Metabolic Syndrome Among HIV-Infected and HIV-Uninfected Women
Metabolic Syndrome Among HIV-Infected and HIV-Uninfected Women
Objectives: To assess the prevalence of metabolic syndrome (MetSynd) among participants of the Women's Interagency HIV Study and to describe the association of MetSynd with HIV infection, antiretroviral therapies, and sociodemographic factors.
Methods: Prevalence of MetSynd, defined by updated Adult Treatment Panel III guidelines, was assessed among 2393 (1725 seropositive and 668 seronegative) participants from the Women's Interagency HIV Study seen between October 2000 and October 2004.
Results: HIV-1 infection was independently associated with MetSynd [33% vs 22%, P < 0.0001 in HIV-seropositive compared with HIV-seronegative women; adjusted odds ratio (OR) 1.79 (95% confidence interval 1.48, 2.16)]. HIV-infected women had higher mean triglyceride (154 vs 101 mg/dL, P < 0.0001) and lower mean high-density lipoprotein cholesterol levels (46 vs 55 mg/dL, P < 0.0001). Most notable factors associated with higher prevalence of MetSynd among HIV-infected women included older age (OR = 1.38 per 5 year increase, P < 0.0001); higher body mass index; current smoking; HIV-1 RNA (OR = 1.36, P = 0.019, for >50,000 vs <80 copies/mL); and use of stavudine (OR = 1.28, P = 0.009). Nevirapine use was protective (OR = 0.75, P = 0.016). There was no significant association of MetSynd with ritonavir-boosted protease inhibitors (OR = 1.15, P = 0.134).
Conclusions: MetSynd is more prevalent in HIV-seropositive than HIV-seronegative women. This increased prevalence was due to dyslipidemias rather than higher blood pressure, glucose, or waist circumference.
Although potent antiretroviral therapy has reduced HIV related morbidity and mortality, concerns about treatment-related metabolic complications persist. These complications resemble metabolic and body composition abnormalities of the metabolic syndrome (MetSynd) described with increasing frequency in the general adult population. The MetSynd is clinically defined as having at least 3 of the following 5 conditions: impaired fasting glucose, increased waist circumference, elevated triglycerides, low high-density lipoprotein cholesterol (HDL-C), and hypertension. This constellation of metabolic and physical abnormalities is frequently associated with increased risk of insulin resistance and cardiovascular morbidity and mortality in the general population.
There is considerable controversy about the completeness and precision of the current MetSynd definition and whether certain risk factors associated with proinflammatory states should be included in the definition. Despite this controversy, most agree that this constellation of risk factors predicts increased future risk of diabetes, cardiovascular events, and other complications. Current MetSynd criteria may therefore identify individuals who could benefit from lifestyle modification and in some cases pharmacologic interventions to delay the progression to diabetes and cardiovascular disease.
According to recent data from National Health and Nutrition Examination Survey III (NHANES III), the overall age-adjusted prevalence of MetSynd in adults increased from 29% to 32% over the last decade; women in the 20-39 age group experienced the most dramatic change, with MetSynd almost doubling in prevalence from 11% to 19%. In addition, data from NHANES III also indicate ethnic differences in the distribution of the syndrome; the highest prevalence was noted among Mexican American (36%) compared with white women (23%). This increase in MetSynd prevalence was largely ascribed to an increase in the prevalence of hypertriglyceridemia and high blood pressure. Other population-based studies of US adults have reported an association of high baseline body mass index (BMI), older age, and lack of alcohol intake with an increased risk for the MetSynd.
There are limited data about the prevalence of the MetSynd among HIV-infected persons, but it seems to be higher than in the general population. Recent data from the Data Collection on Adverse Events of Anti-HIV Drugs (DAD) study, which does not include HIV negative participants, found that men were more likely than women to have MetSynd and that therapy with nonnucleoside reverse transcriptase inhibitors (NNRTIs) may be protective. Few studies have evaluated the risks and prevalence of MetSynd in the growing population of HIV-infected women. We, therefore, examined the prevalence of MetSynd among participants of the Women's Interagency HIV Study (WIHS) and assessed the association of MetSynd with HIV status, use of particular antiretroviral medications, and sociodemographic factors.
