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Asgedom YS, Kebede TM, Gebrekidan AY, Koyira MM, Azeze GA, Lombebo AA, Efa AG, Haile KE, Kassie GA. Prevalence of metabolic syndrome among people living with human immunodeficiency virus in sub-Saharan Africa: a systematic review and meta-analysis. Sci Rep 2024; 14:11709. [PMID: 38777850 PMCID: PMC11111734 DOI: 10.1038/s41598-024-62497-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 05/17/2024] [Indexed: 05/25/2024] Open
Abstract
Metabolic syndrome (MetS) poses a significant clinical challenge for individuals living with HIV (PLHIV). In sub-Saharan Africa (SSA), this condition is becoming a growing concern, owing to lifestyle changes and an increasingly aging population. Several SSA countries have reported on the prevalence of MetS. However, these estimates may be outdated because numerous recent studies have updated MetS prevalence among PLHIV in these countries. Moreover, prior research has focused on various study designs to report the pooled prevalence, which is a methodological limitation. Therefore, this systematic review and meta-analysis aimed to determine the pooled estimates of MetS in PLHIV in SSA by addressing these gaps. We systematically searched Google Scholar, Science Direct, Scopus, Web of Sciences, EMBASE, and PubMed/Medline for the prevalence of MetS and its subcomponents among people with HIV in sub-Saharan Africa. The estimated pooled prevalence was presented using a forest plot. Egger's and Begg's rank regression tests were used to assess evidence of publication bias. Twenty-five studies fulfilled the inclusion criteria after review of the updated PRISMA guidelines. The pooled prevalence of MetS was 21.01% [95% CI: (16.50, 25.51)] and 23.42% [95% CI: (19.16, 27.08)] to the National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATP III) and International Diabetes Federation (IDF) criteria, respectively. Low levels of high-density lipoprotein cholesterol (Low HDL) at 47.25% [95% CI: 34.17, 60.33)] were the highest reported individual subcomponent, followed by abdominal obesity at 38.44% [95% CI: (28.81, 48.88)]. The prevalence of MetS is high in sub-Saharan Africa. Low HDL levels and increased waist circumference/abdominal obesity were the most prevalent components of MetS. Therefore, early screening for MetS components and lifestyle modifications is required. Policymakers should develop strategies to prevent MetS before an epidemic occurs.PROSPERO: CRD42023445294.
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Ruiz-Herrera VV, Navarro-Lara SA, Andrade-Villanueva JF, Alvarez-Zavala M, Sánchez-Reyes K, Toscano-Piña M, Méndez-Clemente AS, Martínez-Ayala P, Valle-Rodríguez A, González-Hernández LA. Pilot study on the efficacy and safety of berberine in people with metabolic syndrome and human immunodeficiency virus infection. Int J STD AIDS 2023; 34:1042-1052. [PMID: 37611246 DOI: 10.1177/09564624231196600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
BACKGROUND Antiretroviral therapy has increased the life expectancy of people living with HIV. However, this increase is not free of comorbidities, and metabolic syndrome is one of the most prevalent. Berberine is an alkaloid nutraceutical that has been shown to ameliorate metabolic disorders such as prediabetes, polycystic ovary syndrome, and non-alcoholic fatty liver disease. However, it has not been tested in HIV infection. Therefore, we conducted a randomized controlled trial to evaluate the efficacy of berberine in improving metabolic syndrome. METHODS AND RESULTS In this double-blind, placebo-controlled trial, adults living with HIV under virological suppression and metabolic syndrome received either berberine 500 mg TID or placebo for 20 weeks. The primary outcomes were a composite of weight reduction, insulin resistance decrease, and lipid profile improvement. A total of 43 participants were randomized (22 in the berberine group and 21 in the placebo group); 36 participants completed the follow-up and were analyzed. The berberine group showed a reduction in weight and body mass index, lower insulin resistance, and a reduction in TNF-alpha. The control group had higher total cholesterol, c-LDL, and IL-6 concentration. CONCLUSION In people living with HIV under virological suppression, berberine was safe and improves clinical and biochemical components of metabolic syndrome. However, further studies with more participants and longer intervention periods need to be explored.
