ABSTRACT Objective: Fasting insulin and the homeostasis model assessment of insulin resistance (HOMA-IR) index are relatively simple and reliable noninvasive markers of insulin resistance (IR). Given the relevance of correctly diagnosing IR, we emphasize the importance of establishing reliable reference intervals (RIs) for these markers. This study aimed to determine the RIs of fasting insulin and HOMA-IR index in adults living in Rio de Janeiro and, secondarily, to verify potential RI differences between sexes. Subjects and methods: Serum insulin levels of 146,497 individuals (ages 20-60 years) who underwent blood sampling in the state of Rio de Janeiro were obtained retrospectively through access to an extensive laboratory database. Insulin was measured using the electrochemiluminescence immunoassay method. After applying exclusion criteria, 21,684 individuals (18,576 [86%] women) were included. The RIs were estimated using a computational mining approach that integrates a selection of R packages. Results: The 95% RIs in women and men and in the overall population were, respectively, 2.54-13.30 μU/mL (15.3-80.12 pmol/L), 2.43-11.89 μU/mL (14.6-71.7 pmol/L), and 2.52-13.14 μU/mL (15.2-79.2 pmol/L) for fasting insulin levels and 0.39-2.86, 0.38-2.81, and 0.39-2.86 for HOMA-IR values. Despite significant differences in insulin levels and HOMA-IR index between men and women, the use of sex-specific RIs was not justified. Conclusion: The RIs of fasting insulin levels and HOMA-IR values found in the overall population can be applied to both sexes. Thus, for our population, we suggest the RIs of 2.52-13.14 μU/mL (15.1-78.8 pmol/L) for fasting insulin and 0.39-2.86 for the HOMA-IR index. Objective HOMAIR HOMA IR (HOMA-IR IR. . (IR) (RIs secondarily sexes methods 146497 146 497 146,49 ages 2060 20 60 20-6 years database method criteria 21684 21 684 21,68 18,576 18576 18 576 (18,57 86% 86 [86% included packages Results 95 respectively 2.5413.30 2541330 2.54 13.30 2 54 13 30 2.54-13.3 μUmL μU mL 15.380.12 1538012 15.3 80.12 15 3 80 12 (15.3-80.1 pmol/L, pmolL pmol/L , pmol L 2.4311.89 2431189 2.43 11.89 43 11 89 2.43-11.8 14.671.7 146717 14.6 71.7 14 6 71 7 (14.6-71. 2.5213.14 2521314 2.52 13.14 52 2.52-13.1 15.279.2 152792 15.2 79.2 79 (15.2-79. 0.392.86, 039286 0.39 2.86, 0 39 0.382.81, 038281 0.38 2.81, 38 81 0.38-2.81 0.392.86 2.86 0.39-2.8 sexspecific sex specific justified Conclusion Thus 15.178.8 151788 15.1 78.8 1 78 8 (15.1-78. (IR 14649 49 146,4 206 20- 2168 68 21,6 18,57 1857 57 (18,5 [86 9 5413 2.5413.3 254133 254 2.5 1330 13.3 5 2.54-13. 380 15.380.1 153801 153 15. 8012 80.1 (15.3-80. 4311 2.4311.8 243118 243 2.4 1189 11.8 4 2.43-11. 671 14.671. 14671 14. 717 71. (14.6-71 5213 2.5213.1 252131 252 1314 13.1 2.52-13. 279 15.279. 15279 152 792 79. (15.2-79 392 03928 039 0.3 286 382 0.382.81 03828 038 281 2.81 0.38-2.8 0.392.8 2.8 0.39-2. 178 15.178. 15178 151 788 78. (15.1-78 1464 146, 216 21, 18,5 185 (18, [8 541 2.5413. 25413 25 2. 133 13. 2.54-13 15.380. 15380 801 80. (15.3-80 431 2.4311. 24311 24 118 11. 2.43-11 67 14.671 1467 (14.6-7 521 2.5213. 25213 131 2.52-13 27 15.279 1527 (15.2-7 0392 03 0. 28 0.382.8 0382 0.38-2. 0.392. 0.39-2 17 15.178 1517 (15.1-7 18, (18 [ 2.5413 2541 2.54-1 15.380 1538 (15.3-8 2.4311 2431 2.43-1 14.67 (14.6- 2.5213 2521 2.52-1 15.27 (15.2- 0.382. 0.38-2 0.392 0.39- 15.17 (15.1- (1 2.541 2.54- 15.38 (15.3- 2.431 2.43- (14.6 2.521 2.52- (15.2 0.382 0.38- (15.1 ( (15.3 (14. (15. (14 (15

