Metabolic Syndrome, Diabetes, and Cardiovascular Risk in HIV

Abstract

HIV infection and its treatment have been associated with adipose tissue changes and disorders of glucose and lipid metabolism. The proportion of HIV-infected adults over the age of 50 is also growing placing HIV-infected adults at particular risk for metabolic perturbations and cardiovascular disease. The metabolic syndrome in HIV-infected adults has been increasingly studied but whether HIV is associated with greater risk remains unclear, likely because of the interplay of host, viral and antiretroviral factors that are associated with the components of the metabolic syndrome. While the Framingham Risk Score is a well-accepted measure of 10-year cardiovascular risk in the general population, it may not accurately predict risk in the HIV setting due to HIV-related factors such as inflammation that are not accounted for. The relationship between HIV and diabetes mellitus (DM) risk has also been debated. We summarize the recent literature on metabolic syndrome, DM, and cardiovascular risk in HIV-infected adults.

Complement Component 3 Is Associated with Metabolic Comorbidities in Older HIV-Positive Adults

“…1 Components of the metabolic syndrome (MetS), including dyslipidemia, hypertension, insulin resistance, and central obesity, have all been observed in this aging population, though the underlying causes of HIV-associated cardiometabolic disease have not been firmly established. [2][3][4] Hypotheses include cART-related toxicities and persisting effects of HIV disease such as immune dysregulation and chronic low-level inflammation. 3,[5][6][7] In this study we aimed to better understand the link between chronic inflammation and MetS in older, treated HIV + individuals compared to age-matched HIV negative (HIV -) controls.…”

Untitled

“…The breakthrough in the treatment of HIV, the increased survival and adverse effects of antiretroviral therapy are associated with the emergence of problems related to metabolic syndrome and cardiovascular diseases, including diabetes [119]. The use of incretin mimetic medications is an interesting therapeutic option since it is known that the activity of the DPP-4 enzyme is altered in diabetic patients with HIV.…”

Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome in Older Adults

“…Implicated agents include NRTIs and PIs that are now less commonly used e.g., stavudine, didanosine, zidovudine, indinavir and 8 lopinavir/ritonavir. 20 Whether there is an association between newer ART agents or between HIV infection per se and increased risk of diabetes remains unclear. 20 Fat redistribution, i.e., lipoatrophy (loss of subcutaneous fat) and lipohypertrophy (visceral fat accumulation) commonly affects those infected with HIV and has been associated with insulin resistance, abnormal lipid metabolism, hypertension and increased mortality.…”

“…20 Whether there is an association between newer ART agents or between HIV infection per se and increased risk of diabetes remains unclear. 20 Fat redistribution, i.e., lipoatrophy (loss of subcutaneous fat) and lipohypertrophy (visceral fat accumulation) commonly affects those infected with HIV and has been associated with insulin resistance, abnormal lipid metabolism, hypertension and increased mortality. 21 Mitochondrial DNA toxicity associated with NRTIs, especially with drugs used more often in prior years such as didanosine, stavudine and zidovudine, has been proposed as a cause of lipoatrophy.…”

“…abdominal obesity, dyslipidemia, hypertension, and insulin resistance. 20 Risk factors include the use of PIs, particularly lopinavir/ritonavir, stavudine and didanosine, and unsuppressed HIV replication. 24 Liver disease is a significant cause of mortality in patients with HIV.…”