Insulin resistance and diabetes mellitus in individuals with HIV infection under antiretroviral therapy and oral anti-diabetic therapeutic
Keywords:
Insulin resistance, antidiabetic therapy, antiretroviral therapyAbstract
Treatment of HIV infection with highly active antiretroviral therapy
(HAART) can induce severe metabolic complications, including
insulin resistance, which is likely to confer an increased incidence
of cardiovascular disease. Both protease inhibitors (PI) and, to a
lesser extent, nucleoside analogue reverse transcriptase inhibitors
(NRTIs) appear to be involved, through direct metabolic effects of
PI and an indirect effect of PI and NRTI. This definitions, metabolic
syndrome and insulin resistance, exist to identify those “at risk”
and, although treatment is commonly recommended, antidiabetic
therapy is likely to be of greater benefit in those patients with
a greater perceived cardiovascular risk and the lowest risk of
HIV disease progression. The most effective strategies for the
treatment of diabetes in patients under HAART appear to be IP
switching and/or initial antidiabetic therapy administration, with
metformin or tioglitazones; however, all oral antidiabetics have
their role in this patient’s type and are not significant interactions
between different antidiabetics and antiretroviral therapy were
described until now.
Downloads
References
Kathleen M, Yanga Y, David AW et al. Effects of Metformin and Rosiglitazone in HIV-infected Patients with Hyperinsulinemia and Elevated Waist/Hip Ratio. N Engl J Med 1996; 334: 952-957.
Bruno R, Gazzaruso C, Sacchi P et al. High prevalence of metabolic syndrome among HIV-infected patients: link with the cardiovascular risk. J Acquir Immune Defic Syndr 2002; 31:363-365.
Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001; 285 (19): 2486– 2497.
Justman JE, Benning L, Danoff A et al. Protease inhibitor use and the incidence of diabetes mellitus in a large cohort of HIV-infected women. J Acquir Immune Defic Syndr 2003; 32: 298-302.
Dad Study Group. Class of Antiretroviral Drugs and the Risk of Myocardial Infarction. NEJM 2007; 356: 1723-1735.
Aberg JA et al. Cardiovascular complications in HIV management past, present, and future. J Acquir Immune Defic Syndr 2009; 50 (1): 54-64.
Florescu D, Kotler DP. Insulin resistance, glucose intolerance and diabetes mellitus in HIV-infected patients. Antivir Ther. 2007;12 (2):149-162.
Katherine S, Handan W, Matthew L et al. Prevalence of Metabolic Syndrome in HIV-Infected Patients Receiving Highly Active Antiretroviral Therapy Using International Diabetes Foundation and Adult Treatment Panel III Criteria. Diabetes Care 2007; 30: 113-119.
Behrens G, Dejam A, Schimidt H et al. Impaired glucose tolerance, beta cell function and lipid metabolism in HIV patients under treatment with protease inhibitors. AIDS 1999; 13 (10): F63-70.
Todd TB, Stephen RC, Xiuhong Li et al. Antiretroviral Therapy and the Prevalence and Incidence of Diabetes Mellitus in the Multicenter AIDS Cohort Study. Arch Intern Med. 2005; 165:1179-1184.
Noor MA, Flint OP, Maa JF, Parker RA. Effects of atazanavir/ritonavir and lopinavir/ritonavir on glucose uptake and insulin sensitivity: demonstrable differences in vitro and clinically. AIDS 2006; 20 (14): 1813-1821.
Dragsted UB, Gerstoft J, Pedersen C et al, for the MaxCmin1 Trial Group. Randomized trial to evaluate indinavir/ritonavir versus saquinavir/ritonavir in human immunodeficiency virus type 1-infected patients: the MaxCmin1 Trial. J Infect Dis 2003; 188:635-642.
