Relationship of ethnicity and CD4 Count with glucose metabolism among HIV patients on Highly-Active Antiretroviral Therapy (HAART)

BMC Endocrine Disorders

Ashok Balasubramanyam²  Rajagopal V Sekhar²  Dorothy E Lewis⁸  Ivonne Coraza⁶  Henry J Pownall¹  Shivani Shinde³  Dustin M Long⁴  Steven E Riechman⁷  Prakash Chandra⁵  Ranjita Misra⁷ 

[1] Section of Atherosclerosis and Lipoprotein Research, Baylor College of Medicine, Houston, TX, USA;Endocrine Service, Ben Taub General Hospital, Houston, TX, USA;University of Texas School of Public Health, Houston, TX, USA;Department of Biostatistics, West Virginia University, Morgantown, USA;Translational Metabolism Unit, Division of Diabetes, Endocrinology and Metabolism, Baylor College of Medicine, Houston, TX, USA;Legacy Community Health Services, Houston, TX, USA;Department of Social and Behavioral Sciences, School of Public Health, West Virginia University, Morgantown, USA;Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA

关键词: Dyslipidemia;    HbA1c;    Impaired glucose tolerance;    Hispanic;    African American;   

Others  :  1085909
DOI  :  10.1186/1472-6823-13-13

 received in 2012-08-22, accepted in 2013-03-18,  发布年份 2013

【 摘 要 】

Background

HIV patients on HAART are prone to metabolic abnormalities, including insulin resistance, lipodystrophy and diabetes. This study purports to investigate the relationship of ethnicity and CD4+ T cell count attained after stable highly-active antiretroviral treatment (HAART) with glucose metabolism in hyperrtriglyceridemic HIV patients without a history of diabetes.

Methods

Demographic, anthropometric, clinical, endocrinologic, energy expenditure and metabolic measures were obtained in 199 multiethnic, healthy but hypertriglyceridemic HIV-infected patients [46% Hispanic, 17% African-American, 37% Non-Hispanic White (NHW)] on stable HAART without a history of diabetes. The relationship of glucose and insulin responses to ethnicity, CD4 strata (low (<300/cc) or moderate-to-high (≥ 300/cc)), and their interaction was determined.

Results

African-Americans had significantly greater impairment of glucose tolerance (P < 0.05) and HbA1c levels (P < .001) than either Hispanics or NHWs. In multivariate models, after adjusting for confounders (age, sex, HIV/HAART duration, smoking, obesity, glucose, insulin and lipids), African-Americans and Hispanics had significantly higher HbA1c and 2-hour glucose levels than NHW’s. Demonstrating a significant interaction between ethnicity and CD4 count (P = 0.023), African Americans with CD4 <300/cc and Hispanics with CD4 ≥300/cc had the most impaired glucose response following oral glucose challenge.

Conclusions

Among hypertriglyceridemic HIV patients on HAART, African-Americans and Hispanics are at increased risk of developing diabetes. Ethnicity also interacts with CD4+ T cell count attained on stable HAART to affect post-challenge glycemic response.

