Metabolic syndrome among HIV-infected Taiwanese patients in the era of highly active antiretroviral therapy: prevalence and associated factors

Wu, Pei‐Ying; Hung, Chien‐Ching; Liu, Wen-Chun; Hsieh, Chia Chien; Sun, Hsin‐Yun; Lu, Ching-Lan; Wu, Hsiu; Chien, Kuo‐Liong

doi:10.1093/jac/dkr558

Cited by 50 publications

(60 citation statements)

References 46 publications

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“…Jantarapakde et al (19) reported a higher prevalence of lipodystrophy and median total cholesterol, HDL-cholesterol, and triglycerides in patients who had received antiretroviral therapy. Moreover, increases in mean total cholesterol, HDL-cholesterol, and triglyceride levels were observed as the duration of antiretroviral therapy increased in previous studies in Asian patients (2021). Therefore, in consideration of these studies, it can be presumed that antiretroviral therapy influenced the prevalence of metabolic complications.…”

Section: Discussionmentioning

confidence: 58%

Metabolic Complications among Korean Patients with HIV Infection: The Korea HIV/AIDS Cohort Study

Ahn

Kim

et al. 2017

J Korean Med Sci

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Currently, metabolic complications are the most common problem among human immunodeficiency virus (HIV)-infected patients, with a high incidence. However, there have been very few studies regarding metabolic abnormalities published in Asia, especially in Korea. This cross-sectional study was performed to investigate the prevalence of and risk factors for metabolic abnormalities in 1,096 HIV-infected patients of the Korea HIV/AIDS cohort study enrolled from 19 hospitals between 2006 and 2013. Data at entry to cohort were analyzed. As a result, the median age of the 1,096 enrolled subjects was 46 years, and most patients were men (92.8%). The metabolic profiles of the patients were as follows: median weight was 63.8 kg, median body mass index (BMI) was 22.2 kg/m2, and 16.4% of the patients had a BMI over 25 kg/m2. A total of 5.5% of the patients had abdominal obesity (waist/hip ratio ≥ 1 in men, ≥ 0.85 in women). Increased levels of fasting glucose, total cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides were present in 10.4%, 6.0%, 5.5%, and 32.1% of the patients. Decreased high-density lipoprotein (HDL) cholesterol levels were observed in 44.2% of the patients. High systolic blood pressure was present in 14.3% of the patients. In multivariate analysis, high BMI and the use of protease inhibitors (PIs) were risk factors for dyslipidemia in HIV-infected patients. In conclusion, proper diagnosis and management should be offered for the prevalent metabolic complications of Korean HIV-infected patients. Further studies on risk factors for metabolic complications are needed.

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Section: Discussionmentioning

confidence: 58%

Metabolic Complications among Korean Patients with HIV Infection: The Korea HIV/AIDS Cohort Study

Ahn

Kim

et al. 2017

J Korean Med Sci

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“…Third, we did not have an HIV-uninfected population for comparison in terms of the frequency of comorbidity. Therefore, it is not known whether the frequency of any comorbidity examined in this study is higher in HIV-infected patients than in HIV-uninfected patients in Taiwan, although several studies have suggested that cART and HIV infection may accelerate aging and increase risk of metabolic, cardiovascular and renal complications [10], [14], [15], [39], [40], [42].…”

Section: Discussionmentioning

confidence: 84%

“…Several studies have provided evidence that comorbidities such as diabetes mellitus [6]–[11], hypertension [6], [8], [9], [12], coronary artery disease [11], hyperlipidemia [13], [14], renal disease [7], [11], [15], and reduced bone mineral density [16]–[18] are more common among HIV-infected elderly patients than HIV-uninfected controls. Other than cART, medications for management of metabolic complications and cardiovascular diseases will be needed, which will increase the pill burden and potential for drug-drug interactions in the elderly patients [19],[20].…”

