PT271 Prevalence of Metabolic Syndrome in Patients with HIV in the Era of Highly Active Antiretroviral Therapy

Lombo, Bernardo; Fotjadhi, Irma; Ravi, Sreedhar; Golden, Marjorie; Virata, Michael; Liévano, Martha Constanza; Díez, José; Ghantous, Andre; Donohue, Thomas J.

doi:10.1016/j.gheart.2014.03.2016

Cited by 9 publications

(11 citation statements)

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“…High prevalence of obesity among women than men has also been previously established by studies in SSA (24-26) and Europe [ 29 ]. The observed risk of obesity from PI-based ART corroborates results from a US based observational study [ 30 ] and is possibly attributed to ART associated metabolic aberrations and fat mal-distribution. Studies from developed countries attested to a high risk of abnormal non HDL cholesterol among individuals on PI ART [ 31 ].…”

Section: Discussionsupporting

confidence: 85%

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

Kazooba¹,

Kasamba²,

Mayanja³

et al. 2017

Pan Afr Med J

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IntroductionWe investigated the prevalence, predictors of and effect of Antiretroviral Therapy (ART) regimen on cardiometabolic risk among HIV-positive Ugandan adults at enrolment into a prospective cohort to study the Complications of Long-Term ART (CoLTART).MethodsWe collected data on cardiometabolic risk factors including dyslipidemia, hypertension, hyperglycemia, obesity and calculated the mean atherogenic index for Plasma (AIP) and 10 year Framingham risk score (FHS). Exposures were: ART regimen, duration on ART, demographic, socio-economic, behavioral, and life-style factors including smoking, physical activity and diet (including fruit and vegetables consumption).ResultsWe enrolled 1024 participants, 65% female, mean age was 44.8 years (SD 8.0) and median duration on ART was 9.4 years (IQR 6.1-9.8). The prevalence of abdominal obesity was 52.6%, BMI≥25 kg/m2 -26.1%, hypertension-22.6%, high AIP-31.3% and FHS above 10% was 16.6%. The prevalence of low High Density Lipoprotein (HDL) was 37.5%, high Total cholesterol (Tc)-30.2%, high Low Density Lipoprotein (LDL) -23.6%, high Triglycerides (TG)-21.2%, low physical activity-46.4% and alcohol consumption-26.4%. In multivariate linear regression analyses, increasing age was associated with higher mean Tc, HDL, LDL, FHS (P<0.001) and hyperglycemia (p<0.005). In multivariate logistic regression analyses, Protease Inhibitor (PI) containing regimens were significantly associated with higher risks of abnormal: Tc, LDL, TG, AIP, abdominal obesity, hypertension, low HDL and lower risk of a FHS >10% compared to the non PI regimen.ConclusionART increases cardiometabolic risk. Integration of routine assessment for cardiometabolic risk factors and preventive interventions into HIV care programs in resource-limited settings is recommended.

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Section: Discussionsupporting

confidence: 85%

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

Kazooba¹,

Kasamba²,

Mayanja³

et al. 2017

Pan Afr Med J

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“… 25 . More recently, the prevalence of MS in HIV-treated patients was 27% using the International Diabetes Federation criteria and 26% using NCEP criteria 36 . Our result, confirming the high prevalence of MS among HIV positive patients on HAART, further supports the increased burden of CV risk of HIV-treated patients.…”

Section: Discussionmentioning

confidence: 99%

Urinary albumin-to-creatinine ratio is associated with endothelial dysfunction in HIV-infected patients receiving antiretroviral therapy

Pirro

Mannarino

Francisci

et al. 2016

Sci Rep

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Endothelial dysfunction, a marker of cardiovascular (CV) risk, is common in human immunodeficiency virus (HIV)-infected patients. Microalbuminuria is frequent in HIV-infected patients, and is a predictor of renal impairment and CV risk. We investigated the association between microalbuminuria and endothelial dysfunction among HIV-infected patients receiving highly-active antiretroviral therapy (HAART). Endothelial function, measured by brachial artery flow-mediated dilatation (bFMD), and urine albumin-to-creatinine ratio (UACR), were measured in 170 HAART-treated HIV-infected adults. The relationship between UACR and bFMD was evaluated. The prevalence of increased UACR, defined by two cut-off levels (20 mg/g and 30 mg/g), was 29% and 17%. UACR was significantly higher while bFMD was lower among patients with metabolic syndrome (MS). UACR was associated with bFMD (r = −0.31; p < 0.001). This association was stronger in MS-patients (r = −0.44; p = 0.003). UACR above 20 mg/g was associated with an increased risk (OR 2.37, 95% CI 1.15–4.89, p = 0.020) of severely impaired bFMD (bFMD ≤ 2.1%). Patients with MS and increased UACR had the lowest bFMD compared with those with none or one of the two conditions. Microalbuminuria and endothelial dysfunction are positively associated in HIV-infected patients regardless of known confounders. The coexistence of microalbuminuria and MS amplifies their deleterious influence on endothelial function.

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“…However, lower prevalence rates are reported in European countries, ranging from 6–30% [6–9]. The real prevalence of MS among HIV-infected individuals is still of debate, with many observational studies reporting very wide-range estimates from 7–52% (table 2)[10–52]. These large differences are probably due to differences in study design, most being cross-sectional with small study groups, different population characteristics, and differences in the definition of MS applied, making it difficult to conclusively establish if the prevalence in individuals living with HIV-infection is comparable to that seen in the general population.…”

Section: Prevalence and Predictors Of The Metabolic Syndrome In Hiv-imentioning

confidence: 99%

“…It is not clear if this association is also applicable for newer PI as darunavir and atazanavir with a more favourable metabolic profile [33,52]. Recent results from the Swiss HIV Cohort Study revealed that individuals exposed to atazanavir were less likely to develop MS [33].…”

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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PT271 Prevalence of Metabolic Syndrome in Patients with HIV in the Era of Highly Active Antiretroviral Therapy

Cited by 9 publications

References 0 publications

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

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

Urinary albumin-to-creatinine ratio is associated with endothelial dysfunction in HIV-infected patients receiving antiretroviral therapy

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

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