title: Changes in metabolic syndrome status after initiation of antiretroviral therapy.
abstract: BACKGROUND
  Data on changes in metabolic syndrome (MetS) status in HIV-infected adults on antiretroviral therapy (ART) are limited.
  
  
  METHODS
  MetS was assessed at ART initiation and every 48 weeks on ART in ART-naive HIV-infected individuals from the AIDS Clinical Trials Group Longitudinal Linked Randomized Trials (ALLRT) cohort. MetS, defined using the Adult Treatment Panel III criteria, required at least 3 of the following: elevated fasting glucose, hypertension, elevated waist circumference, elevated triglycerides, low high-density lipoprotein (HDL) cholesterol. Prevalence of MetS and the individual criteria were compared between ART initiation and during follow-up using McNemar test.
  
  
  RESULTS
  At ART initiation, 450 (20%) ALLRT participants had MetS. After 96 weeks of ART, 37% of the 411 with MetS at ART initiation and with available data at this time point did not meet the MetS criteria. Among these participants, there was a dramatic decline in the proportion with low HDL (95% versus 26%, P < 0.0001). Among the 63% who continued to meet MetS criteria at week 96, the proportion with ≥4 criteria was higher at week 96 compared to at the time of ART initiation (48% versus 40%, P = 0.03); at week 96, the proportion with high triglycerides was greater (87% versus 69%, P < 0.0001) as was the proportion with high glucose (59% versus 42%, P < 0.0001).
  
  
  CONCLUSIONS
  One in 5 ART-naive subjects met criteria for MetS at ART initiation. Although more than half of these individuals continued to have MetS after 96 weeks of ART, 37% with MetS at ART initiation no longer met criteria for MetS; this decrease was driven largely by increases in HDL cholesterol.
authors.affiliation: *Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, MA; †Department of Surgery, University of Washington School of Medicine, Seattle, WA; ‡Harborview Medical Center, Seattle, WA; §Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University, Baltimore, MD; ‖AIDS Clinical Trials Unit, University of North Carolina, Chapel Hill, NC; ¶Division of Pediatric Infectious Diseases and Rheumatology, Case School of Medicine, Cleveland, OH; #Division of Infectious Diseases, Department of Medicine, Weill Cornell Medical College, New York, NY; **Hawaii Center for AIDS, University of Hawaii, Honolulu, HI; and ††University of California San Diego, San Diego, CA.
authors.forename: Supriya
authors.initials: S
authors.lastname: Krishnan
authors.forename: Jeffrey T
authors.initials: JT
authors.lastname: Schouten
authors.forename: Benjamin
authors.initials: B
authors.lastname: Atkinson
authors.forename: Todd T
authors.initials: TT
authors.lastname: Brown
authors.forename: David A
authors.initials: DA
authors.lastname: Wohl
authors.forename: Grace A
authors.initials: GA
authors.lastname: McComsey
authors.forename: Marshall J
authors.initials: MJ
authors.lastname: Glesby
authors.forename: Cecilia
authors.initials: C
authors.lastname: Shikuma
authors.forename: Richard
authors.initials: R
authors.lastname: Haubrich
authors.forename: Denise L
authors.initials: DL
authors.lastname: Jacobson
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications / Q000503:physiopathology*
chemical_list: D019380:Anti-HIV Agents