10th International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV 6-8 November 2008, London, UK

AUTONOMOUS NERVOUS SYSTEM ACTIVITY AND GLUCOSE METABOLISM IN HIV PATIENTS RECEIVING ANTIRETROVIRAL THERAPY

Antiviral Therapy 2008; 13(Suppl. 4):A11 (abstract no. O-15)

M Wiese, M Kaspari, U Moebius, RE Schmidt and GMN Behrens
Hannover Medical School, Hannover, Germany

BACKGROUND: Lipodystrophy has been described as a side effect of antiretroviral therapy and the autonomous nervous system (ANS) has been proposed to contribute peripheral fat loss and metabolic disturbances.

METHODS: This was a prospective cross-sectional study including 38 HIV patients, with or without lipodystrophy, receiving antiretroviral therapy and 15 therapy-naïve HIV patients. After an overnight fast, patients underwent an oral glucose tolerance test (OGGT), indirect calorimetry, assessment of autonomous nervous system activity (Finometer^®), anthropometric measurements and DEXA. Constitutive individual differences in ANS activity were assessed by monitoring the sd of each indicator about its mean value of interbeat interval and systolic blood pressure during the final 60 s of a verbal serial subtraction task or metronome-paced respiration (6 respiration cycles/min^–1).

RESULTS: Patients on therapy had dyslipidaemia with significantly higher total cholesterol, total triglycerides, apolipoprotein A-2, Abp E and lipoprotein(a), and lower high-density lipoprotein cholesterol (P<0.05). Therapy was associated with insulin resistance and signs of beta cell dysfunction indicated by higher 120 min glucose during OGTT (5.1 ±0.3 versus 6.3 ±0.3 mmol/l, P=0.007), 120 min insulin (30.8 ±5.1 versus 57.7 ±7.8 µU/ml, P=0.006) and 120 min proinsulin (2.9 ±0.6 versus 7.7 ±1.2 pmol/l, P=0.001). HOMA-IR index was higher in patients on therapy (1.1 ±0.1 versus 1.7 ±0.2 mmol×µU, P=0.075). Patients receiving antiretroviral therapy with low ANS activity had significantly higher 120 min glucose concentrations as compared with patients who had low ANS activity (6.9 ±0.5 versus 5.5 ±0.4 mmol/l, P=0.041) and a trend towards a higher area under the curve for insulin 6,195.8 ±718.0 versus 8,825.3 ±1470.3 µU/ml) and C-peptide (1,060.3 ±64.2 versus 1,295.0 ±139.3 ng/ ml, P<0.09). Basal resting energy consumption and during OGTT was significantly lower in patients with low ANS activity and these patients had a lower central-toperipheral fat ratio (1.7 ±0.2 versus 2.2 ±0.2, P=0.078), although serum lipid was not different.

CONCLUSIONS: To our knowledge these data provide the first evidence that low ANS activity might be associated with impaired glucose homeostasis in HIV patients receiving antiretroviral therapy.

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2008-11-06
O-15

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