Abstract
Objectives: To assess the prevalence of metabolic syndrome (MetSynd) among participants of the Women's Interagency HIV Study and to describe the association of MetSynd with HIV infection, antiretroviral therapies, and sociodemographic factors.
Methods: Prevalence of MetSynd, defined by updated Adult Treatment Panel III guidelines, was assessed among 2393 (1725 seropositive and 668 seronegative) participants from the Women's Interagency HIV Study seen between October 2000 and October 2004.
Results: HIV-1 infection was independently associated with MetSynd [33% vs 22%, P < 0.0001 in HIV-seropositive compared with HIV-seronegative women; adjusted odds ratio (OR) 1.79 (95% confidence interval 1.48, 2.16)]. HIV-infected women had higher mean triglyceride (154 vs 101 mg/dL, P < 0.0001) and lower mean high-density lipoprotein cholesterol levels (46 vs 55 mg/dL, P < 0.0001). Most notable factors associated with higher prevalence of MetSynd among HIV-infected women included older age (OR = 1.38 per 5 year increase, P < 0.0001); higher body mass index; current smoking; HIV-1 RNA (OR = 1.36, P = 0.019, for >50,000 vs <80 copies/mL); and use of stavudine (OR = 1.28, P = 0.009). Nevirapine use was protective (OR = 0.75, P = 0.016). There was no significant association of MetSynd with ritonavir-boosted protease inhibitors (OR = 1.15, P = 0.134).
Conclusions: MetSynd is more prevalent in HIV-seropositive than HIV-seronegative women. This increased prevalence was due to dyslipidemias rather than higher blood pressure, glucose, or waist circumference.
Introduction
Although potent antiretroviral therapy has reduced HIV related morbidity and mortality, concerns about treatment-related metabolic complications persist. These complications resemble metabolic and body composition abnormalities of the metabolic syndrome (MetSynd) described with increasing frequency in the general adult population. The MetSynd is clinically defined as having at least 3 of the following 5 conditions: impaired fasting glucose, increased waist circumference, elevated triglycerides, low high-density lipoprotein cholesterol (HDL-C), and hypertension. This constellation of metabolic and physical abnormalities is frequently associated with increased risk of insulin resistance and cardiovascular morbidity and mortality in the general population.
There is considerable controversy about the completeness and precision of the current MetSynd definition and whether certain risk factors associated with proinflammatory states should be included in the definition. Despite this controversy, most agree that this constellation of risk factors predicts increased future risk of diabetes, cardiovascular events, and other complications. Current MetSynd criteria may therefore identify individuals who could benefit from lifestyle modification and in some cases pharmacologic interventions to delay the progression to diabetes and cardiovascular disease.
According to recent data from National Health and Nutrition Examination Survey III (NHANES III), the overall age-adjusted prevalence of MetSynd in adults increased from 29% to 32% over the last decade; women in the 20-39 age group experienced the most dramatic change, with MetSynd almost doubling in prevalence from 11% to 19%. In addition, data from NHANES III also indicate ethnic differences in the distribution of the syndrome; the highest prevalence was noted among Mexican American (36%) compared with white women (23%). This increase in MetSynd prevalence was largely ascribed to an increase in the prevalence of hypertriglyceridemia and high blood pressure. Other population-based studies of US adults have reported an association of high baseline body mass index (BMI), older age, and lack of alcohol intake with an increased risk for the MetSynd.
There are limited data about the prevalence of the MetSynd among HIV-infected persons, but it seems to be higher than in the general population. Recent data from the Data Collection on Adverse Events of Anti-HIV Drugs (DAD) study, which does not include HIV negative participants, found that men were more likely than women to have MetSynd and that therapy with nonnucleoside reverse transcriptase inhibitors (NNRTIs) may be protective. Few studies have evaluated the risks and prevalence of MetSynd in the growing population of HIV-infected women. We, therefore, examined the prevalence of MetSynd among participants of the Women's Interagency HIV Study (WIHS) and assessed the association of MetSynd with HIV status, use of particular antiretroviral medications, and sociodemographic factors.