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Affiliation(s)
- Vida V Ruiz-Herrera
- Hospital Civil de Guadalajara "Fray Antonio Alcalde", Unidad de VIH, Guadalajara, Mexico
| | - Shaúl A Navarro-Lara
- Hospital Civil de Guadalajara "Fray Antonio Alcalde", Servicio de Medicina Interna, Guadalajara, México
| | - Jaime F Andrade-Villanueva
- Hospital Civil de Guadalajara "Fray Antonio Alcalde", Unidad de VIH, Guadalajara, Mexico
- Universidad de Guadalajara, Centro Universitario de Ciencias de la Salud, Instituto de Investigación en Inmunodeficiencias y VIH (InIVIH), Guadalajara, México
| | - Monserrat Alvarez-Zavala
- Universidad de Guadalajara, Centro Universitario de Ciencias de la Salud, Instituto de Investigación en Inmunodeficiencias y VIH (InIVIH), Guadalajara, México
| | - Karina Sánchez-Reyes
- Universidad de Guadalajara, Centro Universitario de Ciencias de la Salud, Instituto de Investigación en Inmunodeficiencias y VIH (InIVIH), Guadalajara, México
| | - Marcela Toscano-Piña
- Hospital Civil de Guadalajara "Fray Antonio Alcalde", Unidad de VIH, Guadalajara, Mexico
| | | | - Pedro Martínez-Ayala
- Hospital Civil de Guadalajara "Fray Antonio Alcalde", Unidad de VIH, Guadalajara, Mexico
| | | | - Luz A González-Hernández
- Hospital Civil de Guadalajara "Fray Antonio Alcalde", Unidad de VIH, Guadalajara, Mexico
- Universidad de Guadalajara, Centro Universitario de Ciencias de la Salud, Instituto de Investigación en Inmunodeficiencias y VIH (InIVIH), Guadalajara, México
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Abera W, Wube TB, Alemayehu T. The association of aspartate transaminase-to-alanine transaminase ratio and metabolic syndrome among HIV patients in Sidama Region, South Ethiopia. SAGE Open Med 2023; 11:20503121231196701. [PMID: 37694128 PMCID: PMC10483979 DOI: 10.1177/20503121231196701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 08/07/2023] [Indexed: 09/12/2023] Open
Abstract
Objective Studies on the association of the aspartate transaminase-to-alanine transaminase ratio with the metabolic syndrome and its components among HIV patients were scarce. This study aims to determine the association between the aspartate transaminase-to-alanine transaminase ratio and the metabolic syndrome and its components in adult HIV patients on highly active antiretroviral therapy. Methods This was a cross-sectional study conducted on 302 HIV patients from January 15 to June 30, 2021. Sociodemographic, clinical, and anthropometric data were collected using a structured questionnaire. The patient's medical records were reviewed. Biochemical analysis was performed after 5 ml of venous blood was collected from each study participant. Metabolic syndrome was defined by the third report of the national cholesterol education program-adult treatment panel. Logistic regression was done to assess the association of MetS with the independent variables, and correlation analysis was performed to see the correlation of MetS components with the aspartate aminotransferase-to-alanine aminotransferase ratio. Result 302 HIV-positive patients on highly active antiretroviral therapy were included in this study, and 54.6% were female. The median and interquartile range of the age of the study participants were 41 (35-50) years. The prevalence of metabolic syndrome was 29.5% (confidence interval = 24.5-35.1). Chronic illness (Adjusted odds ratio = 4.8, confidence interval = 2.2-10.9) and aspartate aminotransferase-to-alanine aminotransferase ratio (adjusted odds ratio = 2.5, confidence interval = 1.4-4.4) were significantly associated with Metabolic syndrome among the study participants. The aspartate aminotransferase-to-alanine aminotransferase ratio was significantly correlated with blood pressure. Conclusion This study found the existence of a significant association between the aspartate aminotransferase-to-alanine aminotransferase ratio and metabolic syndrome among HIV patients.
