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

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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.

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Keywords

Insulin Resistance, Efavirenz, Antiretroviral therapy, Rifampicin, TyG index, Ethiopia

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