Oral glucose tolerance and insulin sensitivity are unaffected by HIV infection or antiretroviral therapy in overweight women.

OBJECTIVE: To assess the frequency of diabetes, prediabetes, and insulin resistance among a subset of participants in the Women's Interagency HIV Study (WIHS). DESIGN: Cross-sectional substudy nested within a prospective multicenter cohort study. Women underwent 75 g oral glucose tolerance testing. Diagnoses of diabetes and prediabetes were made according to the American Diabetes Association criteria, and insulin resistance was determined by area under the curve insulin and homeostasis model assessment values. SETTING: Six urban clinical sites in the United States (Brooklyn, NY; Bronx, NY; Washington, DC; Chicago, IL; San Francisco, CA; Los Angeles, CA) participate in the entire WIHS. The Bronx, NY, and San Francisco, CA, WIHS sites participated in this substudy. PARTICIPANTS: A total of 258 women, 88 HIV negative, 74 HIV positive not on highly active antiretroviral therapy (HAART), and 96 HIV positive taking HAART were enrolled in the study. MAIN OUTCOMES: Prevalence of diabetes, prediabetes, and insulin resistance was compared among the HIV-uninfected and HIV-infected women. RESULTS: The frequency of diabetes, prediabetes, or insulin resistance was unrelated to HIV status or antiretroviral treatment. Increasing body mass index was the only characteristic associated with the combined endpoints of diabetes and prediabetes (odds ratio = 1.104, P = 0.0002). CONCLUSIONS: Routine oral glucose tolerance testing of HIV-infected women is not supported by these findings. Elucidation of putative perturbations from HIV or antiretroviral medications requires direct studies of insulin resistance and beta-cell function.

Fat distribution in HIV-infected women in the United States: DEXA substudy in the Women's Interagency HIV Study.

Surveys in HIV-infected men on antiretroviral therapy (ART) consistently demonstrate decreased levels of peripheral fat, with variable effects on central fat. This substudy of the Women's Interagency HIV Study was undertaken to examine fat distribution in a well-characterized cohort of HIV-positive and HIV-negative women in the United States. Whole-body dual-energy x-ray absorptiometry scanning with standardized regional analysis was performed in 271 nonpregnant women. Results were compared in the following groups: HIV negative (n = 88); and HIV positive on no ART (n = 70), highly active ART with a protease inhibitor (HAART/PI) (n = 48), or non-PI-containing HAART (n = 53). The groups were well matched with respect to race, with the majority of women coming from racial/ethnic minorities. The majority of both HIV-positive and HIV-negative women were overweight (body mass index [BMI] >/=25 kg/m), and many were obese (BMI >30 kg/m). Leg fat in both groups on HAART was significantly lower than in HIV-negative women (P = 0.01 and <0.0001 vs. HIV-negative for HAART/PI and HAART/no PI, respectively), whereas trunk fat was lower only in HAART/no PI (P = 0.0004 vs. HIV-negative). Thus, consistent with reports in men, lower levels of peripheral (leg) fat are seen in HIV-infected women on HAART, despite the high prevalence of obesity in this population.