Markers of gut permeability, systemic inflammation and insulin resistance in people living with HIV in rural South Africa.

Abstract

Background: The relative contributions of HIV infection, antiretroviral therapy (ART), and classical metabolic risk factors to the link between gut permeability and insulin resistance (IR) remain unclear.

Aim: To examine the relationship between gut permeability, systemic inflammation, and insulin resistance among people with HIV in Mthatha, South Africa.

Methods: A cross-sectional study was conducted with 226 participants: 82 HIV^-, 64 HIV⁺ART^-, and 80 HIV⁺ART⁺. Anthropometry and lipid profiles were assessed to evaluate obesity and dyslipidaemia. Gut permeability (intestinal fatty acid binding protein, IFABP) and inflammation (soluble CD14, sCD14) were measured, alongside fasting insulin and glucose to calculate HOMA-IR.

Results: Overweight/obesity was more prevalent among ART-treated people with HIV (HIV⁺ART⁺) than ART-naïve participants (HIV⁺ART^-). Both HIV-positive groups showed increased gut permeability and inflammation compared with controls (p < 0.05). In ART-naïve people with HIV, gut permeability was associated with triglycerides, while in ART-treated people with HIV it was linked to gut-associated inflammation and markers of IR (fasting glucose, TG/HDL-c ratio). HOMA-IR correlated with obesity and dyslipidaemia (total cholesterol, LDL) in ART-naïve participants but was associated only with gut-associated inflammation in ART-treated participants (p < 0.05, respectively).

Conclusion: Gut permeability is linked to insulin resistance in ART-treated people with HIV, independent of obesity and dyslipidaemia. This highlights a novel pathway for intervention to reduce NCD burden.