654   Hepatitis C Virus Chronic Infection Constitutes a Risk Factor for Insulin Resistance in HIV/HVC Co-Infected Patients Undergoing Antiretroviral Therapy.

M. Duong, J. M. Petit*, L. Piroth, M. Grappin, M. Buisson, P. Chavanet, and H. Portier .
Hosp. de Dijon, Dijon, France.

Background:Insulin resistance (IR) in the setting of highly active antiretroviral therapy (HAART) is increasingly common in HIV-infected patients (pts.). However, little is known regarding the factors that may contribute to abnormal insulin sensitivity in this population. It has been demonstrated that pts. with chronic HVC infection have an increased risk of insulin resistance and type 2 diabetes possibly through mechanisms involving increase steatosis or hepatic iron content. The objective of this study was to investigate whether chronic HVC infection constitutes a risk factor for insulin resistance in HIV/HVC pts. under HAART.

Methods:We did a cross-sectional study of HIV/HVC pts. under HAART to assess insulin sensitivity and lipid profile. Inclusion criteria were a positive HCV viremia and a sustained increase of alanine aminotransferase (ALAT) of at least twofold the normal value. 28 HIV/HVC pts., 76 HIV pts. and 121 HVC controls were tested for IR and body mass index (BMI). IR was measured with the homeostasis model assessment (HOMA) using the fasting glucose and insulin concentrations. In HIV/HVC and HIV pts., presence of a peripheral lipoatrophy and lipid profile were assessed.

Results:There was no significant difference in age, CD4 cell count and HIV viral load between HIV/HCV and HIV groups. HIV/HCV and HVC pts. had a significant increase in IR when compared with HIV patients (2.26+1.91, 2.32+2.84 and 1.64+2.34 respectively; p = 0.01 and p = 0.001). BMI was significantly decreased in HIV/ HVC pts. in comparison with HIV and HCV groups (21.70+3.14, 23.01+2.94 and 23.59+3.35 respectively; p = 0.05 and p = 0.01). Lipoatrophy was observed more frequently in VHC/VIH pts. in comparison with HIV pts. (48% versus 19.5%, respectively, p = 0.003). In VHI/VHC pts., total cholesterol levels were significantly lower than in HIV pts. (4.61+1.20 versus 5.49+1.38, p = 0.003).

Conclusions:Our findings suggest that chronic HCV infection is a significant factor associated with the development of metabolic abnormalities and with modifications in body composition in HIV patients receiving antiretroviral treatment.