Background

Therapy with HIV protease inhibitors (PI) has been associated with hyperglycemia, hyperlipidemia and changes in body composition. It is unclear whether these adverse effects are drug related, involve an interaction with the host response to HIV or reflect changes in body composition.

Methods

Indinavir 800 mg twice daily was given to 10 HIV-seronegative healthy men to distinguish direct metabolic effects of a PI from those related to HIV infection. Fasting glucose and insulin, lipid and lipoprotein profiles, oral glucose tolerance (OGTT), insulin sensitivity by hyperinsulinemic euglycemic clamp, and body composition were measured prior to and after 4 weeks of indinavir therapy.

Results

Fasting glucose (4.9±0.1 versus 5.2±0.2 mmol/l; P= 0.05) insulin concentrations (61.7±12.2 versus 83.9±12.2 pmol/l; P< 0.05), insulin: glucose ratio (12.6±1.7 versus 15.9±1.9 pmol/mmol; P< 0.05) and insulin resistance index by homeostasis model assessment (1.9±0.3 versus 2.8±0.5; P< 0.05) all increased significantly. During OGTT, 2 h glucose (5.1±0.4 versus 6.5±0.6 mmol/l; P< 0.05) and insulin levels (223.1±48.8 versus 390.3±108.8 pmol/l; P= 0.05) also increased significantly. Insulin-mediated glucose disposal decreased significantly (10.4±1.4 versus 8.6±1.2 mg/kg⋅ min per μU/ml insulin; 95% confidence interval 0.6–3.0; P< 0.01). There was no significant change in lipoprotein, triglycerides or free fatty acid levels. There was a small loss of total body fat (15.8±1.4 versus 15.2±1.4 kg; P= 0.01) by X-ray absorptiometry without significant changes in weight, waist: hip ratio, and visceral or subcutaneous adipose tissue by computed tomography.

Conclusions

In the absence of HIV infection, treatment with indinavir for 4 weeks causes insulin resistance independent of increases in visceral adipose tissue or lipid and lipoprotein levels.