Virologic failure and metabolic syndrome in patients with HIV infection

Purpose of the study

The objective of our study was to assess the association between HIV-RNA viral load (HIV-VL) and metabolic syndrome (MS) prevalence in a cohort of HIV patients experienced to ART with lipodystrophy (LD).

Methods

This was a cross-sectional observational study that included all consecutive HIV-infected patients evaluated at the metabolic clinic of the University of Modena and Reggio Emilia, Italy, between January 2006 and January 2008 who had received antiretroviral therapy for at least 2 years. Lipodystrophy and metabolic syndrome were defined according to MACS classification and to NCEP-ATP III criteria, respectively.

Summary of results

1,348 patients were analyzed. 850 (63.1%) were males; mean age was 44.8 years (± 7.1). Obesity, defined by body mass index >30, was diagnosed in 78 patients (5.8%). Prevalence of metabolic syndrome was 24.4%. 84.8% of the patients had HIV VL<400 copies/mL. LD was diagnosed in 88.3%: 515 (39.3%) patients had lipoatrophy; 116 (8.9%) had fat accumulation; and 527 (40.2%) had mixed forms. Patients with MS had statistically significant greater value of each diagnostic criteria than those without (Table 1). Higher BMI, lipodystrophy presence, as well as VAT/TAT, trunk fat, total fat and total lean mass were associated with MS diagnosis (Table 1). MS was more prevalent in patients with higher log HIV-VL, PI and NNRTI current use and NNRTI exposure (Table 1). Multivariate logistic regression shown in Table 2 illustrates that log HIV-VL is an independent predictor of metabolic syndrome.

Table 1

Table 2

Conclusion

Our study highlights that HIV-infected patients experiencing virological failure are more at risk to develop MS. It is necessary to obtain virologic suppression to prevent not only AIDS-related opportunistic infections, but also those cardiovascular events and diabetes related to MS presence.