CROI 2008: Boston, Massachussetts; February 3-6, 2008

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The Body PRO Covers: The 15th Conference on Retroviruses and Opportunistic Infections

HIV/HCV-Coinfected Patients Appear More Likely Than HIV-Monoinfected Patients to Develop Insulin Resistance After Initiating HAART

An Interview With Cecilia Shikuma, M.D.

February 5, 2008

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There's nothing like hearing the results of studies directly from those who actually conducted the research. It is these women and men who are transforming HIV treatment and care. In this interview, you'll meet one of these impressive HIV researchers and read an explanation of the study he is presenting at CROI 2008. Accompanying me on this interview is Gerald Pierone, M.D., an HIV clinician/researcher and the founder and executive director of the AIDS Research and Treatment Center of the Treasure Coast in Fort Pierce, Fla.

Cecilia Shikuma: My name is Cecilia Shikuma. I'm with the University of Hawaii. This is an ACTG [AIDS Clinical Trials Group] study that was a sub-analysis1 of the A5095 antiretroviral trial for antiretroviral-naïve patients.2 Essentially, we took a trial that used a [regimen consisting of] nucleosides plus or minus an NNRTI [non-nucleoside reverse transcriptase inhibitor] and then segregated the cohort by whether they were hepatitis C positive, [in other words] coinfected, versus those who were just HIV singularly infected. We had fasting metabolic parameters done at week 0, week 24 and [week] 96. We proceeded to analyze what the difference was as they were placed on antiretroviral therapy, depending on whether they were hepatitis C infected or not.

What we essentially found out is that there were some metabolic differences as these coinfected people went on antiretroviral therapy. We saw higher levels of insulin resistance as measured by HOMA [homeostasis model assessment] and increased rates of diabetes at week 96, which was a significant level of P = .03.

We also found that there were low levels of LDL [low-density lipoprotein] cholesterol and higher increases in HDL [high-density lipoprotein] cholesterol in hepatitis C-coinfected individuals than in [hepatitis C]-negative individuals.

Bonnie Goldman: What was most surprising about your findings?

Cecilia Shikuma: I think what was most surprising was that the insulin resistance really is higher in the coinfected individuals, and that it does seem to result in a higher rate of diabetes over time.

Bonnie Goldman: Is there a guess why?

Cecilia Shikuma: We know that hepatitis C does affect insulin resistance,3 and we also know that antiretroviral therapy affects insulin resistance,4 so I think it's a compounding of both effects.

Bonnie Goldman: The changes in triglycerides, could you talk a little bit about that?

Cecilia Shikuma: We also found that, at least in the short term -- between week 0 and week 24 -- we did see a difference in triglycerides. In hepatitis C-negative people, we saw an increase in triglycerides, as you typically do in most people, while there was a decrease in triglycerides in the hepatitis C-positive group. [The latter result is] a little bit unusual in that, if you had someone that was becoming insulin resistant, triglycerides usually go up. To have it flipped is a little bit, I thought, interesting.

Gerald Pierone: Any explanation for why that would be?

Cecilia Shikuma: I understand that triglycerides do go down over time as people become cirrhotic. Somebody had mentioned that to me, and I'm not quite sure if that's true or not. I thought that it may just be a hepatitis C[-related] cirrhosis type of effect.

Gerald Pierone: Do you have any sub-analysis looking at the hepatitis C patients? Did any of them decompensate? Do you have any data relating to decompensation or hepatitis C disease progression?

Cecilia Shikuma: Unfortunately, since this was an antiretroviral treatment trial, not much information was gathered on the status of the liver for these coinfected individuals, so we don't have that data. But I think, moving forward, it will be something very interesting to look at.

Bonnie Goldman: Thank you.

This transcript has been lightly edited for clarity.


  1. Shikuma C, Ribaudo H, Zheng E, et al. The effect of hepatitis C infection on metabolic parameters following initial therapy of HIV-infected subjects with nucleoside +/- NNRTI regimens. In: Program and abstracts of the 15th Conference on Retroviruses and Opportunistic Infections; February 3-6, 2008; Boston, Mass. Abstract 931.
    View poster: Download PowerPoint
  2. Gulick RM, Ribaudo HJ, Shikuma CM, et al, for the AIDS Clinical Trials Group Study A5095 Team. Triple-nucleoside regimens versus efavirenz-containing regimens for the initial treatment of HIV-1 infection. N Engl J Med. April 29, 2004;350(18):1850-1861.
  3. Imazeki F, Yokosuka O, Fukai K, Kanda T, Kojima H, Saisho H. Prevalence of diabetes mellitus and insulin resistance in patients with chronic hepatitis C: comparison with hepatitis B virus-infected and hepatitis C virus-cleared patients. Liver Int. March 2008;28(3):355-362.
  4. De Wit S, Sabin CA, Weber R, et al. Incidence and risk factors for new onset diabetes mellitus in HIV infected patients: The D:A:D study. Diabetes Care [serial online]. February 11, 2008.

This article was provided by TheBodyPRO.

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