Saint-Marc T, Partisani M, Poizot-Martin I et al. A syndrome of peripheral fat wasting (lipodystrophy) in patients receiving long-term nucleoside analogue therapy. AIDS 1999; 13: 1659-1967;
Carr A, Miller J, Law M et al. A syndrome of lipoatrophy, lactic acidaemia and liver dysfunction associated with HIV nucleoside analogue therapy: contribution to protease inhibitor-related lipodystrophy syndrome. AIDS 2000; 14(3):F25-F32.
Noor MA, Senevitatne T, Aweeka FT et al. Indinavir acutely inhibits insulin-stimulated glucose disposal in humans: a randomized, placebo-controlled study. AIDS 2002; 16(5):F1-8.
Gang H, Pekka J et Jaakko T. Prevalence of Nonalcoholic Fatty Liver Disease and Its Association With Cardiovascular Disease Among Type 2 Diabetic Patients: Response to Talim. Diabetes Care 2007; 30: e56.
Lars R, Eberhard S, Malgorzata B et al. Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: executive summary: The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and
of the European Association for the Study of Diabetes (EASD). European Heart Journal 2007; 28: 88-136.
Knowler WC, Barret-Connor E, Fowler SE et al. Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346 (6): 393-403.
American Diabetes Association. The Prevention or Delay of Type 2 Diabetes.
Diabetes Care 2002; 25: 742-749.
The Dream Trial Investigators. Effect of Ramipril in the Incidence of Diabetes. N Engl J Med 2006; 355: 1551-1562.
Ramachandran A, Snehalatha C, Mary S et al. Indian Diabetes Prevention Programme (IDPP). The Indian Diabetes Prevention Programme shows that lifestyle modification and metformin prevent type 2 diabetes in Asian Indian subjects with impaired glucose tolerance (IDPP-1). Diabetologia 2006;49:289-97.
Wohl DA, Mccomsey G, Tebas P et al. Current concepts in the diagnosis and management of metabolic complications of HIV infection and its therapy. Clin Infect Dis 2006; 43 (5): 645-653.
Saint-Marc T, Touraine JL. Effects of metformin on insulin resistance and central adiposity in patients receiving effective protease inhibitor therapy. AIDS 1999; 13:1000-1002.
Hadigan C, Corcoran C, Basgoz N et al. Metformin in the treatment of HIV lipodystrophy syndrome: A randomized controlled trial. JAMA 2000; 284(4): 472-7 284: 472.
Rui D, Elisabete R, Sequeira D et al. Recomendações da Sociedade Portuguesa de Diabetologia para o Tratamento da Hiperglicemia e Factores de Risco na Diabetes Tipo 2. Revista Portuguesa de Diabetes. 2007; 2 (4): 5-18.
Rosenstock J, Brazg R, Andryuk PJ et al. Efficacy and safety of the dipeptidyl peptidase-4 inhibitor sitagliptin added to ongoing pioglitazone
therapy in patients with type 2 diabetes: a 24-week, multicenter, randomized, double-blind, placebo-controlled, parallel-group study. Clin Ther. 2006; 28 (10): 1556-1568.
Bernard C, Avraham K, JI L et al. Efficacy and Safety of the Dipeptidyl Peptidase-4 Inhibitor Sitagliptin Added to Ongoing Metformin Therapy in Patients With Type 2 Diabetes Inadequately Controlled With Metformin Alone. Diabetes Care 2006; 29: 2638-2643.
Bente MB. Cardiovascular Risk in Patients with HIV Infection: Impact of Antiretroviral Therapy. Review Article. Drugs 2006; 66: 1971-1987.
Martinez E, Conget I, Lozano L et al. Reversion of metabolic abnormalities after switching from HIV-1 protease inhibitors to nevirapine. AIDS 1999; 13 (7): 805-810.
Lichtenstein K et al. Analysis of cardiovascular risk factors in the HIV outpatient study cohort. 13th Conference on Retroviruses and Opportunistic (CROI). 2006; Denver, CO Abstract
Additional Files
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2023 Medicina Interna
Open Access
