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. 2015 Jan 1;68(1):73-80.
doi: 10.1097/QAI.0000000000000397.

Changes in metabolic syndrome status after initiation of antiretroviral therapy

Supriya Krishnan  1 , Jeffrey T Schouten, Benjamin Atkinson, Todd T Brown, David A Wohl, Grace A McComsey, Marshall J Glesby, Cecilia Shikuma, Richard Haubrich, Denise L Jacobson
Affiliations

Changes in metabolic syndrome status after initiation of antiretroviral therapy

Supriya Krishnan et al. J Acquir Immune Defic Syndr. .

Abstract

Background: Data on changes in metabolic syndrome (MetS) status in HIV-infected adults on antiretroviral therapy (ART) are limited.

Methods: MetS was assessed at ART initiation and every 48 weeks on ART in ART-naive HIV-infected individuals from the AIDS Clinical Trials Group Longitudinal Linked Randomized Trials (ALLRT) cohort. MetS, defined using the Adult Treatment Panel III criteria, required at least 3 of the following: elevated fasting glucose, hypertension, elevated waist circumference, elevated triglycerides, low high-density lipoprotein (HDL) cholesterol. Prevalence of MetS and the individual criteria were compared between ART initiation and during follow-up using McNemar test.

Results: At ART initiation, 450 (20%) ALLRT participants had MetS. After 96 weeks of ART, 37% of the 411 with MetS at ART initiation and with available data at this time point did not meet the MetS criteria. Among these participants, there was a dramatic decline in the proportion with low HDL (95% versus 26%, P < 0.0001). Among the 63% who continued to meet MetS criteria at week 96, the proportion with ≥4 criteria was higher at week 96 compared to at the time of ART initiation (48% versus 40%, P = 0.03); at week 96, the proportion with high triglycerides was greater (87% versus 69%, P < 0.0001) as was the proportion with high glucose (59% versus 42%, P < 0.0001).

Conclusions: One in 5 ART-naive subjects met criteria for MetS at ART initiation. Although more than half of these individuals continued to have MetS after 96 weeks of ART, 37% with MetS at ART initiation no longer met criteria for MetS; this decrease was driven largely by increases in HDL cholesterol.

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Figures

Figure 1
Figure 1
Figure 1a. Distribution (%) of MetS criteria at week 0 and 96 among 139 subjects who had MetS only at ART initiation. Note: all McNemar’s p-values comparing proportions at ART initiation to week 96 <0.0001 Figure 1b. Distribution (%) of MetS criteria at week 0 and 96 among 239 subjects who had MetS at both time-points. Note: McNemar’s p-values comparing proportions at ART initiation to week 96 for triglycerides, glucose and HDL <0.0001; p-values for waist circumference and blood pressure>0.1
Figure 2
Figure 2
Figure 2a. Distribution (%) of MetS criteria at week 0 and 96 among 79 subjects with baseline BMI <25 Figure 2b. Distribution (%) of MetS criteria at week 0 and 96 among 136 subjects with baseline BMI 25–29 Figure 2c. Distribution (%) of MetS criteria at week 0 and 96 among 162 subjects with baseline BMI 30+
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