Berket Yemane, Melaku Umeta, Fikre Enquselassie, Wondwossen Amogne

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Berket Yemane, Melaku Umeta, Fikre Enquselassie, Wondwossen Amogne Insulin Resistance in adult Ethiopian HIV positive patients receiving NNRTI based first line antiretroviral Therapy Berket Yemane, Melaku Umeta, Fikre Enquselassie, Wondwossen Amogne

Metabolic Complications? Bone Dysregulation of glucose metabolism Body fat redistribution Lipid abnormalities Mitochondrial Toxicity

Soaring Diabetes statistics in Ethiopia Do ARVs contribute to this problem? Statistics International Diabetes Federation, 2011 ( Ref: http://www.idf.org/diabetesatlas/map) 1 - Prevalence of DM age 20-79 yrs= 3-5% (1.37 m) + 2- Prevalence of IGT age 20-79 yrs= 8.2% (3.26 m) > 4.5 million pts in Ethiopia (11.7% aged 20-79)

Study objectives In Ethiopian patients taking NNRTI based first line antiretroviral therapy, evaluate: 1. Prevalence of Insulin Resistance (IR) & related factors. 2. Prevalence of Dysglycemia & Dyslipidemia. 3. Prevalence of Metabolic syndrome 4. the Framingham score to estimate cardiovascular risk.

Results

Baseline characteristics Variables Cases=172 Controls=174 P-value Age(median +IQR) 39(33-47) 37(31-43) 0.8 Male: Female 0.91 1 HIV duration since diagnosis (months, median + IQR) 45( 36-60) 27(17-38) <0.05 Smoking # (%) 5 (2.9%) 4 (2.3%) 0.74 BMI Kgs/m2 (median +IQR) 21.6(19.6-24.3) 22(20-24.8) 0.9 Last CD4 count (median + IQR) 266(182-353) 339(280-411)

Types of antiretroviral regimen

Duration of antiretroviral therapy in weeks

Group comparison Variable Cases Controls P-value TG (mg/dl) 139.5 (105.3-181.8) 123.5 (92.3-170.8) <0.05 Chol-T (mg/dl) 170.0 (142.3-200) 154.5 (128-176) <0.001 NEFA (mmol/l) 0.3 (0.2-0.5) 0.3 (0.2-0.4) 0.4 LDL (mg/dl) 65 (55-79) 62 (54-69.8) Chol: HDL ratio 3 (2.4-4.5) 2.7 (2-3.5) LDL: HDL ratio 1.3 (0.9-1.7) 1.1 (0.8-1.4) HDL (mg/dl) 51.5 (39-69) 56 (45.3-72.5) 0.1 FPG (mg/dl) 103.5 (88-122) 95 (84-107.8) FSI (IU/ml) 4.4 (3.7-7.3) 5.1 (3.9-8.7) HOMA-IR 1.1(0.8-1.9) 1.2 (0.8-1.9) 0.6

Correlation between HOMA and FPG, TG, Chol (T) & NEFA.

Framingham score values

Metabolic & CVS risks compared Cases Controls P-value Framingham score % mean + sd 3.9% + 4 2.9% + 3 0.015 Metabolic syndrome (%) 14(8%) 12(6.9%) 0.68 IFG (%) 60(34.5%) 58(33.3%) 0.82 Diabetes mellitus (%) 40(23%) 15(8.6%) 0.001 IFG & DM grouped (%) 100(57.5%) 73(42%) 0.004

Conclusion No strong correlation b/n NNRTI-based regimens & IR. Long term cumulative effect due to ↑ TG, age and HAART can’t be ruled out. Lipid adverse Effect of some NRTIs may be counterbalanced by lipid friendly ARVs like NVP. Framingham score not useful predicator in the young HIV- infected age group (< 30 yrs). ↑FPG detected among the cases not aware of DM. + DM prevalence increasing in the general population. = → Need for more frequent screening in the ART clinics.

Thank you. Acknowledgment to 1. Addis Ababa University, School of Medicine 2. ART clinic staff at TAH 3. Ras Desta Hospital 4. Patients who voluntarily participated.