What should we know about metabolic syndrome and lipodystrophy in AIDS?

Signorini, Dario José Hart Pontes; Monteiro, Michelle Carreira Miranda; Andrade, Marion de Fátima Castro de; Signorini, Dario Hart; Eyer-Silva, Walter de Araújo

doi:10.1590/s0104-42302012000100017

Cited by 13 publications

(9 citation statements)

References 24 publications

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“…The relation between CD4 count and MS was unclear with some studies reporting a direct link [ 43 , 44 ] while others demonstrate the inverse [ 45 ] or no association [ 46 , 47 ]. However, these findings were based on only seven studies and did not report the viral loads [ 13 , 17 , 22 , 40 , 42 , 48 , 49 ].…”

Section: Discussionmentioning

confidence: 99%

A Meta-Analysis of the Metabolic Syndrome Prevalence in the Global HIV-Infected Population

et al. 2016

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BackgroundCardio-metabolic risk factors are of increasing concern in HIV-infected individuals, particularly with the advent of antiretroviral therapy (ART) and the subsequent rise in longevity. However, the prevalence of cardio-metabolic abnormalities in this population and the differential contribution, if any, of HIV specific factors to their distribution, are poorly understood. Therefore, we conducted a systematic review and meta-analysis to estimate the global prevalence of metabolic syndrome (MS) in HIV-infected populations, its variation by the different diagnostic criteria, severity of HIV infection, ART used and other major predictive characteristics.MethodsWe performed a comprehensive search on major databases for original research articles published between 1998 and 2015. The pooled overall prevalence as well as by specific groups and subgroups were computed using random effects models.ResultsA total of 65 studies across five continents comprising 55094 HIV-infected participants aged 17–73 years (median age 41 years) were included in the final meta-analysis. The overall prevalence of MS according to the following criteria were: ATPIII-2001:16.7% (95%CI: 14.6–18.8), IDF-2005: 18% (95%CI: 14.0–22.4), ATPIII-2004-2005: 24.6% (95%CI: 20.6–28.8), Modified ATPIII-2005: 27.9% (95%CI: 6.7–56.5), JIS-2009: 29.6% (95%CI: 22.9–36.8), and EGIR: 31.3% (95%CI: 26.8–36.0). By some MS criteria, the prevalence was significantly higher in women than in men (IDF-2005: 23.2% vs. 13.4, p = 0.030), in ART compared to non-ART users (ATPIII-2001: 18.4% vs. 11.8%, p = 0.001), and varied significantly by participant age, duration of HIV diagnosis, severity of infection, non-nucleoside reverse transcriptase inhibitors (NNRTIs) use and date of study publication. Across criteria, there were significant differences in MS prevalence by sub-groups such as in men, the Americas, older publications, regional studies, younger adults, smokers, ART-naïve participants, NNRTIs users, participants with shorter duration of diagnosed infection and across the spectrum of HIV severity. Substantial heterogeneities across and within criteria were not fully explained by major study characteristics, while evidence of publication bias was marginal.ConclusionsThe similar range of MS prevalence in the HIV-infected and general populations highlights the common drivers of this condition. Thus, cardio-metabolic assessments need to be routinely included in the holistic management of the HIV-infected individual. Management strategies recommended for MS in the general population will likely provide similar benefits in the HIV-infected.

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Section: Discussionmentioning

confidence: 99%

A Meta-Analysis of the Metabolic Syndrome Prevalence in the Global HIV-Infected Population

et al. 2016

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“…BF% was calculated as the sum of skinfolds of upper and lower limbs. The nutritional status was classified according to WHO recommendations for adults 37 .…”

Section: Methodsmentioning

confidence: 99%

Discordance Between Body Mass Index and Anthropometric Measurements Among Hiv-1-Infected Patients on Antiretroviral Therapy and With Lipoatrophy/Lipohypertrophy Syndrome

Soares

Silva²,

Gonsalez³

et al. 2015

Rev. Inst. Med. trop. S. Paulo

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Introduction:Highly Active Antiretroviral Therapy (HAART) has improved and extended the lives of thousands of people living with HIV/AIDS around the world. However, this treatment can lead to the development of adverse reactions such as lipoatrophy/lipohypertrophy syndrome (LLS) and its associated risks.Objective:This study was designed to assess the prevalence of self-reported lipodystrophy and nutritional status by anthropometric measurements in patients with HIV/AIDS.Methods:An observational study of 227 adult patients in the Secondary Immunodeficiencies Outpatient Department of Dermatology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo (3002 ADEE-HCFMUSP). The sample was divided into three groups; Group 1 = 92 patients on HAART and with self-reported lipodystrophy, Group 2 = 70 patients on HAART without self-reported lipodystrophy and Group 3 = 65 patients not taking HAART. The nutritional status of individuals in the study sample was determined by body mass index (BMI) and percentage of body fat (% BF). The cardiovascular risk and diseases associated with abdominal obesity were determined by waist/hip ratio (WHR) and waist circumference (WC).Results:The prevalence of self-reported lipoatrophy/lipohypertrophy syndrome was 33% among women and 59% among men. Anthropometry showed depletion of fat mass in the evaluation of the triceps (TSF) in the treatment groups with HAART and was statistically independent of gender; for men p = 0.001, and for women p = 0.007. Similar results were found in the measurement of skin folds of the upper and lower body (p = 0.001 and p = 0.003 respectively). In assessing the nutritional status of groups by BMI and % BF, excess weight and body fat were more prevalent among women compared to men (p = 0.726). The WHR and WC revealed risks for cardiovascular and other diseases associated with abdominal obesity for women on HAART and with self-reported LLS (p = 0.005) and (p = 0.011).Conclusions:Anthropometric measurements were useful in the confirmation of the prevalence of LLS. BMI alone does not appear to be a good parameter for assessing the nutritional status of HIV-infected patients on HAART and with LLS. Other anthropometric measurements are needed to evaluate patients with the lipoatrophy/lipohypertrophy syndrome.

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“…Diversos estudos corroboram estes dados, apontando a hipercolesterolemia e aumento de LDL-colesterol como efeito colateral principal da TARV e principal fator colaborador do surgimento de DCV. [12][13][14] Apesar do aumento significativo destes dois parâmetros metabólicos, a alteração destas variáveis após um ano de TARV não contribuiu suficientemente para alterar a pontuação do escore de Framingham. Para significativas alterações dos escores, deve haver aumento no nível sérico de colesterol total e queda do HDL-colesterol.…”

Section: Discussão E Conclusãounclassified

Metabolic changes and estimating cardiovascular risk of people living with HIV/AIDS twelve months after the start of HAART

Guimarães¹,

Caporali²,

Reis³

et al. 2017

Revista Médica De Minas Gerais

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What should we know about metabolic syndrome and lipodystrophy in AIDS?

Abstract: Both traditional risk factors for cardiovascular disease and factors associated with HIV infection itself, such as an increased CD4 cell count and a longer exposure to antiretroviral therapy, seem to be associated with metabolic syndrome in the present study population.

Cited by 13 publications

References 24 publications

A Meta-Analysis of the Metabolic Syndrome Prevalence in the Global HIV-Infected Population

A Meta-Analysis of the Metabolic Syndrome Prevalence in the Global HIV-Infected Population

Discordance Between Body Mass Index and Anthropometric Measurements Among Hiv-1-Infected Patients on Antiretroviral Therapy and With Lipoatrophy/Lipohypertrophy Syndrome

Metabolic changes and estimating cardiovascular risk of people living with HIV/AIDS twelve months after the start of HAART

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