Metabolic syndrome before and after initiation of antiretroviral therapy in treatment-naive HIV-infected individuals.

TitleMetabolic syndrome before and after initiation of antiretroviral therapy in treatment-naive HIV-infected individuals.
Publication TypeJournal Article
Year of Publication2012
AuthorsKrishnan S, Schouten JT, Atkinson B, Brown T, Wohl D, McComsey GA, Glesby MJ, Shikuma C, Haubrich R, Tebas P, Campbell TB, Jacobson DL
JournalJ Acquir Immune Defic Syndr
Volume61
Issue3
Pagination381-9
Date Published2012 Nov 1
ISSN1944-7884
KeywordsAdult, Anti-HIV Agents, Body Mass Index, CD4 Lymphocyte Count, Female, HIV Infections, Humans, Incidence, Male, Metabolic Syndrome X, Middle Aged, Prevalence, Proportional Hazards Models, Risk Factors, Viral Load
Abstract

BACKGROUND: Metabolic syndrome (MetS) is a cluster of risk factors for cardiovascular disease and diabetes, many of which are associated with HIV and antiretroviral therapy (ART). We examined prevalence and incidence of MetS and risk factors for MetS in ART-naive HIV-infected individuals starting ART.

METHODS: MetS, defined by the Adult Treatment Panel III criteria, was assessed at and after ART initiation in HIV-infected individuals who enrolled in selected AIDS Clinical Trials Group trials and were followed long-term after these trials as part of the AIDS Clinical Trials Group Longitudinal Linked Randomized Trials cohort. Cox proportional hazards models were used to examine risk factors of incident MetS. Adjusted hazard ratios (aHRs) and 95% confidence intervals (CI) are reported.

RESULTS: At ART initiation, the prevalence of MetS was 20%. After ART initiation, the incidence of MetS was 8.5 per 100 person-years. After adjusting for demographics and body mass index, the risk of MetS was decreased for CD4+ T-cell counts >50 cells per cubic millimeter (aHR = 0.62, 95% CI = 0.43 to 0.90 for CD4 >500), and the risk was increased for HIV-1 RNA >400 copies per milliliter (aHR = 1.55 (95% CI = 1.25 to 1.92) and use of a protease-inhibitor (PI)-based regimen [relative to no PI use, aHR = 1.25 (95% CI = 1.04 to 1.51) for any PI use].

CONCLUSIONS: In HIV-infected individuals on ART, virologic suppression and maintenance of high CD4+ T-cell counts may be potentially modifiable factors that can reduce the risk of MetS. The effect of MetS on the risk of cardiovascular disease and diabetes needs to be evaluated.

DOI10.1097/QAI.0b013e3182690e3c
Alternate JournalJ. Acquir. Immune Defic. Syndr.
PubMed ID22828718
PubMed Central IDPMC3480980
Grant ListAI 069450 / AI / NIAID NIH HHS / United States
AI 38855 / AI / NIAID NIH HHS / United States
AI 38858 / AI / NIAID NIH HHS / United States
AI 68634 / AI / NIAID NIH HHS / United States
AI 68636 / AI / NIAID NIH HHS / United States
AI064086 / AI / NIAID NIH HHS / United States
AI27670 / AI / NIAID NIH HHS / United States
AI36214 / AI / NIAID NIH HHS / United States
K24 AI064086 / AI / NIAID NIH HHS / United States
K24 AI078884 / AI / NIAID NIH HHS / United States
K24 AI078884 / AI / NIAID NIH HHS / United States
P30 AI036214 / AI / NIAID NIH HHS / United States
P30 AI050410 / AI / NIAID NIH HHS / United States
RR 025780 / RR / NCRR NIH HHS / United States
U01 AI027670 / AI / NIAID NIH HHS / United States
U01 AI038855 / AI / NIAID NIH HHS / United States
U01 AI038858 / AI / NIAID NIH HHS / United States
U01 AI068634 / AI / NIAID NIH HHS / United States
U01 AI068636 / AI / NIAID NIH HHS / United States
U01 AI069419 / AI / NIAID NIH HHS / United States
U01 AI069450 / AI / NIAID NIH HHS / United States
U01 AI069467 / AI / NIAID NIH HHS / United States
U01 AI069467 / AI / NIAID NIH HHS / United States
U01 AI69419 / AI / NIAID NIH HHS / United States
UL1 RR025780 / RR / NCRR NIH HHS / United States