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Virologic failure and metabolic syndrome in patients with HIV infection

  • 1,
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  • 1,
  • 1,
  • 1 and
  • 1
Journal of the International AIDS Society200811 (Suppl 1) :P115

https://doi.org/10.1186/1758-2652-11-S1-P115

  • Published:

Keywords

  • Metabolic Syndrome
  • Lean Mass
  • Lipodystrophy
  • Virologic Failure
  • Virologic Suppression

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

 

SM+

SM-

p

Systolic BP, mmHg

129.84 ± 14.43

117.72 ± 14.67

< 0.0001

Diastolic BP, mmHg

86.88 ± 11.01

76.43 ± 12.42

< 0.0001

Glucose, mg/dL

107.73 ± 34.57

91.74 ± 13.84

< 0.0001

HDL, mg/dL

35.85 ± 8.63

48.84 ± 16.08

< 0.0001

Triglycerides, mg/dL

300.91 ± 206.15

179.15 ± 159.54

< 0.0001

Apo B, mg/dL

111.51 ± 29.64

100.57 ± 31.22

< 0.0001

TCol/HDL

5.58 ± 1.63

4.21 ± 1.46

< 0.0001

HOMA > 3.8, n (%)

210 (65.02)

354 (35.36)

< 0.0001

HOMA, median (IQR)

5.14 (3.00; 8.15)

2.95 (1.93; 4.57)

< 0.0001

HIV duration, months

169.33 ± 62.15

172.35 ± 64.46

0.46

Log10 VL

2.17 ± 0.94

2.02 ± 0.79

0.0048

CD4 nadir, median (IQR)

150 (50; 250)

146 (60; 238)

0.86

CD4 current, median (IQR)

500 (342; 701)

502 (357; 681)

0.99

BMI

25.17 ± 4.40

22.80 ± 3.38

< 0.0001

Waist, cm

91.04 ± 11.27

83.71 ± 9.41

< 0.0001

PI current

199 (61.61)

529 (52.85)

0.006

NRTI current

321 (99.38)

998 (98.70)

0.31

NNRTI current

90 (27.86)

381 (38.06)

0.001

PI exposure, months

51.37 ± 47.95

49.05 ± 43.57

0.41

NRTI exposure, months

104.08 ± 58.67

108.46 ± 56.17

0.23

NNRTI exposure, months

26.15 ± 26.78

30.18 ± 30.94

0.0358

HCV

102 (31.58)

372 (37.16)

0.17

VAT/TAT

0.54 ± 0.17

0.48 ± 0.18

< 0.0001

%fat leg, median (IQR)

8.97 (5.89; 15.79)

9.67 (5.86; 15.88)

0.61

%fat leg/BMI, median (IQR)

0.36 (0.25; 0.61)

0.41 (0.26; 0.70)

0.0074

Trunk fat, g

7343.25 ± 3720.89

5943.93 ± 3219.04

< 0.0001

Total fat, g

12451.16 ± 7293.54

10200.50 ± 5768.74

< 0.0001

Total lean, g

53038.16 ± 9722.90

48689.95 ± 10030.84

< 0.0001

Table 2

Variables

Adjusted OR (95% CI)

P-value

Log10 VL

1.23 (1.01–1.65)

0.006

Age (per 10-year increment)

1.41 (1.18–1.69)

< 0.0001

Waist, cm

1.05 (1.03–1.06)

< 0.0001

HOMA > 3.8

2.49 (1.89–3.29)

< 0.0001

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.

Authors’ Affiliations

(1)
Infectious Diseases Clinic, University of Modena and Reggio Emilia, Modena, Italy

Copyright

© Squillace et al; licensee BioMed Central Ltd. 2008

This article is published under license to BioMed Central Ltd.

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