A Metabolic Syndrome among HIV Infected Outpatients in the Era of Highly Active Antiretroviral Therapy: Prevalence and Contributing Factors

Abstract

Background: Treatment of HIV infection with highly active antiretroviral therapy (HAART) has been shown to induce metabolic complications including lipodystrophy, dyslipidaemia and insulin resistance [1]. Some metabolic complications have been more strongly associated with longer duration HAART and protease inhibitor (PI) based HAART [2]. Therefore, despite the drastically reduced morbidity and mortality conferred from immune reconstruction, HAART can significantly impact cardiovascular health [3]. The aim of this study was to investigate associations between HAART regimen and the components of the commonly defined metabolic syndrome.  Methods: This was a cross-sectional study with a cohort of 100 HIV infected adults from Birmingham Heartland’s Hospital HIV Service. Relevant anthropometric, biochemical and clinical data was collected as part of a national dietetics (DHIVA) audit and then extracted for the use of this research project. Metabolic syndrome and its components prevalence were examined against HAART regimen and duration among patients using the U.S. National Cholesterol Education Programme Adult Treatment Panel (ATP III) criteria.  Results: The prevalence of metabolic syndrome was 16% in both HAART patients (n=81) and those HAART naive (n=19). The prevalences and means of metabolic syndrome’s components were also found to be similar in the two treatment groups. The only significant difference was between the prevalence of central obesity (68% HAART, 50% HAART naïve, p=0.035). No evidence was found of any difference in the prevalence or the means of metabolic components in PI (n=33) and non-PI (n=48) based HAART treatment groups (p>0.05 for all). Similarly, no significant associations were found between duration of HAART and metabolic syndrome components (p>0.05 for all).  Discussion: Despite indications in literature, HAART was not associated with an increased risk of metabolic complications in HIV infected patients. It appears that since most of this research was conducted, more has been learnt about the causes and treatment of HAART associated metabolic complications and strategies to prevent and treat it are continuing to evolve with success. However, weaknesses associated with the observational design of this study and the small sample size mean that reliability of the results is limited. Future prospective studies will help to uncover greater understanding behind the relationship between HIV/HAART with metabolic complications, including the development of metabolic syndrome, hopefully assisting in reducing co-morbidities like type 2 diabetes mellitus and cardiovascular disease in this patient group with extending life expectancies.  Conclusion: Clinical practice should focus metabolic management strategies on HIV infected patients, regardless of their treatment e.g. regular cardiovascular screening, appropriate dietetic referral and suitable pharmaceutical intervention for all.