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Objectives   to assess the incidence and risk factors for insulin resistance (IR) in a cohort of naive HIV-infected patients 48 weeks after satarting highly active antiretroviral therapy (HAART).Design   prospective, two centre, observational, cohort study.Methods   One-hundred and thirty-seven patients who started HAART and maintained the same regimen for 48 weeks were included. IR was determined by the homeostasis model assessment (HOMA-IR) method. Individuals with a HOMA-IR value &gt;3.8 were defined as insulin resistant. Independent associations with the development of IR at 48 weeks were evaluated.Results   Seventeen (12.4%) individuals showed a HOMA-IR value &gt;3.8 at baseline and were excluded for incidence analyses. Fifteen patients developed IR at 48 weeks of HAART, giving an incidence of 13%. Independent predictors of the development or IR were indinavir exposure (β-coefficient 5.45, 95% confidence interval [CI] 1.30–22.8; P=0.02), and hepatitis C virus (HCV) antibody positivity (β-coefficient 5.22, 95% CI 1.34–20.33; P=0.01). The appearance of IR was associated with a higher BMI (β-coefficient 1.72 for each 2 kg/m 2  increase, 95% CI 1.54–1.94; P=0.02) and with the presence of lipodystrophy at 48 weeks (β-coefficient 5.59, 95% CI 1.45-21.5; P=0.01).Conclusions   HAART induces the development of IR in previously naive non-insulin-resistant HIV-infected individuals, with an incidence of 13% in the first year of therapy. Indinavir exposure, and HCV coinfection are associated with an increased risk of developing IR.

antiviral therapy

Incidence of and Risk Factors for Insulin Resistance in Treatment-Naive HIV-Infected Patients 48 Weeks after Starting Highly Active Antiretroviral Therapy