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


CONCLUSIONS
MS seems an inevitable consequence of long-term successful HAART.
Jevtović
D J
DJ
Institute for Infectious and Tropical Diseases, Clinical Centre of Serbia, Belgrade University School of Medicine, Belgrade, Serbia. djordjejevtovic@hotmail.com
Dragović
G
G
Salemović
D
D
Ranin
J
J
Djurković-Djaković
O
O
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology / Q000378:metabolism; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D005947:Glucose / Q000378:metabolism; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology / Q000378:metabolism; D039682:HIV-Associated Lipodystrophy Syndrome / Q000139:chemically induced / Q000453:epidemiology / Q000378:metabolism; D006801:Humans; D006949:Hyperlipidemias / Q000139:chemically induced / Q000453:epidemiology / Q000378:metabolism; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008659:Metabolic Diseases / Q000139:chemically induced* / Q000453:epidemiology / Q000378:metabolism; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D013577:Syndrome; D055815:Young Adult
D005947:Glucose