title: Metabolic Syndrome After HIV Acquisition in South African Women.
abstract: BACKGROUND
  Noncommunicable diseases are common among chronically infected patients with HIV in the developed world, but little is known about these conditions in African cohorts. We assessed the epidemiology of metabolic syndrome among young South African women during the first 3 years after HIV acquisition.
  
  
  METHODS
  A total of 160 women were followed prospectively in the CAPRISA 002 Acute Infection study. Metabolic syndrome was defined as a constellation of hyperlipidemia, hypertension, hyperglycemia/diabetes, and abdominal obesity. Time trends were assessed using generalized estimation equation models.
  
  
  RESULTS
  Median age was 24 years and body mass index 27 kg/m. Prevalence of metabolic syndrome at infection was 8.7% increasing to 19.2% over 36 months (P = 0.001). The proportion of women with body mass index >30 kg/m increased from 34.4% to 47.7% (P = 0.004), those with abnormal waist circumference and elevated blood pressure increased from 33.5% to 44.3% (P = 0.060) and 23.8% to 43.9% (P < 0.001), respectively. Incidence of metabolic syndrome was 9.13/100 person-years (95% CI: 6.02 to 13.28). Predictors of metabolic syndrome were age (per year increase odds ratio (OR) = 1.12; 95% CI: 1.07 to 1.16), time postinfection (per year OR = 1.47; 95% CI: 1.12 to 1.92), family history of diabetes (OR = 3.13; 95% CI: 1.71 to 5.72), and the human leukocyte antigen (HLA)-B*81:01 allele (OR = 2.95; 95% CI: 1.21 to 7.17), whereas any HLA-B*57 or B*58:01 alleles were protective (OR = 0.34; 95% CI: 0.15 to 0.77). HIV-1 RNA (OR = 0.89; 95% CI: 0.62 to 1.27) and CD4 count (OR = 1.03; 95% CI: 0.95 to 1.11) did not predict metabolic syndrome.
  
  
  CONCLUSIONS
  The high burden of metabolic conditions in young South African HIV-infected women highlights the need to integrate noncommunicable disease and HIV care programs. Interventions to prevent cardiovascular disease must start at HIV diagnosis, rather than later during the disease course.
authors.affiliation: *Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa; †Division of Infectious Disease, Department of Medicine, Columbia University, New York, NY; ‡Department of Medical Microbiology, University of KwaZulu-Natal, Durban, South Africa; §National Health Laboratory Service, Durban, South Africa; Divisions of ‖Medical Virology, ¶Immunology, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, South Africa; and #Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY.
authors.forename: Magdalena E
authors.initials: ME
authors.lastname: Sobieszczyk
authors.forename: Lise
authors.initials: L
authors.lastname: Werner
authors.forename: Koleka
authors.initials: K
authors.lastname: Mlisana
authors.forename: Nivashnee
authors.initials: N
authors.lastname: Naicker
authors.forename: Addi
authors.initials: A
authors.lastname: Feinstein
authors.forename: Clive M
authors.initials: CM
authors.lastname: Gray
authors.forename: Lindi
authors.initials: L
authors.lastname: Masson
authors.forename: Jo-Ann S
authors.initials: JS
authors.lastname: Passmore
authors.forename: Carolyn
authors.initials: C
authors.lastname: Williamson
authors.forename: Quarraisha
authors.initials: Q
authors.lastname: Abdool Karim
authors.forename: Salim S
authors.initials: SS
authors.lastname: Abdool Karim
authors.forename: Nigel J
authors.initials: NJ
authors.lastname: Garrett
mesh_terms: D000328:Adult; D016207:Cytokines / Q000097:blood / Q000378:metabolism; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000150:complications* / Q000453:epidemiology*; D006801:Humans; D024821:Metabolic Syndrome / Q000097:blood / Q000453:epidemiology* / Q000209:etiology*; D016017:Odds Ratio; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology; D055815:Young Adult
chemical_list: D016207:Cytokines