The purpose was to determine the prevalence and related factors of vitamin D (VitD) insufficiency in adolescents and young adults with perinatally acquired human immunodeficiency virus. A cohort of 65 patients (17.6 ± 2 years) at the Federal University of Rio de Janeiro, Brazil, were examined for pubertal development, nutrition, serum parathormone and serum 25-hydroxyvitamin D [s25(OH)D]. s25(OH)D levels < 30 ng/mL (< 75 nmol/L) were defined as VitD insufficiency. CD4+ T-cell counts and viral load, history of worst clinical status, immunologic status as nadir, current immunologic status, and antiretroviral (ART) regimen were also evaluated as risk factors for VitD insufficiency. Mean s25(OH)D was 37.7 ± 13.9 ng/mL and 29.2% had VitD insufficiency. There was no difference between VitD status and gender, age, nutritional status, clinical and immunological classification, and type of ART. Only VitD consumption showed tendency of association with s25(OH)D (p = 0.064). Individuals analysed in summer/autumn season had a higher s25(OH)D compared to the ones analysed in winter/spring (42.6 ± 14.9 vs. 34.0 ± 11.9, p = 0.011). Although, the frequency of VitD insufficiency did not differ statistically between the groups (summer/autumn 17.9% vs. winter/spring 37.8%, p = 0.102), we suggest to monitor s25(OH)D in seropositive adolescents and young adults, especially during winter/spring months, even in sunny regions.

Doenças tiroidianas autoimunes (DTAI) são a maior causa de disfunção tiroidiana e são as doenças autoimunes mais comuns no mundo. A associação entre DTAI e infecções com o vírus da imunodeficiência humana (HIV), em combinação com a terapia antirretroviral altamente ativa (HAART), foi sugerida por vários grupos de pesquisadores. O objetivo do presente estudo foi avaliar a fre-quência de disfunção tiroidiana e DTAI em mulheres com mais 35 anos de idade infectadas com o HIV e identificar fatores associados com a emergência dessas anormalidades tiroidianas. As mulheres infectadas com HIV (n = 153), selecionadas do ambulatório de doenças infecciosas de um hospital universitário do Rio de Janeiro, foram caracterizadas com base no nível de linfócitos CD4+ circulantes, carga viral, níveis de TSH sérico e presença de anticorpos FT4 e antitiroperoxidase (TPO-Ab). Um total de 129 participantes se tratava com HAART e 24 não. A frequência de desordens da tiroide foi 7,8% (12/153 pacientes) e todas estavam em tratamento com HAART no momento do diagnóstico, levando a uma prevalência 9,3% em pacientes recebendo HAART, em comparação com 0% em pacientes não tratadas com HAART. DTAI, hipertireoidismo e hipotireoidismo foram detectados em 4,6%, 3,1% e 4,1% das pacientes tratadas com HAART. Não foram detectadas disfunção tiroidiana ou autoimunidade em mulheres infectadas com HIV e não tratadas com HAART. Este estudo demonstrou uma associação entre a HAART e o desenvolvimento de DTAI. Além disso, a DTAI apenas se desenvolveu em pacientes tratadas com HAART e que apresentavam cargas virais indetectáveis e contagens de células CD4+ T levemente elevadas.

Autoimmune thyroid diseases (AITD) are the main causes of thyroid dysfunction and the most common autoimmune diseases in the world. An association between AITD and infections with the human immunodeficiency virus (HIV), in combination with the effects of highly active anti-retroviral therapy (HAART), has been suggested by several research groups. The aim of the present study was to evaluate the frequency of thyroid dysfunction and AITD in women > 35 years of age infected with HIV, and to identify factors associated with the emergence of these thyroid abnormalities. HIV-infected women (n = 153) selected from the infectious disease outpatient clinic at a University Hospital in Rio de Janeiro were characterized based on their circulating CD4+ lymphocytes levels, viral loads, serum TSH levels, and the presence of FT4 and anti-thyroperoxidase antibodies (TPO-Ab). A total of 129 participants were on HAART and 24 were not. The frequency of thyroid disorders was 7.8% (12/153 patients) and all were on HAART at the time of diagnosis, yielding a prevalence of 9.3% in patients receiving HAART compared with 0% in patients not on HAART. AITD, hyper, and hypothyroidism were detected in 4.6%, 3.1%, and 4.1% of HAART patients. It was not detected any thyroid dysfunction or autoimmunity in HIV-infected women not on HAART. This study demonstrated an association between HAART and the development of AITD. In addition AITD only developed in HAART patients also presenting with undetectable viral loads and slightly elevated CD4+ T cell counts.