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Affiliation(s)
- Wondwossen Abera
- School of Medical Laboratory Science, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
| | - Temesgen Bizuayehu Wube
- School of Medical Laboratory Science, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
| | - Tsegaye Alemayehu
- School of Medical Laboratory Science, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
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Ortíz DW, Marroquin HE, Larson L, Franco KB, Spec A, Melendez JR, Pinzón R, Samayoa AJ, Mejia-Chew C, O Halloran JA. Metabolic syndrome in people with HIV from Guatemala: analysis of components and risk factors. Int J STD AIDS 2022; 33:987-994. [PMID: 35978450 DOI: 10.1177/09564624221119321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND People with HIV (PWH) in Latin America are at a greater risk of developing comorbidities due to the increasing burden of obesity and metabolic syndrome in the region. We explored the associations between social, cardiovascular and HIV-related risk factors with metabolic syndrome in PWH from Guatemala. METHODS Cross-sectional study analyzing demographic, clinical and laboratory data from PWH. Metabolic syndrome diagnosis and components are defined by the harmonized Joint Scientific Statement criteria. Data were collected from July 2019 to March 2020 and analyzed using correlations and logistic regression. RESULTS Median age was 39 years [IQR 31-48], 56.8% of participants were male and 31.5% (n = 266, 95% CI 0.28-0.34) had metabolic syndrome. Age (adjusted odds ratio (aOR): 1.03, 95% CI 1.02-1.05, p <0.001), urban dweller (aOR: 1.48, 95% CI 1.00-2.18, p = 0.049), low physical activity (aOR: 1.45, 95% CI 1.01-2.08, p = 0.046), hyperuricemia (aOR: 3.31, 95% CI 1.93-5.67, p <0.001), current CD4+ T cell count < 200 cells/mm3 (aOR: 1.96, 95% CI 1.19-3.23, p = 0.009), 6 months of efavirenz (aOR: 1.89, 95% CI 1.29-2.77, p = 0.001), and obesity (aOR: 37.0, 95% CI 7.70-178.2, p < 0.001) were independently associated with metabolic syndrome. CONCLUSIONS Prevalence of metabolic syndrome in this study was high and driven mainly by social and cardiovascular risk factors such as age, urban dwelling, obesity, hyperuricemia and low physical activity. Efavirenz use and CD4 count were the only HIV-related factors associated with metabolic syndrome.
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Affiliation(s)
- Dean W Ortíz
- 277606Unidad de Atención Integral de VIH e Infecciones Crónicas del Hospital Roosevelt "Dr. Carlos Rodolfo Mejía Villatoro", Guatemala
| | - Hugo E Marroquin
- 277606Unidad de Atención Integral de VIH e Infecciones Crónicas del Hospital Roosevelt "Dr. Carlos Rodolfo Mejía Villatoro", Guatemala
| | - Lindsey Larson
- Department of Medicine, Division of Infectious Diseases, 7548Washington University in Saint Louis, St. Louis, MO, USA
| | - Katherine B Franco
- 277606Unidad de Atención Integral de VIH e Infecciones Crónicas del Hospital Roosevelt "Dr. Carlos Rodolfo Mejía Villatoro", Guatemala
| | - Andrej Spec
- Department of Medicine, Division of Infectious Diseases, 7548Washington University in Saint Louis, St. Louis, MO, USA
| | - Johanna R Melendez
- 277606Unidad de Atención Integral de VIH e Infecciones Crónicas del Hospital Roosevelt "Dr. Carlos Rodolfo Mejía Villatoro", Guatemala
| | - Rodolfo Pinzón
- 277606Unidad de Atención Integral de VIH e Infecciones Crónicas del Hospital Roosevelt "Dr. Carlos Rodolfo Mejía Villatoro", Guatemala
| | - Ana J Samayoa
- 277606Unidad de Atención Integral de VIH e Infecciones Crónicas del Hospital Roosevelt "Dr. Carlos Rodolfo Mejía Villatoro", Guatemala
| | - Carlos Mejia-Chew
- Department of Medicine, Division of Infectious Diseases, 7548Washington University in Saint Louis, St. Louis, MO, USA
| | - Jane A O Halloran
- Department of Medicine, Division of Infectious Diseases, 7548Washington University in Saint Louis, St. Louis, MO, USA
