Baylor University Medical Center Proceedings April 2014, Volume 27, Number 2 | Page 30

Table 1. Baseline demographics in 112 Native American
HIV-positive patients
Variable

Table 2. Comorbid conditions in 112 Native American
HIV-positive patients

Mean (range)

Comorbid condition

n (%)

Age at diagnosis (years)

33 (0–65)

Psychiatric disorder

34 (30%)

Men

93 (83%)

Viral load (copies/mL)
CD4 (cells/μL)
Serum creatinine (mg/dL)

137,807 (43–750,000)
374 (2–1142)
0.95 (0.61–1.51)

Height (cm)

175 (150–198)

Weight (kg)

80 (45–182)

Depression

24 (71%)

Anxiety

18 (53%)

Bipolar disorder

2 (6%)

Schizophrenia

1 (3%)

Attention deficit hyperactive disorder

1 (3%)

Hypertension

17 (15%)

Dyslipidemia

17 (15%)

Diabetes mellitus

profiles at baseline. Six patients, all of whom were treatment naive, were sensitive to all antiretroviral agents, while
three were resistant to at least one agent. Of the three, one
was treatment naive with conferred resistance to lamivudine.
The other two patients reported having previously been
on therapy, and genotyping showed resistance to nelfinavir
and nucleoside/nucleotide reverse transcriptase inhibitors
(NRTIs), respectively.
The most common comorbid conditions were psychiatric disorders (depression and anxiety being the most
common), hypertension, dyslipidemia, diabetes mellitus,
alcohol abuse, tobacco abuse, and hepatitis (Table 2). Based
on home medication lists, these conditions were being
treated 33% to 50% of the time. Twenty-seven patients
entered our clinic with a CD4 count <200/μL, and nine
of these patients had lower CD4 counts of <50/μL. Prophylaxis for pneumocystis pneumonia and mycobacterium
avium complex was continued or initiated in 70% and
56%, respectively.

8 (7%)

Alcohol abuse

11 (10%)

Tobacco abuse

29 (26%)

Hepatitis B

4 (4%)

Hepatitis C

9 (8%)

DISCUSSION
Disease states found in our HIV-positive Native
American patients refl ect those reported in national data
for Native American patients. However, there was a lower
prevalence of hypertension, diabetes mellitus, and cardiac
disease than would be anticipated. This could be due to the
overall younger age of the study patient population. Data
including all ethnicities has shown a higher frequency of the
metabolic syndrome among patients between 45 and 64 than
in younger populations (2). Nevertheless, due to the known
increased ri sk in the Native American population for metabolic disease, patients should be closely monitored for this
disease state and screened as
appropriate. Serum glucose
levels should be monitored
80
with the initiation/change
of antiretroviral therapy and
70
every 6 months thereafter;
60
monitoring should be more
frequent if abnormalities
50
are found (3). The NRTIs
didanosine, stavudine, and
40
Male
zidovudine as well as some
Female
protease inhibitors, particu30
larly those that are ritonavir
20
boosted, have been found to
increase the risk of diabetes
10
mellitus and insulin resistance (3–5). Non-nucleoside
0
reverse transcriptase inhibiMSM
Heterosexual
IVDU
Not
Other
tors (NNRTI) and integrase
Documented
inhibitors do not appear to
Figure. Modes of transmission among 112 Native American HIV-positive patients. MSM indicates men having sex with alter insulin resistance and
men; IVDU, intravenous drug use.
104

Baylor University Medical Center Proceedings

Volume 27, Number 2