Section: Introductionmentioning

confidence: 99%

Comorbidities among the HIV-Infected Patients Aged 40 Years or Older in Taiwan

Chen

Hsieh

et al. 2014

PLoS ONE

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BackgroundWith the widespread use of combination antiretroviral therapy (cART), life expectancy of HIV-infected patients has significantly prolonged. An increasing number of HIV-infected patients are aging and concurrent use of medications are not uncommon for management of metabolic complications and cardiovascular diseases related to aging and prolonged exposure to cART.MethodsWe reviewed medical records of all HIV-infected patients aged 40 years or older who had been followed at a university hospital for HIV care in Taiwan between January and December 2013. A standardized case record form was used to collect information on demographics and clinical characteristics, comorbidity, cART, and concurrent medications.ResultsDuring the study period, 610 patients aged 40 to 49 years (mean, 44.1) and 310 aged 50 years or older (mean, 58.8) sought HIV care at this hospital. Compared with patients aged 40 to 49 years, those aged 50 years or older were significantly more likely to be female (15.9% vs 3.8%); to have received cART (97.7% vs 94.8%) and a lower plasma HIV RNA load (1.6 vs 1.7 log10 copies/ml); and to have diabetes mellitus (18.4% vs 4.6%), hypertension (31.0% vs 10.8%), hyperlipidemia (29.4% vs 11.6%), coronary artery disease (6.8% vs 0.5%), and an estimated glomerular filtration rate <60 ml/min/1.73 m2 (11.5% vs 2.7%); and were significantly less likely to have syphilis. Other than HIV infection, patients aged 50 years or older were more likely to have been receiving two or more concurrent medications than those aged 40 to 49 years (22.9% vs 6.4%).ConclusionsOur findings show a significant proportion of the HIV-infected patients aged 50 years or older have multiple comorbidities that may increase the risk for cardiovascular and renal complications. Issues of poly-pharmacy among the HIV-infected patients who are aging should be addressed to ensure adherence and minimize drug-drug interactions.

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“…Some retrospective studies have found a higher prevalence of MS associated with exposure to HAART [13,18,31,39] and in particular with older PIs [14,18,19,31,34,36,38,39,42,51,99] and thymidine analogues [14,19,33,42], however this has not been confirmed in other studies [12,15,16,20,25,27,29]. …”

Section: The Role Of Antiretroviral Therapy In the Metabolic Syndromementioning

confidence: 99%

Hypertension Is a Key Feature of the Metabolic Syndrome in Subjects Aging with HIV

et al. 2016

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With widespread and effective antiretroviral therapy, the life expectancy in the HIV population has dramatically improved over the last two decades. Consequently, as patients are aging with HIV, other age-related comorbidities, such as metabolic disturbances and cardiovascular disease (CVD), have emerged as important causes of morbidity and mortality. An overrepresentation of traditional cardiovascular risk factors (RF), toxicities associated with long exposure to antiretroviral therapy, together with residual chronic inflammation and immune activation associated with HIV infection are thought to predispose to these metabolic complications and to the excess risk of CVD observed in the HIV population. The metabolic syndrome (MS) represents a clustering of RF for CVD that includes abdominal obesity, hypertension, dyslipidemia, and insulin resistance. Hypertension is a prevalent feature of the MS in HIV, in particular in the aging population, and constitutes an important RF for CVD. Physicians should screen their patients for metabolic and cardiovascular risk at the regular visits to reduce MS and the associated CVD risk among people aging with HIV, since many of RF are under-diagnosed and under-treated conditions. Interventions to reduce these RF can include life-style changes and pharmacological interventions such as antihypertensive and lipid-lowering therapy, and treatment of glucose metabolism disturbances. Changes in antiretroviral therapy to more metabolic neutral antiretroviral drugs may also be considered.

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Metabolic syndrome among HIV-infected Taiwanese patients in the era of highly active antiretroviral therapy: prevalence and associated factors

Abstract: Approximately one-fourth of HIV-infected Taiwanese patients developed metabolic syndrome in the HAART era. Receipt of HAART and prolonged exposure to PI and nucleoside reverse transcriptase inhibitor(s) were associated with metabolic syndrome.

Cited by 50 publications

References 46 publications

Metabolic Complications among Korean Patients with HIV Infection: The Korea HIV/AIDS Cohort Study

Metabolic Complications among Korean Patients with HIV Infection: The Korea HIV/AIDS Cohort Study

Comorbidities among the HIV-Infected Patients Aged 40 Years or Older in Taiwan

Hypertension Is a Key Feature of the Metabolic Syndrome in Subjects Aging with HIV

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