Association of Gut Intestinal Integrity and Inflammation with Insulin Resistance in Adults Living with HIV in Uganda

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dc.contributor.authorReid, Michael J.A.
dc.contributor.authorMa, Yifei
dc.contributor.authorGolovaty, Iya
dc.contributor.authorOkello, Samson
dc.contributor.authorSentongo, Ruth
dc.contributor.authorFeng, Maggie
dc.contributor.authorTsai, Alexander C.
dc.contributor.authorKakuhikire, Bernard
dc.contributor.authorTracy, Russell
dc.contributor.authorHunt, Peter W.
dc.contributor.authorSiedner, Mark
dc.contributor.authorTien, Phyllis C.
dc.date.accessioned2022-04-29T07:42:24Z
dc.date.available2022-04-29T07:42:24Z
dc.date.issued2019
dc.description.abstractWe 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.en_US
dc.identifier.citationReid, 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.2019.0032en_US
dc.identifier.other10.1089/apc.2019.0032
dc.identifier.urihttps://nru.uncst.go.ug/handle/123456789/2931
dc.language.isoenen_US
dc.publisherAIDS Patient Care and STDsen_US
dc.subjectHIVen_US
dc.subjectInsulin resistanceen_US
dc.subjectDiabetes mellitusen_US
dc.subjectSub-Saharan Africaen_US
dc.titleAssociation of Gut Intestinal Integrity and Inflammation with Insulin Resistance in Adults Living with HIV in Ugandaen_US
dc.typeArticleen_US
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