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Woldu M, Minzi O, Shibeshi W, Shewaamare A, Engidawork E. Biomarkers and Prevalence of Cardiometabolic Syndrome Among People Living With HIV/AIDS, Addis Ababa, Ethiopia: A Hospital-Based Study. Clin Med Insights Endocrinol Diabetes 2022; 15:11795514221078029. [PMID: 35237088 PMCID: PMC8883384 DOI: 10.1177/11795514221078029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 01/14/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND While the fast extension of combination antiretroviral therapy (cART) has resulted in significant increases in life expectancy, disorders such as cardiometabolic syndrome (CMetS), which have received less attention, are becoming a major concern in HIV/AIDS patients (PLWHA). OBJECTIVES The purpose of this research was to identify biomarkers and determine the prevalence of CMetS in PLWHA using the National Cholesterol Education Program (NCEP) and the International Diabetes Federation (IDF) tools. METHODS Between January 2019 and February 2021, a hospital-based study of HIV-infected patients (n = 288) was conducted. The data were analyzed using binary logistic regression. To control the effect of confounders, independent variables with a P-value of <.20 in the bivariate logistic regression were incorporated into multivariate logistic regression. Statistical significance was defined as a 95% confidence interval and a P-value of less than .05. RESULTS The risk of CMetS increased twofold as age increased each year (P = .009), 1.2 times as the age at which cART began increased (P = .015), and 6 times with 1 or more co-morbidities (P = .028), according to the NCEP tool. Furthermore, significant NCEP-CMetS correlations were produced by a rise in diastolic blood pressure (P < .001) and cART duration (P = .006). Male gender was 99.9% less likely to be related to CMetS using the IDF tool, and the risk of CMetS increased fourfold with each unit increase in waist circumference (P < .001). Triglycerides and blood type "A" have been found to have substantial relationships with CMetS using both techniques. CONCLUSION According to the study, CMetS was found to be common in PLWHA. Age, time on cART, age when cART started, gender, co-morbidities, waist circumference, and diastolic blood pressure were all revealed to be significant predictors of CMetS. Triglycerides and blood type "A" were the only biomarkers found to be significant with CMetS using both the NCEP and IDF tools.
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Affiliation(s)
- Minyahil Woldu
- Department of Clinical Pharmacy and Pharmacology, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania.,Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Omary Minzi
- Department of Clinical Pharmacy and Pharmacology, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Workineh Shibeshi
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Ephrem Engidawork
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Liu D, Zhang X, Kang J, Gao F, He Y, He S. Gradual increasing dyslipidemia in treatment-naive male patients with human immunodeficiency virus and treated with tenofovir plus lamivudine plus efavirenz for 3 years. Diabetol Metab Syndr 2021; 13:135. [PMID: 34794501 PMCID: PMC8600744 DOI: 10.1186/s13098-021-00756-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 11/03/2021] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Since the development of antiretroviral therapy (ART) with TDF plus 3TC plus EFV, this specific regimen has not been studied enough with long-term lipid and uric acid monitoring. METHODS A prospective follow-up cohort study was performed. Sixty-one treatment-naive male patients with human immunodeficiency virus (HIV) were divided into three groups based on their baseline CD4+ cell count (26, 12, and 23 patients in the < 200, 200 to 350, and > 350 groups, respectively). The lipid and purine metabolism parameters of the patients over 144 weeks were analyzed. RESULT Within 144 weeks, TG, LDL-c, TC and HDL-c gradually increased, especially TC and HDL-c (P = 0.001, 0.000, respectively). Moreover, the percentages of hyper-cholesterolemia, hyper LDL cholesterolemia, hyper-triglyceridemia and low HDL cholesterolemia also gradually increased, especially low HDL cholesterolemia significantly increased (P = 0.0007). The lower the baseline CD4+ cell counts were, the higher the TG levels and the lower the TC, LDL-c and HDL-c levels were. But there was significant difference of only baseline LDL-c levels between the three groups (P = 0.0457). No significant difference of the UA level and the percentages of hyperuricemia was found between the different follow-up time point groups or between the three CD4+ cell counts groups (all P > 0.05). The risk factors for dyslipidemia included age, anthropometric parameters and follow-up weeks, and for hyperuricemia was virus load. CONCLUSIONS Gradual increasing dyslipidemia was found in male patients with human immunodeficiency virus primarily treated with tenofovir plus lamivudine plus efavirenz for 3 years. There-fore lipid metabolism parameters should be closely monitored during long-term ART with the TDF plus 3TC plus EFV regimen.
