Determination of efavirenz based Antiretroviral Therapy associated Insulin Resistance in adult Human Immunodeficiency Virus infected patients receiving Antiretroviral Therapy alone and in combination with Anti Tuberculosis drugs in Addis Ababa.
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Date
2019-06
Authors
Journal Title
Journal ISSN
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Publisher
Addis Abeba University
Abstract
The invention of Highly Active Antiretroviral Therapy (HAART) has achromatized the Human
Immunodeficiency Virus (HIV) infection from a fatal disease to a chronic condition marked by
reduced morbidity and mortality. This success in controlling HIV replication and restoring immunity
has been displeasured by the acclamation that metabolic changes, such as Insulin Resistance (IR) are
increasing among people living with HIV. The goal of this study was to determine IR and assess risk
factors associated with it among HIV infected patients receiving efavirenz (EFV) based antiretroviral
medications alone and in combination with rifampicin (RIF) based anti-Tuberculosis (TB)
medications. A prospective and comparative two arm cohort study of 30 HIV infected patients on
HAART and 30 TB-HIV coinfected patients on HAART and Anti-Tuberculosis drugs was employed.
Blood samples of patients with HIV infection and TB-HIV co-infection were identified and
compared for presence of insulin resistance. Association between insulin resistance and risk factors
was analyzed. The Mean Triglyceride to Glucose (TyG) index, the measure of IR, in HIV infected
groups receiving EFV based HAART alone and TB-HIV co-infected groups receiving EFV based
HAART in combination with RIF based anti TB, was not significantly different. Baseline plasma
triglyceride was associated with elevated TyG index and IR (OR, 95% CI = 1.170; p < 0.01) in the
TB-HIV co-infected groups. In both treatment groups, a significant mean difference in IR was
observed in patients with an advanced HIV infection. In HIV only treatment group, a higher mean
TyG was found among stage 4 patients at week 4 (p = 0.034) and week 16 (p = 0.049); and in TB HIV
cotreatment
groups,
a
higher
mean
TyG
index
was
found
among
stage
4 patients
at
week
16 (p =
0.019).
No
significant
difference in insulin resistance was observed between HIV patients receiving
EFV based Antiretroviral Therapy (ART) alone and TB-HIV co-infected patients receiving EFV
based ART with RIF based Anti TB medications. EFV based HAART can lead to insulin resistance
independent of HIV and non-HIV related risk factors.
Description
Keywords
Insulin Resistance, Efavirenz, Antiretroviral therapy, Rifampicin, TyG index, Ethiopia