Prevalence and Determinants of Metabolic Syndrome among Adults Living with HIV on Antiretroviral Therapy at a Tertiary Hospital in Burkina Faso

Abstract

Background: The advent of highly active antiretroviral therapy (HAART) has transformed HIV infection into a chronic manageable condition, but has introduced new metabolic complications, particularly metabolic syndrome (MetS). Understanding the prevalence and determinants of MetS in HIV-positive populations in sub-Saharan Africa remains crucial for optimizing long-term care. Objective: To determine the prevalence of metabolic syndrome and identify associated factors among people living with HIV (PLWH) receiving antiretroviral therapy at the Day Hospital of Yalgado Ouédraogo University Hospital Center in Burkina Faso. Methods: A cross-sectional descriptive study was conducted from October 2022 to November 2023 among 641 HIV-positive adults aged 18 years and above on antiretroviral therapy for at least one year, without severe comorbid conditions. MetS was assessed using the International Diabetes Federation (IDF) 2005 criteria. Data included sociodemographic characteristics, anthropometric measurements, clinical parameters, immunovirological markers, and biochemical profiles. Bivariate and multivariate logistic regression analyses were performed to identify factors associated with MetS. Results: The mean age was 49.78 years, with 74.73% female participants. MetS prevalence was 40.72% by IDF criteria and 30.42% by NCEP-ATP III criteria. Mean HIV infection duration was 12.37 years, with 68.02% infected for 10 years or more. In multivariate analysis, significant risk factors for MetS included advanced age (OR=1.14, p=0.001), female gender (OR=1.28, p=0.012), HIV infection duration of 10 years or more (OR=1.79, p=0.030), BMI of 25 kg/m² or higher (OR=1.26, p<0.001), personal history of hypertension (OR=4.01, p<0.001), diabetes (OR=6.14, p<0.001), obesity (OR=1.90, p<0.001), presence of dyslipidemia (OR=3.96, p<0.001), and higher last CD4 count (OR=1.78, p=0.005). Protective factors included AZT-based therapy (OR=0.57, p=0.033) and current regimens TLD (OR=0.98, p<0.001) and ABC/3TC/DTG (OR=0.56, p=0.016). Marginally associated regimens included D4T/3TC+NVP (OR=1.63, p=0.050) and AZT/3TC+LPV/r (OR=2.96, p=0.023). Conclusion: MetS prevalence among PLWH in Burkina Faso is substantial and associated with both traditional risk factors and HIV-specific factors including infection chronicity and antiretroviral regimen type. Comprehensive metabolic screening and personalized therapeutic strategies are essential for optimizing long-term outcomes in this population.