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Affiliation(s)
- Dafeng Liu
- Department of Internal Medicine, The Public and Health Clinic Centre of Chengdu, No. 377 Jingming Road, Jinjiang District, Sichuan, 610066, Chengdu, People's Republic of China.
| | - Xinyi Zhang
- Clinical Medicine, Sichuan University West China Clinical Medical College, Chengdu, China
| | - Jun Kang
- Department of Internal Medicine, The Public and Health Clinic Centre of Chengdu, No. 377 Jingming Road, Jinjiang District, Sichuan, 610066, Chengdu, People's Republic of China
| | - Fengjiao Gao
- Department of Internal Medicine, The Public and Health Clinic Centre of Chengdu, No. 377 Jingming Road, Jinjiang District, Sichuan, 610066, Chengdu, People's Republic of China
| | - Yinsheng He
- Department of Internal Medicine, The Public and Health Clinic Centre of Chengdu, No. 377 Jingming Road, Jinjiang District, Sichuan, 610066, Chengdu, People's Republic of China
| | - Shenghua He
- Department of Infectious Disease, The Public and Health Clinic Centre of Chengdu, No. 377 Jingming Road, Jinjiang District, Sichuan, 610066, Chengdu, People's Republic of China.
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Hamooya BM, Mulenga LB, Masenga SK, Fwemba I, Chirwa L, Siwingwa M, Halwiindi H, Koethe JR, Lipworth L, Heimburger DC, Musonda P, Mutale W. Metabolic syndrome in Zambian adults with human immunodeficiency virus on antiretroviral therapy: Prevalence and associated factors. Medicine (Baltimore) 2021; 100:e25236. [PMID: 33832083 PMCID: PMC8036111 DOI: 10.1097/md.0000000000025236] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 02/25/2021] [Indexed: 01/05/2023] Open
Abstract
Metabolic syndrome (MetS) is a constellation of factors including hypertension, abdominal obesity, dyslipidemia, and insulin resistance that separately and together significantly increase risk for cardiovascular disease (CVD) and diabetes. In sub-Saharan Africa, with a substantial burden of human immunodeficiency virus (HIV) and increasing prevalence of CVD and diabetes, there is a paucity of epidemiological data on demographic, laboratory, and clinical characteristics associated with MetS among people with HIV (people with human [PWH]). Therefore, this study aimed to determine the burden and factors influencing MetS in antiretroviral therapy (ART)-experienced individuals in Zambia.We collected cross-sectional demographic, lifestyle, anthropometric, clinical, and laboratory data in a cohort of ART-experienced (on ART for ≥6 months) adults in 24 urban HIV treatment clinics of Zambia between August, 2016 and May, 2020. MetS was defined as having ≥3 of the following characteristics: low high density lipoprotein cholesterol (HDL-c) (<1.0 mmol/L for men, <1.3 for women), elevated waist circumference (≥94 cm for men, ≥80 cm for women), elevated triglycerides (≥1.7 mmol/L), elevated fasting blood glucose (≥5.6 mmol/L), and elevated blood pressure (BP) (systolic BP ≥130 or diastolic BP ≥85 mm Hg). Virological failure (VF) was defined as HIV viral load ≥1000 copies/mL. The following statistical methods were used: Chi-square test, Wilcoxon rank-sum test, and multivariable logistic regression.Among 1108 participants, the median age (interquartile range [IQR]) was 41 years (34, 49); 666 (60.1%) were females. The prevalence of MetS was 26.3% (95% confidence interval [CI] 23.9-29.1). Age (adjusted odds ratio [OR] 1.07; 95% CI 1.04-1.11), female sex (OR 3.02; 95% CI 1.55-5.91), VF (OR 1.98; 95% CI 1.01-3.87), dolutegravir (DTG)-based regimen (OR 2.10; 95% CI 1.05-4.20), hip-circumference (OR 1.03; 95% CI 1.01-1.05), T-lymphocyte count (OR 2.23; 95% CI 1.44-3.43), high-sensitivity C-reactive protein (hsCRP) (OR 1.14; 95% CI 1.01-1.29), and fasting insulin (OR 1.02; 95% CI 1.01-1.04) were significantly associated with MetS.Metabolic syndrome was highly prevalent among HIV+ adults receiving ART in Zambia and associated with demographic, clinical, anthropometric, and inflammatory characteristics. The association between MetS and dolutegravir requires further investigation, as does elucidation of the impact of MetS on ART outcomes in sub-Saharan African PWH.
