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Screening for metabolic syndrome in HIV-infected adults recommended

Freitas P. BMC Infect Dis. 2011;doi:10.1186/1471-2334-11-246.

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Researchers from Portugal observed a high prevalence of metabolic syndrome among HIV-infected adults and said this may explain why these patients are at increased risk for cardiovascular disease.

“All HIV-infected patients on combination antiretroviral therapy (ART) must be screened for metabolic syndrome,” Paula Freitas, MD, of the University of Porto Medical School in Portugal, told Infectious Disease News. “Lifestyle changes — stop smoking, increase physical activity and improve food habits — must be offered to these patients, and all metabolic abnormalities must be treated according to the guidelines.”

In the cross-sectional study, Freitas and colleagues set out to assess the prevalence of metabolic syndrome among HIV-infected adults on combination ART (n=345). The median age of the patients was 40 years. Researchers further assessed whether patients with or without clinical lipodystrophy had a different prevalence of metabolic abnormalities, such as abdominal obesity, hyperglycemia, hypertension, high triglycerides or low HDL levels.

Overall, 58.7% of patients had clinical lipodystrophy. The prevalence of metabolic syndrome, according to the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults criteria, was 52.2%; it was 43.2%, based on the International Diabetes Federation criteria. The prevalence for metabolic syndrome did not significantly differ between patients with or without clinical lipodystrophy.

Paula Freitas, MD

Compared with those without clinical lipodystrophy, patients with the condition had a significantly higher risk for coronary heart disease at 10 years. Higher frequencies of moderate and high-risk categories were observed in those with both clinical lipodystrophy and metabolic syndrome vs. those without metabolic syndrome.

Further, the researchers found that clinical lipodystrophy was significantly associated with metabolic syndrome, hypertriglyceridemia, low HDL cholesterol, combination ART and BMI in women. In male patients, high blood pressure, high-waist circumference and metabolic syndrome were more frequent in those with isolated central fat accumulation and mixed forms of clinical lipodystrophy. – by Ashley DeNyse

Disclosure: This research was funded by research fellowship Dr. Manuel Almeida Ruas, Portuguese Society of Diabetology, research fellowship of the Portuguese Association for Clinical Study of AIDS, and a research grant to support doctoral studies in the area of HIV/AIDS Foundation GlaxoSmithKline of Health Sciences.

These findings confirm that the prevalence and phenotypic profiles for MS differ between cART-treated HIV-positive men and women. We are reminded that MS and clinical lipodystrophy are not physiologic constructs; they are categorization techniques. In addition, we lack HIV-specific threshold values for the individual MS components, and these values likely differ from those outlined for the general population. However, MS and clinical lipodystrophy do provide phenotypic indicators for clinicians ( ie, they identify HIV-positive patients that require closer monitoring for CV events or intervention). Key questions remain; what is the relationship between immune status (CD4 nadir or peak) to the development of cardiometabolic complications and CVD risk? What are the pro-inflammatory mediators and molecular level events that link chronic HIV infection with higher CV event rates? What safe and effective methods do we have for tobacco cessation in HIV? To address these and other questions, we need to turn our focus away from describing and categorizing cardiometabolic complications in HIV-positive, and move towards a better understanding of underlying pathophysiologic mechanisms, and safe and effective treatments for cardiometabolic risk factors that are responsible for higher CV event rates among the aging population of people living with HIV.

– Kevin Yarasheski, PhD

Washington University School of Medicine

Disclosure: Dr. Yarasheski reports no relevant financial disclosures.

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