High Prevalence of Metabolic Syndrome and Cardiovascular Disease Risk Among People with HIV on Stable ART in Southwestern Uganda

Abstract

The objectives of this study were to determine the epidemiology and correlates of cardiovascular disease (CVD) risk among Ugandans on first-line antiretroviral therapy (ART). We conducted a cross-sectional study at an HIV clinic in southwestern Uganda. We enrolled adult patients on non-nucleoside-based ART regimens for a minimum of 2 years. We collected anthropometric and clinical measurements, smoking history, and blood for fasting lipid profile and blood sugar (FBS). Outcomes of interest were (1) presence of metabolic syndrome (at least two of the following: FBS >100 mg/dL, blood pressure of ≥130/85 mmHg, triglycerides ≥150 mg/dL, HDL <40 mg/DL, or waist circumference ≥94 cm in males or ≥80 cm in females); and (2) a Framingham score correlating to >5% 10-year CVD risk. Of the 250 participants enrolled, metabolic syndrome was detected in 145/250 (58%) of participants (62% in females and 50% in males). Forty-three participants (17%) had a Framingham risk correlating to a 5% or greater risk for CVD within 10 years (26% in males and 13% in females). In multivariate analyses, being female (AOR 3.13; 95% CI: 1.0-9.70; p = 0.04) and over 40 years of age (AOR 1.78; 95% CI: 1.00-3.17; p = 0.05) was independently associated with having metabolic syndrome. We found no independent risk factors for a Framingham risk score 10-year risk exceeding 5%, or associations between ART regimen and CVD risk profiles. We conclude that metabolic abnormalities are common among patients on first-line ART in rural Uganda, and appear to be more common in women than men.

Cardiometabolic risk among hiv-positive Ugandan adults: prevalence, predictors and effect of long-term antiretroviral therapy

“…Consistent with other studies, we found a low prevalence of hyperglycemia (3.4%) [24–26], which was not affected by ART regimen [27] but significantly affected by increasing age [28]. The prevalence of abdominal obesity in our study is comparable to the 30% observed in a Southwestern Ugandan ART cohort [26] but was lower than that reported in the background GPC population-56% [10]. High prevalence of obesity among women than men has also been previously established by studies in SSA (24-26) and Europe [29].…”

Metabolic syndrome in patients on first‐line antiretroviral therapy containing zidovudine or tenofovir in rural Lesotho, Southern Africa

“…A recently published single‐centre study in Uganda with a sample size of 250 patients found an aOR of 1.67 for MetS in patients on AZT/3TC/NVP as compared to TDF/3TC/EFV. The finding was, however, not significant, and the analysed subgroups were small (129 in TDF and 68 in AZT group) .…”

“…A recently published single-centre study in Uganda with a sample size of 250 patients found an aOR of 1.67 for MetS in patients on AZT/3TC/NVP as compared to TDF/3TC/EFV. The finding was, however, not significant, and the analysed subgroups were small (129 in TDF and 68 in AZT group) [17]. With near-normal life expectancies among PLWHA taking ART and increasing age of patients on ART, cardio-vascular risk factors in PLWHA gain considerable importance.…”

Metabolic Complications and Glucose Metabolism in HIV Infection: A Review of the Evidence

“…[1–4] The prevalence of diseases related to altered glucose and fat metabolism, including diabetes and cardiovascular disease, has also continued to increase among PLWH in the United States. A longitudinal study of insulin resistance (IR) in PLWH on newer ART regimens identified IR in 21% of participants, which represents a significant decrease from estimates of 35–63% prevalence IR with older ART regimens.…”