Physiol Rep. 2026 Sep;14(17):e71093. doi: 10.14814/phy2.71093.
ABSTRACT
Insulin resistance (IR) contributes substantially to cardiovascular disease and type 2 diabetes mellitus, with increasing concern among people living with HIV (PLWH). However, sex-specific factors of IR in sub-Saharan Africa remain poorly understood. This study evaluated sex-specific associations between IR and clinical, metabolic, and inflammatory markers among adults with and without HIV in Zambia. A cross-sectional study was conducted among 233 adults in Zambia. Insulin resistance was assessed using the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR). Sex-stratified multivariable linear regression models were used to identify factors associated with IR. Females had higher body mass index (26.9 vs. 23.5 kg/m2, p < 0.001), waist circumference (88.3 vs. 83.2 cm, p = 0.008), fasting insulin, and HOMA-IR compared with males. In the adjusted overall model, female sex was associated with higher HOMA-IR (β = 0.95, 95% CI: 0.06-1.84; p = 0.037), while HIV-positive status was associated with lower HOMA-IR (β = -1.54, 95% CI: -3.06 to -0.02; p = 0.046). Among males, hypertension was associated with higher HOMA-IR (β = 0.61; p = 0.019), whereas among females, HIV-positive status was inversely associated with HOMA-IR (β = -2.31; p = 0.049). Insulin resistance highlighted sex-specific patterns, with greater metabolic risk among females and distinct clinical factors among males. Future studies incorporating lifestyle and hormonal factors are needed to clarify these relationships.
PMID:42682013 | DOI:10.14814/phy2.71093