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Affiliation(s)
- Benson M. Hamooya
- University of Zambia School of Public Health
- Mulungushi University School of Medicine and Health Sciences, Livingstone
- Vanderbilt Institute for Global Health
| | - Lloyd B. Mulenga
- Ministry of Health
- University of Zambia School of Medicine, Lusaka, Zambia
- University Teaching Hospital, Adult Infectious Disease Center, Zambia
| | - Sepiso K. Masenga
- Mulungushi University School of Medicine and Health Sciences, Livingstone
- Vanderbilt Institute for Global Health
- Department of Biomedical Sciences, University of Zambia School of Health Sciences, Lusaka
| | | | - Lameck Chirwa
- University Teaching Hospital, Adult Infectious Disease Center, Zambia
| | - Mpanji Siwingwa
- University Teaching Hospital, Adult Infectious Disease Center, Zambia
| | | | - John R. Koethe
- Vanderbilt Institute for Global Health
- Vanderbilt University Medical Center Nashville, Tennessee
| | - Loren Lipworth
- Vanderbilt University Medical Center Nashville, Tennessee
| | - Douglas C. Heimburger
- Vanderbilt Institute for Global Health
- University of Zambia School of Medicine, Lusaka, Zambia
- Vanderbilt University Medical Center Nashville, Tennessee
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Dragović G, Andjić M, Toljić B, Jevtović D, Lukić R, de Luka S, Trbovich A, Milašin J. Correlation between metabolic syndrome and relative telomere length shortening in HIV/AIDS patients on combined antiretroviral therapy. Exp Gerontol 2021; 147:111269. [PMID: 33529748 DOI: 10.1016/j.exger.2021.111269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 12/20/2020] [Accepted: 01/29/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Components of the metabolic syndrome (MetS) play an important role in the accelerated aging process. Relative telomere length (RTL) is a marker of biological aging. The aim of our study was to determine RTL and its possible association with MetS and the components of MetS in HIV-infected patients treated with cART. METHODS We included 24 HIV-infected men, all Caucasians, with successful cART (<50 HIV-RNA copies/mL) and on stable cART for at least 24 months. The presence of MetS and its components was determined by the criteria prescribed by the International Diabetes Federation. RTL was determined by Real-Time PCR and ΔΔCt method. We performed a multiple linear regression modeling on log-transformed RTL (dependant variable) to evaluate which components of the metabolic syndrome as well as cART duration and cART type, had an impact on RTL. RESULTS Eleven (45.8%) patients had and 13 (54.2%) had not MetS. All patients, had an undetectable viral RNA and a relatively good immune status. The mean RTL was 0.62 ± 0.15 and 0.95 ± 0.36 in patients with and without MetS, respectively (p = 0.01). Multiple linear regression model showed no significant association between duration of cART, cART type and RTL (p = 0.2165, p = 0.8628, respectively). The same analysis showed that an increase in number of MetS components was associated with shorter telomere length (β = -0.4982, p = 0.042). CONCLUSIONS We showed for the first time association between RTL shortening in HIV-infected men with metabolic syndrome. Furthermore, our study also indicated that an increment of metabolic syndrome components is strongly associated with shorter telomere length.
