Insulin resistance in people living with HIV is associated with exposure to thymidine analogues and/or didanosine and prior immunodeficiency

Background: As people living with HIV (PLWH) are growing older, there is increased incidence of metabolic diseases, including diabetes, for which insulin resistance (IR) is a key determinant. In this study, we aimed to investigate risk factors associated with insulin resistance in PLWH. Methods: : We included well-regulated PLWH without hepatitis co-infection, and with available fasting serum insulin and plasma glucose (n=643) from the Copenhagen Comorbidity in HIV Infection Study. Insulin resistance was calculated using the homeostasis model assessment of insulin resistance (HOMA-IR). We investigated the association between risk factors and high HOMA-IR in a logistic regression model adjusted for age, sex, abdominal obesity, smoking status, and origin. When including use of thymidine analogues and/or didanosine in the model, we also adjusted for time with HIV. Results: : Median [IQR] age of PLWH was (IQR) age was 52 years (46-61), 87% (n=557) were male. Median [IQR] insulin resistance was 1.86 [1.23-3.14] mmol/L x mU/L. Risk factors significantly associated with insulin resistance included age, BMI ≥25, abdominal obesity, use of thymidine analogues and/or didanosine, duration of treatment with antiretroviral therapy, and CD4 + nadir < 200. Conclusions: : Insulin resistance in PLWH is associated with both use of thymidine analogues and/or didanosine and prior immunodeficiency suggesting that increased attention on blood glucose in these patients could be beneficial.