Insulin Resistance and Renal Function Tests Alterations in People Living With HIV on Antiretroviral Therapy at Shanahan University Teaching Hospital, Onitsha, Nigeria

Abstract

The increasing survival of people living with HIV (PLWH) following widespread access to antiretroviral therapy (ART) has shifted clinical attention toward long-term metabolic and renal comorbidities. Insulin resistance and impaired renal function may occur through a complex interaction involving persistent immune activation, HIV-associated metabolic abnormalities, traditional cardiometabolic risk factors and adverse effects of selected antiretroviral agents. This study assessed insulin resistance and renal function test alterations among people living with HIV receiving ART at Shanahan University Teaching Hospital, Onitsha, Nigeria. A comparative study involving 120 participants divided equally into three groups of 40 was undertaken: HIV-negative controls, HIV-positive participants not receiving ART, and HIV-positive participants receiving ART. Glycaemic and insulin-resistance indices included fasting glucose, glycated haemoglobin (HbA1c), fasting insulin, homeostatic model assessment of insulin resistance (HOMA-IR) and quantitative insulin sensitivity check index (QUICKI). Renal indices included serum urea, creatinine, sodium, potassium, bicarbonate and chloride. Group means were compared using analysis of variance (ANOVA), with statistical significance set at p < 0.05. Marked differences in metabolic indices were observed across the three groups. Fasting glucose was 4.59 ± 0.29 mmol/L in controls, 5.61 ± 0.55 mmol/L in HIV-positive participants not on ART and 5.27 ± 0.42 mmol/L in those receiving ART. Corresponding fasting insulin concentrations were 6.21 ± 1.05, 13.33 ± 5.86 and 8.68 ± 2.40 μIU/mL, while HOMA-IR values were 1.27 ± 0.29, 3.49 ± 1.82 and 2.22 ± 1.23, respectively. QUICKI demonstrated the opposite pattern, with values of 0.37 ± 0.01, 0.34 ± 0.04 and 0.39 ± 0.06, respectively. Renal assessment showed increased serum creatinine among both HIV groups compared with controls: 82.70 ± 11.33 μmol/L in controls, 92.58 ± 10.89 μmol/L in HIV-positive participants not on ART and 90.18 ± 10.42 μmol/L in participants on ART. Urea was highest among participants not on ART (5.72 ± 1.02 mmol/L) and declined to 4.81 ± 0.81 mmol/L among those receiving ART, compared with 4.59 ± 0.56 mmol/L in controls. The findings demonstrate significant metabolic and biochemical differences between HIV-positive and HIV-negative participants, particularly in insulin sensitivity and serum creatinine. HIV-positive participants not receiving ART demonstrated the greatest degree of insulin resistance, whereas ART-treated participants showed partial improvement in insulin-resistance indices but retained evidence of altered renal biochemical parameters. The findings support integration of metabolic and renal surveillance into routine HIV care in Nigeria.