Comparison of Insulin Resistance to Coronary Atherosclerosis in Human Immunodeficiency Virus Infected and Uninfected Men (from the Multicenter AIDS Cohort Study)

The relation between insulin resistance and coronary artery disease (CAD) in patients with HIV infection remains incompletely defined. Fasting serum insulin and glucose measurements from 448 HIV-infected and 306 uninfected men enrolled in the Multicenter AIDS Cohort Study (MACS) were collected at semi-annual visits between 2003 and 2013 and used to compute the homeostatic model assessment of insulin resistance (HOMA-IR). Coronary computed tomographic angiography (CTA) was performed at the end of the study period to characterize coronary pathology. Associations between HOMA-IR (categorized into tertiles and assessed near the time of the CTA and over the 10 year study period) and the prevalence of coronary plaque or stenosis ≥ 50% were assessed with multivariable logistic regression. HOMA-IR was higher in HIV-infected men than HIV-uninfected men when measured near the time of CTA (3.2 vs. 2.7, P = 0.002) and when averaged over the study period (3.4 vs. 3.0, P < 0.001). The prevalence of coronary stenosis ≥ 50% was similar between both groups (17% vs. 15%, P = 0.41). Both measures of HOMA-IR were associated with greater odds of coronary stenosis ≥ 50% in models comparing men with values in the highest versus the lowest tertiles, though the effect of mean HOMA-IR was stronger than the single measurement of HOMA-IR prior to CTA (OR 2.46, 95% CI 1.95–3.11, vs. OR 1.43, 1.20–1.70). This effect was not significantly modified by HIV serostatus. In conclusion, insulin resistance over nearly a decade was greater in HIV-infected men than HIV-uninfected men, and among both groups, was associated with significant coronary artery stenosis.