An observational study of the prevalence of metabolic syndrome in treatment-experienced people living with HIV in Singapore

Abstract

Background While the use of combination antiretroviral therapy (cART) has conferred significant reduction in morbidity and mortality, there are growing concerns about the metabolic complications of antiretroviral regimens in HIV-infected patients. The aim of this study was to estimate the prevalence of metabolic syndrome (MetS) among people living with HIV (PLHIV) in Singapore. Methods We conducted a retrospective study using the clinical database maintained by the Clinical HIV Programme at the National Centre for Infectious Diseases, Singapore. Treatment-experienced PLHIV on follow-up during 2015–2017 were included. MetS was defined as having three or more of the following five abnormalities: hypertriglyceridemia, HDL hypocholesterolemia, hypertension, obesity, and diabetes. Results A total of 2,231 PLHIV were included in this study. 93.9% were men, and the median age at latest follow-up was 48 years. The median duration of HIV infection and duration of exposure to cART was 6.8 years and 5.7 years, respectively. All had been exposed to nucleoside reverse transcriptase inhibitors (NRTIs) as the first line of treatment, 93.9% to non-NRTIs, 28.6% to protease inhibitors (PIs) and 12.8% to integrase strand transfer inhibitors. The most common metabolic abnormality among PLHIV was HDL hypocholesterolemia (60.2%) followed by hypertriglyceridemia (45.5%). Of all the 2,231 individuals, 68.8% had at least one component of MetS. The overall prevalence of MetS was 23.6% (95% confidence interval 21.9%–25.4%). Of the 526 with MetS, the most common combination was HDL hypocholesterolemia, hypertriglyceridemia and hypertension (51.0%), followed by HDL hypocholesterolemia, hypertriglyceridemia, hypertension and diabetes (25.1%). Compared with PLHIV without MetS, a significantly higher proportion of those with MetS were ever on protease inhibitors (33.5% vs. 27.1%). Conclusion MetS is common in PLHIV. In view of the progressive aging of HIV-infected population and long-term use of cART, regular monitoring for metabolic abnormalities, surveillance of drug effects and behavioural interventions are needed to optimize management and prevention of metabolic disorders in PLHIV.

Metabolic syndrome among people living with HIV in Ethiopia: a systematic review and meta-analysis

“…MetS is now becoming a problem for PLHIV [ 9 ]. This SRMA disclosed the pooled prevalence of MetS in Ethiopia.…”

“…This is caused not only by the virus, but also by the ART drugs used to treat the infection. According to the most recent large survey, more PLHIV with MetS than those without MetS had ever been exposed to PIs [ 9 ]. As a result, a detailed patient’s medical assessment is essential for prioritizing risk mitigation and primary care prevention services.…”

“…These include, vascular diseases (e.g., atherosclerotic cardiovascular disease and hypertension), adiposity-related disorders (e.g., sleep disordered breathing and fatty liver disease), insulin resistance conditions (e.g., T2DM or gestational diabetes and polycystic ovary syndrome), atherogenic dyslipidemia, hormonal dysfunction, and chronic kidney disease [8]. Particularly, the consequences of MetS are much aggravated among PLHIV and receiving ART [6,[9][10][11].…”

GWAS identifies genetic clusters of cardiometabolic risk factors in continental Africans

“…Another limitation was that participants were not required to disclose their HIV status, as the regions included had varying burdens of HIV. For example, people with HIV infection have metabolic abnormalities that resemble metabolic syndrome 27 , but risks regarding stigma and preferences to not disclose HIV status in research studies at the time of recruitment were prioritized 28 . Third, we only had HbA 1c measurements to evaluate glycemic status among groups from DDS and UGR, as this was the global standard to screen for T2DM and other metabolic abnormalities, at the time the participants were recruited.…”