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HIV patients face modifiable risk factors for metabolic syndrome

NEW YORK (Reuters Health) – HIV-infected patients on antiretroviral therapy (ART) are at higher risk of metabolic syndrome, and a new study helps identify patients most in need of interventions to reduce that risk.

Dr. Supriya Krishnan from Harvard School of Public Health in Boston and colleagues studied 2,247 participants in three randomized trials being run by the AIDS Clinical Trials Group. At baseline, all patients were ART-naïve, and 20% had metabolic syndrome.

During 5,617 person-years of follow-up, 478 patients developed metabolic syndrome, for an incidence of 8.5 per 100 person-years, the researchers said in a July 23rd online paper in the Journal of Acquired Immune Deficiency Syndromes.

Factors independently associated with a higher risk of developing metabolic syndrome after starting ART included increasing age and body mass index (BMI), CD4+ T-cell count of 50 cells/mm3 or less, HIV-1 viral load greater than 400 copies/mL, and use of a protease inhibitor-based regimen.

Forty percent of the patients with metabolic syndrome at baseline and 49% of those who later developed metabolic syndrome had the combination of high blood pressure, high triglycerides, and low HDL cholesterol, the researchers say.

“This highlights the importance of regular monitoring of HIV-infected patients on ART for metabolic abnormalities,” Dr. Krishnan told Reuters Health in an email. “Further, our results also highlight the importance of virologic suppression and immune restoration to avoid metabolic syndrome.”

Dr. Krishnan said the group’s next step is to see whether metabolic syndrome increases the risk for cardiovascular disease in HIV-infected patients on antiretrovirals. “If indeed metabolic syndrome increases the risk of diabetes and cardiovascular disease,” the investigators say, “reducing metabolic syndrome in HIV-infected populations may be an important step in reducing the burden of cardiovascular disease and diabetes in this population.”

Dr. Katherine Samaras from The University of New South Wales has also studied the prevalence of metabolic syndrome in HIV-infected patients receiving ART. She told Reuters Health, “The key is to consider the metabolic status of the HIV-infected individual. Priority one is to control the virus and stop it replicating, and physicians should chose medications that will do that. Priority two is to select the ‘best fit’ of medications that will protect the health of that individual, by considering that individual’s risks for diabetes and heart disease.”

Lifestyle changes are important, too, Dr. Samaras said. “We know that eating a healthy, fat-reduced, calorie-controlled diet helps prevent blood fat rises on antiretrovirals. Physical activity helps keep weight and waistlines healthy and prevents diabetes. Stopping smoking reduces heart risk.”

Dr. Samaras concluded, “By working in partnership, prescribing physicians and people living with HIV-infection can help stop development of metabolic syndrome and future disease.”


JAIDS 2012.