【 授权许可】

   
2013 Misra et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 6.

【 参考文献 】

• [1]CDC: HIV Prevalence Estimates - United States, 2006. MMWR 2008, 57(39):1073-1076. Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5739a2.htm webcite
• [2]CDC Fact Sheet: HIV and AIDS among African Americans. 2011. Available at http://www.cdc.gov/nchhstp/newsroom/docs/FastFacts-AA-FINAL508COMP.pdf webcite
• [3]Mondy K, Overton ET, Grubb J, Tong S, Seyfried W, Powderly W, et al.: Metabolic syndrome in HIV-infected patients from an urban, midwestern US outpatient population. Clin Infect Dis 2007, 44:726-734.
• [4]Hadigan C, Meigs JB, Corcoran C, Rietschel P, Piecuch S, Basgoz N, et al.: Metabolic abnormalities and cardiovascular disease risk factors in adults with human immunodeficiency virus infection and lipodystrophy. Clin Infect Dis 2001, 32:130-139.
• [5]Vigouroux C, Gharakhanian S, Salhi Y, Nguyen TH, Chevenne D, Capeau J, et al.: Diabetes, insulin resistance and dyslipidaemia in lipodystrophic HIV-infected patients on highly active antiretroviral therapy (HAART). Diabetes Metab 1999, 25:225-232.
• [6]Kotler DP, Thea DM, Heo M, Allison DB, Engelson ES, Wang J, et al.: Relative influences of sex, race, environment, and HIV infection on body composition in adults. Am J Clin Nutr 1999, 69:432-439.
• [7]Miech RA, Kim J, McConnell C, Hamman RF: A growing disparity in diabetes-related mortality U.S. trends, 1989–2005. Am J Prev Med 2009, 36:126-132.
• [8]Bleyer AJ, Hire D, Russell GB, Xu J, Divers J, Shihabi Z, et al.: Ethnic variation in the correlation between random serum glucose concentration and glycated haemoglobin. Diabet Med 2009, 26:128-133.
• [9]Herman WH, Ma Y, Uwaifo G, Haffner S, Kahn SE, Horton ES, et al.: Differences in A1C by race and ethnicity among patients with impaired glucose tolerance in the Diabetes Prevention Program. Diabetes Care 2007, 30:2453-2457.
• [10]Glesby MJ, Hoover DR, Shi Q, Danoff A, Howard A, Tien P, et al.: Glycated haemoglobin in diabetic women with and without HIV infection: data from the Women's Interagency HIV Study. Antivir Ther 2010, 15:571-577.
• [11]Howard AA, Floris-Moore M, Lo Y, Arnsten JH, Fleischer N, Klein RS: Abnormal glucose metabolism among older men with or at risk of HIV infection. HIV Med 2006, 7:389-396.
• [12]Mehta SH, Moore RD, Thomas DL, Chaisson RE, Sulkowski MS: The effect of HAART and HCV infection on the development of hyperglycemia among HIV-infected persons. J Acquir Immune Defic Syndr 2003, 33:577-584.
• [13]Balasubramanyam A, Coraza I, Smith EO, Scott LW, Patel P, Iyer D, Taylor AA, Giordano TP, Sekhar RV, Clark P, Cuevas-Sanchez E, Kamble S, Ballantyne CM, Pownall HM: Combination of niacin and fenofibrate with lifestyle changes improves dyslipidemia and hypoadiponectinemia in HIV Patients on ART: results of Heart Positive, a randomized, controlled study. J Clin Endocrinol Metab 2011, 96:2236-2247.
• [14]Ravussin E, Lillioja S, Anderson TE, Christin L, Bogardus C: Determinants of 24-hour energy expenditure in man. Methods and results using a respiratory chamber. J Clin Invest 1986, 78:1568-1578.
• [15]WHO WHO: Antiretroviral therapy for HIV infection in adults and adolescents in resource-limited settings: towards universal access. Edited by HIV/AIDS Do. Geneva, Switzerland: World Health Organization; 2006.
• [16]Gianotti N, Visco F, Galli L, Barda B, Piatti P, Salpietro S, et al.: Detecting impaired glucose tolerance or type 2 diabetes mellitus by means of an oral glucose tolerance test in HIV-infected patients. HIV Med
• [17]Estrada VM-LM, Gonzalez-Lopez A, Tellez MJ, de Villar N, Perez BM: Glucose tolerance, insulin, proinsulin and leptin in protease inhibitor-treated HIV-infected patients with lipoatrophy. Durban, South Africa; 2000. [Paper presented at the 13th International AIDS Conference]
• [18]El-Sadr WM, Mullin CM, Carr A, Gibert C, Rappoport C, Visnegarwala F, et al.: Effects of HIV disease on lipid, glucose and insulin levels: results from a large antiretroviral-naive cohort. HIV Med 2005, 6:114-121.
• [19]Shikuma CM, Waslien C, McKeague J, Baker N, Arakaki M, Cui XW, et al.: Fasting hyperinsulinemia and increased waist-to-hip ratios in non-wasting individuals with AIDS. AIDS 1999, 13:1359-1365.
• [20]Grinspoon S, Carr A: Cardiovascular risk and body-fat abnormalities in HIV-infected adults. N Engl J Med 2005, 352:48-62.
• [21]Jones CY, Wilson IB, Greenberg AS, Shevitz A, Knox TA, Gorbach SL, et al.: Insulin resistance in HIV-infected men and women in the nutrition for healthy living cohort. J Acquir Immune Defic Syndr 2005, 40:202-211.
• [22]Jones RG, Thompson CB: Revving the engine: signal transduction fuels T cell activation. Immunity 2007, 27:173-178.
• [23]Kalev I, Oselin K, Parlist P, Zilmer M, Rajasalu T, Podar T, et al.: CC-chemokine receptor CCR5-del32 mutation as a modifying pathogenetic factor in type I diabetes. J Diabetes Complications 2003, 17:387-391.
• [24]CDC: HIV Surveillance by Race/Ethnicity. Edited by Services DoHaH. Atlanta; 2008.
• [25]Unites States Census Bureau: Census Demographic Profiles. 2010. Available at http://quickfacts.census.gov/qfd/ webcite
• [26]Harris MI, Hadden WC, Knowler WC, Bennett PH: Prevalence of diabetes and impaired glucose tolerance and plasma glucose levels in U.S. population aged 20–74 yr. Diabetes 1987, 36:523-534.
• [27]Unites States Census Bureau: Population Projections. Available at http://www.census.gov/population/projections/ webcite