BACKGROUND : At the time of the study, the HIV-treatment policy in South Africa included highly active antiretroviral
therapy (HAART) regimens 1 (nucleotide reverse transcriptase inhibitors (NRTIs) only), and 2 (protease inhibitors (PI)
and NRTIs). HAART is associated with the lipodystrophy syndrome, insulin resistance and reduced total adiponectin
(TA) levels. The high molecular weight (HMW):TA ratio is a superior marker of insulin resistance. The aim of this
study was to establish whether HMW:TA ratios are low in patients on PIs and whether they correlate with insulin
METHODS : This was a cross-sectional study undertaken in an antiretroviral clinic at a tertiary hospital. The participants
were 66 HIV-infected females: 22 were on regimen 2 (PI group), 22 on regimen 1 (non-PI) and 22 treatment naïve
(TN), matched for BMI and age. Patients with a history of diabetes or impaired glucose tolerance were excluded.
Serum adiponectin multimers were analysed using the AlpcoTM Adiponectin (Multimeric) enzyme immunoassay.
Waist hip ratios (WHR), glucose and insulin levels were assessed, and HOMA-IR and QUICKI calculated. Data were
analysed non-parametrically and multivariate analysis was performed.
RESULTS : TA and HMW levels were lower in the treatment groups than in the TN group. HMW:TA was lower in the
PI than in the non-PI and TN groups, and in the non-PI than in the TN groups. HMW:TA correlated negatively with
waist, insulin and HOMA-IR, independently of BMI and duration of therapy. HOMA-IR and QUICKI did not differ
among the groups.
CONCLUSION : HMW :TA is significantly decreased with HAART (particularly with PIs, but also with non-PIs) and may be
a more sensitive marker of insulin resistance in these patients than conventional markers or HMW and total