Moreira et al., HIV Curr Res 2016, 1:1 Volume 1 • Issue 1 • 1000101 HIV Curr Res ISSN: HICR, an open access journal Open Access Short Communication HIV-Positive Inflammatory Activity Monitoring Correlated to Peripheral Insulin Resistance - Hire Study Henrique Pires Moreira 1* , Débora Veras da Ponte 1 , Ana Carolina dos Santos Araújo 1 , André Pereira de Brito Neves1, Rebecca Santos Souza 1 , Lean de Sousa Oliveira 1 , Gabriel Dantas Sarubbi 1 , Bruno Almeida Sampaio 1 , Laís Gomes Neves 1 , Luita Almeida da Silveira 1 , Samuell Silva Soares 1 , Fabrício de Maicy Bezerra 1,2 , Huylmer Lucena Chaves 1 and Melissa Soares Medeiros 1,2,3 1 Centro Universitario Unichristus, Brazil 2 Hospital São José de Doenças Infecciosas, Brazil 3 Hospital Geral de Fortaleza - Fortaleza, Brazil Abstract HIV-positive patients have an increased risk of hyperglycemia factors associated with infammatory activity and antirretrovirals treatment, and this can directly impact in survival and life quality. This study proposed to evaluate impact and risk factors for insulin resistance in HIV patients. Total of 218 patients were included and we detected increase in glucose levels after HAART initiation (18.5% vs. 36.7%, p=0.0025). High fasting glucose levels were pointed as risk factor for symptomatic clinic during follow-up (RR=1.35; IC 95% 1,01-1,80; p=0.002), and higher monocyte/lymphocyte ratio was associated with hospitalization after treatment start (p=0.033). *Corresponding author: Moreira HP, Centro Universitario Unichristus, Brazil, Tel: +(21) 2493-24; E-mail: henriquepm_@hotmail.com Received May 21, 2016; Accepted May 31, 2016; Published June 07, 2016 Citation: Moreira HP, da Ponte DV, Araújo ACDS, de Brito Neves AP, Souza RS, et al. (2016) HIV-Positive Infammatory Activity Monitoring Correlated to Peripheral Insulin Resistance - Hire Study. HIV Curr Res 1: 101. Copyright: © 2016 Moreira HP, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Keywords: HIV; Glucose; Monocyte/lymphocyte ratio; Hospitalization Introduction Peripheral Insulin resistance has been associated to abnormal body fat distribution, changes in lipid and carbohydrate metabolism, persistence of infammatory system activation, and antiretroviral therapy [1-3]. Alterations in HIV patient’s glycemic profle, as diabetes, activate infammatory system, especially with higher viral load and prolonged symptomatic periods [4-6]. Antiretroviral therapy is associated with a signifcant increase in blood glucose levels by diferent pathways: increases peripheral insulin resistance modifying cellular insulin signaling or lipid metabolism, increases homocysteine levels, blocking glucose interfering with GLUT-4 transporter (protease inhibitors), or mitochondrial toxicity (nucleoside reverse transcriptase) [7-13]. Higher total cholesterol/HDL (Castelli Index 1) causes mitochondrial oxidative stress [14,15]. A study evidenced increases of 2.2 times in hospitalization rates in diabetic HIV patients, between 1994 and 2004 [16]. Brazil study evidenced an annual increase of 4.1% in diabetes prevalence of HIV infected patients [17]. Recently, Shikuma demonstrated a correlation between increased monocytes cells and peripheral insulin resistance in HIV patients [18,19]. It was observed decreases in T-CD 4 cells associated with increased monocytes [20]. Studies are evidencing a possible role of monocytes in chronic infammatory pathophysiology [21]. Study is a multicenter retrospective cohort, including patients over 18 years, with previous diagnosis of HIV infection and followed up at Hospital Geral de Fortaleza (HGF) and Clínica Escola de Saúde (CES) at Unichristus Center University. Te Epi Info sofware 3.5.1 was used for statistical analysis. Results and Discussion Total of 218 patients were included and 161 (73.9%) male. Mean age was 37.6 ± 11.4 years. Time of follow-up median was 21 months. Arterial Hypertension prevalence before HIV diagnosis was 10.6% (N=23), diabetes mellitus 2.8% (N=6) and dyslipidemia 4.1% (N=9). Final follow-up evidenced 18 patients (8.3%) symptomatic (diarrhea 44.4% and syphilis 38.9%). During monitoring period, were detected 30 patients (13.8%) requiring hospitalization, and 1.8% admitted more than once. Causes of hospitalization were neurotoxoplasmosis (11 admissions - 36.6%), bacterial pneumonia, pulmonary tuberculosis and multifocal leukoencephalopathy, each with 3 admissions (10%). Tenofovir associated to Efavirenz and Lamivudine was started in 62.9%. Before ARV therapy, 18.6% patients had blood glucose above 100 mg/dL. Afer ARV, prevalence increased to 36.7% (12 months), 44.3% (26 months) and 45.9% (33 months), (p=0.0025). Higher glucose levels above 100 mg/dL before antiretroviral therapy was considered a risk factor for symptoms related to HIV at fnal follow-up (RR=1.35, 95% CI: 1.01 to 1.80, p=0.002). Tere was a positive correlation between lower monocytes/lymphocytes ratio and no admission related to HIV (p=0.01). ART Terapy is essential for infected patients survival, but it contributes as risk factors for diabetes and cardiovascular diseases [22-26]. Monocytes/lymphocyte ratio could be used as infammatory activation biomarker for monitoring, and signalizing as risk for hospitalization (Table 1). Monocytes/lymphocytes ratio was controlled in hyperglycemic group afer start ARV, evidencing immunology control of infammation related to blood glucose. Most patients had a suppressed viral load in fnal follow-up (97.3%), witch could not be implicated in hospital admission. Elevated monocytes levels in HIV patients are associated with pro-infammatory mediators production and immune alterations [27,28]. It described an immune system deregulation evidenced by reduced CD 4+ T cells associated with increased number of monocytes. However, this was not observed in present study, since monocytes increased during follow-up as T-CD 4 cells. We also detected unchanged T-CD 8 cells account, suggesting others possible uncontrolled infammatory components involved in our population, which must be studied in future. H I V : C u r r e n t R e s e a r c h ISSN: 2572-0805 HIV: Current Research