Metabolic syndrome, cardiovascular disease and type 2 diabetes mellitus after initiation of antiretroviral therapy in HIV infection.
BACKGROUND
Metabolic syndrome (MS) identifies individuals at risk of cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM). Little is known about MS and its consequences following initiation of antiretroviral therapy (ART).


METHODS
HIV-infected adults (881) initiating ART were evaluated for prevalence and incidence of MS and subsequent diagnosis of CVD and T2DM over a 3-year period. MS was defined by criteria of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Third Report; ATP-III) or of the International Diabetes Federation (IDF).


RESULTS
The prevalence of baseline MS was 8.5% and 7.8% (ATP-III and IDF, respectively). During follow-up, 234 (12/100 patient-years) (ATP-III) and 178 (8/100 patient-years) (IDF) progressed to MS. MS at baseline had a borderline association with increased risk of CVD [ATP-III: hazard ratio (HR), 2.56; 95% confidence interval (CI), 0.86-7.60; P = 0.095; IDF: HR, 2.89; 95% CI, 0.98-8.63; P = 0.058] and was significantly associated with an increased risk of T2DM (ATP-III: HR, 4.34; 95% CI, 1.83-10.25; P = 0.001; IDF: HR, 3.33; 95% CI, 1.35-8.17; P = 0.009). Incident MS was significantly associated with an increased risk of both CVD (ATP-III: HR, 2.73; 95% CI, 1.07-6.96; P = 0.036; IDF: HR, 3.05; 95% CI, 1.20-7.75; P = 0.019) and T2DM (ATP-III: HR, 4.89; 95% CI, 2.22-10.78; P < 0.0001; IDF: HR, 4.84; 95% CI, 2.20-10.64; P < 0.0001).


CONCLUSIONS
Substantial progression to MS occurs within 3 years following initiation of ART. Since baseline and incident MS identifies individuals at risk for subsequent CVD and T2DM, it warrants evaluation in patients commencing ART.
Wand
Handan
H
National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Australia.
Calmy
Alexandra
A
Carey
Dianne L
DL
Samaras
Katherine
K
Carr
Andrew
A
Law
Matthew G
MG
Cooper
David A
DA
Emery
Sean
S
D000328:Adult; D000480:Alkynes; D000886:Anthropometry; D019380:Anti-HIV Agents / Q000009:adverse effects* / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects / Q000379:methods; D048588:Benzoxazines / Q000009:adverse effects; D001824:Body Constitution; D002318:Cardiovascular Diseases / Q000139:chemically induced; D003521:Cyclopropanes; D003924:Diabetes Mellitus, Type 2 / Q000139:chemically induced; D018450:Disease Progression; D004812:Epidemiologic Methods; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000139:chemically induced*; D008875:Middle Aged; D019888:Nelfinavir / Q000009:adverse effects; D018894:Reverse Transcriptase Inhibitors / Q000009:adverse effects
D000480:Alkynes; D019380:Anti-HIV Agents; D048588:Benzoxazines; D003521:Cyclopropanes; D018894:Reverse Transcriptase Inhibitors; D019888:Nelfinavir; C098320:efavirenz