1. 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

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

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

4. 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.

5. Results

6. 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( )
22( )
0.9
Last CD4 count
(median + IQR)
266( )
339( )

7. Types of antiretroviral regimen

8. Duration of antiretroviral therapy in weeks

9. Group comparison Variable Cases Controls P-value TG (mg/dl)
139.5 ( )
123.5 ( )
<0.05
Chol-T (mg/dl)
170.0 ( )
154.5 ( )
<0.001
NEFA (mmol/l)
0.3 ( )
0.3 ( )
0.4
LDL (mg/dl)
65 (55-79)
62 ( )
Chol: HDL ratio
3 ( )
2.7 (2-3.5)
LDL: HDL ratio
1.3 ( )
1.1 ( )
HDL (mg/dl)
51.5 (39-69)
56 ( )
0.1
FPG (mg/dl)
103.5 (88-122)
95 ( )
FSI (IU/ml)
4.4 ( )
5.1 ( )
HOMA-IR
1.1( )
1.2 ( )
0.6

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

11. Framingham score values

12. 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

13. 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.

14. 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.