Insulin resistance and liver biochemical alterations among people living with HIV before and during antiretroviral therapy in Onitsha, Southeast, Nigeria

                @article{CRSIJ26000399,
                  author = {Odo, Vincentmary Chukwuemeka , Iboyi Nathaniel Onuche, Anyadike, N. N., Ogalagu, R. O., Ofordi, O.},
                  title = {Insulin resistance and liver biochemical alterations among people living with HIV before and during antiretroviral therapy in Onitsha, Southeast, Nigeria},
                  journal = {Cosmo Research and Science International Journal},
                  year = {2026},
                  volume = {2},
                  number = {2},
                  pages = {433-446},
                  issn = {3108-1584},
                  url = {https://cosmorsij.com/published/CRSIJ26000399.pdf},
                  abstract = {People living with HIV (PLWH) are increasingly surviving into older age because of effective antiretroviral therapy (ART). Consequently, attention has shifted from AIDS-related morbidity to chronic metabolic and cardiovascular complications, including insulin resistance, dyslipidaemia, abnormal glucose metabolism, weight gain and atherosclerotic cardiovascular disease. Both persistent HIV-associated inflammation and exposure to particular antiretroviral agents may contribute to these abnormalities. Contemporary evidence indicates that the metabolic phenotype associated with ART has evolved, with newer regimens producing less severe lipid toxicity than some older regimens but raising concerns about weight gain and glucose deregulation.  This study assessed differences in insulin-resistance indices and serum lipid profiles among HIV-negative controls, people living with HIV who were not receiving ART, and people living with HIV receiving ART at Shanahan University Teaching Hospital, Waterside, Onitsha, and South-eastern Nigeria. The study comprised 120 participants, allocated equally into three groups of 40: HIV-negative controls, HIV-positive participants not receiving ART, and HIV-positive participants receiving ART. Glucose, HbA1c, fasting insulin, HOMA-IR and QUICKI were assessed as markers of glucose metabolism and insulin sensitivity, while total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and triglycerides (TG) constituted the lipid profile. Group differences were evaluated using analysis of variance (ANOVA), with statistical significance set at p < .05. These included the HIV-positive adults aged 18 years and above and who have been on ART for at least 6 months. Pregnant women, patients on steroids or lipid-altering drugs; patients with pre-existing severe liver or kidney disease, or Concurrent malignancy were excluded. Mean glucose concentrations were 4.59 ± 0.29, 5.61 ± 0.55 and 5.27 ± 0.42 mmol/L in the control, HIV-not-on-ART and HIV-on-ART groups, respectively. HbA1c was 5.05 ± 0.18%, 5.43 ± 0.40% and 5.49 ± 0.40%, respectively. Fasting insulin was substantially higher in untreated HIV (13.33 ± 5.86 μIU/mL) than in controls (6.21 ± 1.05 μIU/mL) and remained elevated among ART recipients (8.68 ± 2.40 μIU/mL). Similarly, HOMA-IR was highest in the untreated HIV group (3.49 ± 1.82), followed by the ART group (2.22 ± 1.23) and controls (1.27 ± 0.29). The lipid profile showed higher TC (5.18 ± 0.67 mmol/L), LDL-C (3.22 ± 0.69 mmol/L) and TG (1.73 ± 0.56 mmol/L) but lower HDL-C (1.13 ± 0.22 mmol/L) among participants not receiving ART. ART recipients showed comparatively improved TC (4.70 ± 0.53 mmol/L) and TG (1.17 ± 0.32 mmol/L), although HDL-C (1.27 ± 0.21 mmol/L) remained below the control value. The findings demonstrate substantial metabolic abnormalities among people living with HIV, particularly increased insulin concentrations and HOMA-IR together with an adverse lipid pattern. The comparatively lower HOMA-IR and improved lipid concentrations among ART recipients suggest that effective HIV treatment may attenuate some metabolic abnormalities associated with untreated HIV, although metabolic risk does not completely disappear after ART initiation. These findings support integration of metabolic screening into routine HIV care in Nigeria.},
                  keywords = {HIV, antiretroviral therapy, insulin resistance, HOMA-IR; QUICK, dyslipidaemia, triglycerides, HDL cholesterol, LDL cholesterol, Nigeria},
                  month = {September}
        }