The metabolic syndrome, an epidemic among HIV-infected patients on HAART

• Published in: Biomedicine & pharmacotherapy Vol. 63; no. 5; pp. 337 - 342
• Main Authors: Jevtović, Dj, Dragović, G, Salemović, D, Ranin, J, Djurković-Djaković, O
• Format: Journal Article
• Language: English
• Published: Paris Elsevier SAS 01-06-2009; Elsevier
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Antiretroviral Therapy, Highly Active - adverse effects; Biological and medical sciences; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - etiology; Cardiovascular Diseases - metabolism; Cohort Studies; Cross-Sectional Studies; Female; Glucose - metabolism; HAART; HIV; HIV Infections - complications; HIV Infections - drug therapy; HIV Infections - epidemiology; HIV Infections - metabolism; HIV-Associated Lipodystrophy Syndrome - chemically induced; HIV-Associated Lipodystrophy Syndrome - epidemiology; HIV-Associated Lipodystrophy Syndrome - metabolism; Human viral diseases; Humans; Hyperlipidemias - chemically induced; Hyperlipidemias - epidemiology; Hyperlipidemias - metabolism; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunopathology; Infectious diseases; Internal Medicine; Kaplan-Meier Estimate; Logistic Models; Male; Medical Education; Medical sciences; Metabolic diseases; Metabolic Diseases - chemically induced; Metabolic Diseases - epidemiology; Metabolic Diseases - metabolism; Metabolic syndrome (MS); Middle Aged; Miscellaneous; Other metabolic disorders; Pharmacology. Drug treatments; Prevalence; Risk Factors; Syndrome; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Young Adult; HIV; Metabolic syndrome (MS); HAART; Endocrinopathy; Epidemic; Immunopathology; Retroviridae; Metabolic diseases; Cardiovascular disease; AIDS; Metabolic syndrome; Immune deficiency; Lentivirus; Infection; Virus; Chemotherapy; Treatment; Viral disease; Antiviral; Human immunodeficiency virus; Public health
• ISSN: 0753-3322; 1950-6007
• DOI: 10.1016/j.biopha.2008.09.011

Summary Background HAART has dramatically changed the prognosis of AIDS, but has led to long-term toxicities of antiretroviral drugs. A major chronic complication is the metabolic syndrome (MS), including hyperlipidemia, lipodystrophy (LD), and impaired glucose metabolism. Methods A cross-sectional study of a series of 582 patients from the Serbian HIV/AIDS cohort, treated with HAART for a mean period of 3.3 ± 2.1 years (range 1–10), was performed to evaluate the prevalence and risk factors for MS during HAART. Results The prevalence of LD was 29.1%, with a 100% probability of development after 10 years of treatment. Risk factors for LD included female gender (OR 1.7, 95% CI 1.0–2.7, P = 0.02), age > 40 (OR 1.7, 95% CI 1.1–2.7, P = 0.01) and AIDS at HAART initiation (OR 1.9, 95% CI 1.2–2.2, P < 0.01), as well as prolonged usage of NRTIs (OR 2.7, 95% CI 1.6–4.5, P < 0.01). The NNRTI-based regimens were less likely to induce LD than those PI-based (OR 1.87, 95% CI 1.2–2.9 vs. OR 3.7, 95% CI 2.3–6.1, respectively). Hyperlipidemia occurred in 47% of the patients, and was associated with male gender (OR 2.2, 95% CI 1.4–3.5, P < 0.01) and prolonged usage of PI + NNRTI HAART (OR 3.0, 95% CI 1.8–4.9, P < 0.01). In contrast, regimens composed of 2 NRTI + NNRTI were less likely to induce hyperlipidemia (OR 0.4, 95% CI 0.3–0.7, P = 0.03). Glucose intolerance and/or diabetes mellitus was recorded in 9.6%, if with AIDS at HAART initiation (OR 3.7, 95% CI 1.2–11.4, P < 0.01), male gender (OR 5.2, 95% CI 1.8–15.1, P < 0.01) and age > 40 (OR 2.6, 95% CI 1.1–6.3, P = 0.02). Conclusion MS seems an inevitable consequence of long-term successful HAART.