possible distinct immune
pathways to IR that are independent of HIV or related to inflammatory changes occurring on HIV treatment.
Description
Keywords
HIV, Insulin resistance, Diabetes mellitus, Sub-Saharan Africa
Citation
Reid, M. J., Ma, Y., Golovaty, I., Okello, S., Sentongo, R., Feng, M., ... & Tien, P. C. (2019). Association of gut Intestinal Integrity and Inflammation with insulin resistance in adults living with HIV in Uganda. AIDS Patient Care and STDs, 33(7), 299-307. DOI: 10.1089/apc.2019.0032