Background:  HAART-associated effects on glucose control, insulin resistance (IR), lipid metabolism, and body fat redistribution including central obesity may increase the risk of cardiovascular disease in patients living with HIV (PLWH). Chromium (Cr) is an essential micronutrient; Cr deficiency has been reported to cause IR, hyperglycemia, and hyperlipidemia. The purpose of this study was to investigate the effect of chromium supplementation on metabolic abnormalities and IR in PLWH.

Methods:  This was a randomized, double-blind, placebo-controlled trial in 59 HIV⁺ subjects with evidence of body fat redistribution, elevated lipids or glucose and who were found to have IR based on the calculation of homeostatic model of assessment (HOMA = [fasting blood glucose x fasting insulin]/22.5). For inclusion, the HOMA had to be >2.5. Subjects were randomized to receive either 400 µg of Cr-nicotinate (Cr) or placebo for 16 weeks. Fasting blood insulin, glucose, and lipid profile were monitored. Lipodystrophy score was calculated at baseline and body composition was monitored by DEXA scan. Compliance was assessed by pill counts and was 98.5% in Cr and 89.7% in the placebo group. Results are reported as mean (SEM). Analysis was done using paired t-tests to compare pre and post supplementation results.

Results:  A total of 50 subjects (47 male, 3 female) completed the study, 25 in each group. Subjects in both groups were similar with respect to gender distribution, age (Cr 47.6 [1.4]; placebo, 50.1 [1.4] years), body mass index (Cr 26.6 [0.8]; placebo 26.1 [0.7] kg/m²), CD4 count (Cr 483 [48]; placebo 465 [55]), and lipodystrophy score (Cr 7.4 [1.4]; placebo, 8.1 [1.7]).Viral load was undetectable in 72% of Cr and 65.2% of placebo groups. Body weight and medication profile remained stable throughout the study for both groups. Cr supplementation resulted in a significant (p <0.05) decrease in: blood insulin (pre, 142 [18]; post, 101 [10] pM/L), plasma triglycerides (pre, 2.9 [0.4]; post, 2.4 [0.3] mM/L), HOMA (pre, 6.0 [0.9]; post, 4.6 [0.7]), and trunk fat mass (pre, 9.9 [0.9]; post, 9.4 [1.0] kg). Blood glucose remained unchanged. These parameters did not change in the placebo group:  blood insulin (pre, 126 [20]; post, 117 [17] pM/L), blood triglycerides (pre, 2.3 [0.2]; post, 2.4 [0.3] mM/L), HOMA (pre, 5.8 [1.1]; post, 6.5 [2.0]), and trunk fat mass (pre, 8.9 [0.7]; post, 8.8 [0.8] kg).

Conclusions:  Cr supplementation may be of benefit in ART patients who have metabolic abnormalities and abdominal obesity.