title: Metabolic syndrome before and after initiation of antiretroviral therapy in treatment-naive HIV-infected individuals.
abstract: BACKGROUND
  Metabolic syndrome (MetS) is a cluster of risk factors for cardiovascular disease and diabetes, many of which are associated with HIV and antiretroviral therapy (ART). We examined prevalence and incidence of MetS and risk factors for MetS in ART-naive HIV-infected individuals starting ART.
  
  
  METHODS
  MetS, defined by the Adult Treatment Panel III criteria, was assessed at and after ART initiation in HIV-infected individuals who enrolled in selected AIDS Clinical Trials Group trials and were followed long-term after these trials as part of the AIDS Clinical Trials Group Longitudinal Linked Randomized Trials cohort. Cox proportional hazards models were used to examine risk factors of incident MetS. Adjusted hazard ratios (aHRs) and 95% confidence intervals (CI) are reported.
  
  
  RESULTS
  At ART initiation, the prevalence of MetS was 20%. After ART initiation, the incidence of MetS was 8.5 per 100 person-years. After adjusting for demographics and body mass index, the risk of MetS was decreased for CD4+ T-cell counts >50 cells per cubic millimeter (aHR = 0.62, 95% CI = 0.43 to 0.90 for CD4 >500), and the risk was increased for HIV-1 RNA >400 copies per milliliter (aHR = 1.55 (95% CI = 1.25 to 1.92) and use of a protease-inhibitor (PI)-based regimen [relative to no PI use, aHR = 1.25 (95% CI = 1.04 to 1.51) for any PI use].
  
  
  CONCLUSIONS
  In HIV-infected individuals on ART, virologic suppression and maintenance of high CD4+ T-cell counts may be potentially modifiable factors that can reduce the risk of MetS. The effect of MetS on the risk of cardiovascular disease and diabetes needs to be evaluated.
authors: Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, MA 02115, USA. krishnan@sdac.harvard.edu
authors: Supriya
authors: S
authors: Krishnan
authors: Jeffrey T
authors: JT
authors: Schouten
authors: Benjamin
authors: B
authors: Atkinson
authors: Todd
authors: T
authors: Brown
authors: David
authors: D
authors: Wohl
authors: Grace A
authors: GA
authors: McComsey
authors: Marshall J
authors: MJ
authors: Glesby
authors: Cecilia
authors: C
authors: Shikuma
authors: Richard
authors: R
authors: Haubrich
authors: Pablo
authors: P
authors: Tebas
authors: Thomas B
authors: TB
authors: Campbell
authors: Denise L
authors: DL
authors: Jacobson
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D015992:Body Mass Index; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D015994:Incidence; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology / Q000209:etiology*; D008875:Middle Aged; D015995:Prevalence; D016016:Proportional Hazards Models; D012307:Risk Factors; D019562:Viral Load / Q000187:drug effects
chemical_list: D019380:Anti-HIV Agents