Homeostatic model assessment for insulin resistance index trajectories in HIV-infected patients treated with different first-line antiretroviral regimens

Nicola Gianotti, Camilla Muccini, Laura Galli, Andrea Poli, Vincenzo Spagnuolo, Andrea Andolina, Nadia Galizzi, Marco Ripa, Emanuela Messina, Pier Marco Piatti, Adriano Lazzarin, Antonella Castagna

Research output: Contribution to journalArticle


Objective: To describe the trajectories of the homeostatic model assessment for insulin resistance (HOMA-IR) index in a cohort of HIV-1 infected patients during their first-line antiretroviral (ART) regimen. Methods: Retrospective analysis of naïve patients who started ART from 2007 at the Infectious Diseases Unit of the San Raffaele Hospital, Milan. We included patients treated with two nucleoside reverse transcriptase inhibitors (NRTIs, tenofovir, abacavir, lamivudine or emtricitabine), and one anchor drug (ritonavir-boosted protease inhibitor [PI/r], non-NRTI [NNRTI], or integrase strand transfer inhibitor [InSTI]), and with HOMA-IR assessed both before and after the start of ART. Univariate and multivariate mixed linear models estimated HOMA-IR changes during ART. Results: Among 618 patients included in the study, 218 received InSTI-, 210 PI/r-, and 190 NNRTI-based regimens. Median follow-up was 27.4 (16.3-41.2) months. Adjusted mean change in HOMA-IR index was significantly higher (P =.041) in patients treated with InSTI-based regimens [0.160 (95% CI: 0.003-0.321) units per year] compared with NNRTI-based regimens [−0.005 (95% CI: −0.184-0.074) units per year]; no difference was observed between patients treated with NNRTI- and PI/r-based regimens or between INSTI-based and PI/r-based regimens. Conclusion: InSTI-based first-line ARTs were independently associated with greater increases in HOMA-IR index.

Original languageEnglish
Pages (from-to)1937-1943
Number of pages7
JournalJournal of Medical Virology
Issue number11
Publication statusPublished - Nov 1 2019



  • HOMA-IR index
  • insulin resistance
  • integrase strand transfer inhibitors
  • non-nucleoside reverse transcriptase inhibitors
  • protease inhibitors

ASJC Scopus subject areas

  • Virology
  • Infectious Diseases

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