The purpose of this study is to assess the level of insulin sensitivity in patients with HIV disease. Altered insulin responsiveness has been reported in HIV+ patients with the fat redistribution syndrome that has been associated with highly active anti-retroviral therapy(HAART). It was initially thought that the protease inhibitors (PI) were the main cause of the syndrome. However, recent reports have suggested that even patients not on PI therapy are developing insulin resistance and fat redistribution. This is a significant problem because of the association of insulin resistance with altered lipid metabolism and accelerated atherosclerosis. In most studies, the insulin sensitivity in this patient population was measured by less sensitive methods and the patients were not well characterized. In the present study, insulin sensity will be measured using a hyperinsulinemic-euglycemic clamp technique and patients will be characterized with body composition studies , inflammatory markers, parameters of immune function, viral load, medications, family history of diabetes mellitus and metabolic parameters such as fasting glucose and lipid profiles. HIV+patients who are diabetic will be excluded. These data will precisely define the level of insulin sensitivity and which clinical parameters may be important in developing this syndrome. GH is being considered as a possible therapy for the truncal obesity in this syndrome. We have proposed to study patients before and after GH therapy. However, patients who are severely insulin resistant will not be given GH, since GH could potentially worsen the insulin resistance and induce hyperglycemia.
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