656   ACTG 5056: Metabolic Status and Cardiovascular Disease Risk for a Cohort of HIV- 1-Infected Persons Durably Suppressed on an Indinavir- Containing Regimen (ACTG 372A).

K. Henry*¹, R. Zackin², M. Dube³, S. Hammer⁴, and J. Currier⁵for the ACTG 5056/372a Team.
¹Univ. of Minnesota;²Harvard Sch. of Publ. Health;³Indiana Univ.;⁴Columbia Univ.; and⁵UCLA, Los Angeles, CA.

Background:There is increasing concern about the health risk related to metabolic effects of therapy. The objective of this study was to evaluate lipid and metabolic status in a cohort of HIV-1-infected patients who achieved durable HIV-1 suppression on a regimen that included the protease inhibitor indinavir (ACTG 372A).

Methods:A cohort of ACTG 372A study subjects had fasting blood samples drawn and stored along with basic cardiovascular risk factor information. A random sample of 100 study subjects had blood samples sent to a central laboratory for metabolic assays. The median age of the study subjects was 40.5 (13% female; 87 % male). 32% of the cohort were smokers, 14% had a history of hypertension, and 10 % had a history of diabetes. The median time enrolled in ACTG 372A was24 months (total time on indinavir = 41.7 months).

Results:The median and noteworthy levels were: glucose = 95mg/dL, insulin = 13.9 mcU/ml (range 0—30), HOMA score = 3.22 (insulin resistance if >2.5) ,cholesterol = 185 mg/dL (39% >200), HDL = 33 mg/dL, LDL = 122.5 mg/dL (46% >130; 24% >160), triglyceride = 184 mg/dL (12% >400), homocysteine = 9.3mmol/L (<10 desirable), apo A1 = 125.5 mg/dL (nl 110—205), apo B = 92.5 mg/dL (nl 50-140), lp(a) = 3 (nl 0—30), and cardiovascular disease score = 4.33 (Circulation100:1481—1492, 1999).

Conclusions:Findings from this study involving durably suppressed HIV-1-infected subjects receiving indinavir + NRTI therapy include elevations in triglycerides and cholesterol, a low HDL, and a high rate of insulin resistance (56%). The constellation of risk factors in this cohort appears to place them at increased risk for coronary artery disease (Circulation97:1837—1847, 1998), warranting intervention for modifiable risk factors.