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Session 90 Poster Session Incidence, Prevalence, and Pathogenic Correlates of Insulin Resistance and Lipodystrophy Syndrome Session Time: 4:30-6:30 pm Room 4E-F

676-T. Screening for Insulin Resistance in HIV Infection J. Falutz* and R. Gardiner Montreal Gen. Hosp., QC, Canada Background: Dyslipidemia and insulin resistance (IR), known risk factors for atherosclerosis, occur frequently in HIV-infected subjects on HAART. Routine screening tests for IR remain controversial, and include the oral glucose tolerance test (OGTT), the homeostasis model assessment (HOMA), elevated fasting insulin (FI), and fasting glucose (FBG). We compared the usefulness of several screening tests for IR to the standard OGTT. Methods: 32 HIV-positive males (n=29) and females (n=3) underwent a standard OGTT and FI determination. The HOMA was calculated (HOMA = [FI x FBG]/22.5). Subjects were characterized as having either normal glucose tolerance (NGT) or impaired glucose tolerance (IGT), consistent with IR, as per the ADA. A HOMA of >4.0, an elevated FI, and a FBG 6.1-7.0 mmol/L, represents IR. Results: Of the 32 patients evaluated, 22 (69%) had NGT on the basis of the OGTT, 9 (28%) had IGT and 1 had DM. The mean age of NGT patients (43±8.5), was similar to patients with IGT (47±11.0). Elevated FBG levels consistent with a diagnosis of impaired fasting glucose (IFG) were found in 4/32 (12.5%); elevated FI occurred in 7/32 (22%), and a calculated HOMA >4.0 occurred in 8/32 (25%). There was no difference in the BMI (Ht/m2) between the NGT group (22.9±5.9) and the IGT group (24.9±3.7). Of the 9 patients with IGT by OGTT, 3/9 had IFG, 5/9 had increased FI, and 5/9 had a HOMA >4.0. Of the 9 patients identified with IGT, only 6 were also identified on the basis of either an elevated FI and/or an elevated HOMA. Of 8 patients with a HOMA >4.0, 7/8 had elevated FI, 4/8 had IFG, and 6/8 had IGT. Conclusions: Abnormal parameters of glucose homeostasis occurred in a significant minority of HIV-infected individuals receiving successful HAART therapy. Elevated FBG alone did not identify most patients who had abnormal parameters on other screening tests. Based on these preliminary results, the use of either elevated FBG, elevated FI, or an elevated HOMA cannot currently be recommended for IR screening. The standard OGTT remains the most reliable screening test available in this population.

©2002 9th Conference on Retroviruses and Opportunistic Infections