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Affiliation(s)
- Gordana Dragović
- Department of Pharmacology, Clinical Pharmacology and Toxicology, School of Medicine, University of Belgrade, Belgrade, Serbia.
| | - Mladen Andjić
- Department of Pharmacology, Clinical Pharmacology and Toxicology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Boško Toljić
- Department of Human Genetics, School of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Djordje Jevtović
- Infectious and Tropical Diseases Hospital, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Relja Lukić
- Obstetrics/Gynaecology Clinic "Narodni front", School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Silvio de Luka
- Institute of Pathological Physiology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Alexander Trbovich
- Institute of Pathological Physiology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jelena Milašin
- Department of Human Genetics, School of Dental Medicine, University of Belgrade, Belgrade, Serbia
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Aging with HIV in Latin America and the Caribbean: a Systematic Review. Curr HIV/AIDS Rep 2021; 18:1-47. [PMID: 33400168 DOI: 10.1007/s11904-020-00538-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE OF REVIEW With the establishment of antiretroviral treatment (ART) programs in low- and middle-income countries, people with HIV (PWH) in Latin America and the Caribbean (LAC) are living longer, subsequently developing chronic non-communicable diseases (NCDs). Few studies focus on the impact of aging among older LAC PWH. This systematic review aims to fill this information gap and understand the burden of aging with HIV in LAC. We identified peer-reviewed literature published in English, Spanish, or Portuguese from several databases to assess currently available evidence on the burden of aging with HIV in LAC and selected six common NCDs found in older PWH (cardiovascular disease [CVD], bone and musculoskeletal [MSK] disorders, cancer, renal disease, neurocognitive impairment [NCI], and depression). RECENT FINDINGS Of the 5942 publications reviewed, only 53 articles were found with populations 40 years and older or age-related findings (27 CVD, 13 NCI or depression, 6 MSK disorders, 4 renal disease, 3 cancer). Most (79%) publications were from Brazil with few longitudinal studies on aging with HIV. Prevalence of illnesses such as CVD, NCI, depression, or osteoporosis varied widely depending on the screening instrument utilized and geographic population surveyed. Age was a significant predictor of comorbidity in nearly all studies. Our results demonstrate the need for longitudinal studies and validated screening instruments appropriate for use among PWH in LAC. Understanding the mechanisms behind aging in HIV and the roles of sociocultural factors and genetic diversity specific to LAC is needed to appropriately manage chronic comorbidities as PWH age.
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Amponsah-Dacosta E, Tchuem CT, Anderson M. Chronic hepatitis B-associated liver disease in the context of human immunodeficiency virus co-infection and underlying metabolic syndrome. World J Virol 2020; 9:54-66. [PMID: 33362998 PMCID: PMC7747023 DOI: 10.5501/wjv.v9.i5.54] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/24/2020] [Accepted: 10/12/2020] [Indexed: 02/06/2023] Open
Abstract
Globally, a shift in the epidemiology of chronic liver disease has been observed. This has been mainly driven by a marked decline in the prevalence of chronic hepatitis B virus infection (CHB), with the greatest burden restricted to the Western Pacific and sub-Saharan African regions. Amidst this is a growing burden of metabolic syndrome (MetS) worldwide. A disproportionate co-burden of human immunodeficiency virus (HIV) infection is also reported in sub-Saharan Africa, which poses a further risk of liver-related morbidity and mortality in the region. We reviewed the existing evidence base to improve current understanding of the effect of underlying MetS on the development and progression of chronic liver disease during CHB and HIV co-infection. While the mechanistic association between CHB and MetS remains poorly resolved, the evidence suggests that MetS may have an additive effect on the liver damage caused by CHB. Among HIV infected individuals, MetS-associated liver disease is emerging as an important cause of non-AIDS related morbidity and mortality despite antiretroviral therapy (ART). It is plausible that underlying MetS may lead to adverse outcomes among those with concomitant CHB and HIV co-infection. However, this remains to be explored through rigorous longitudinal studies, especially in sub-Saharan Africa. Ultimately, there is a need for a comprehensive package of care that integrates ART programs with routine screening for MetS and promotion of lifestyle modification to ensure an improved quality of life among CHB and HIV co-infected individuals.
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Affiliation(s)
- Edina Amponsah-Dacosta
- Vaccines for Africa Initiative, School of Public Health and Family Medicine, University of Cape Town, Cape Town 7925, Western Cape, South Africa
| | - Cynthia Tamandjou Tchuem
- Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town 7925, Western Cape, South Africa
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Vargas-Pacherrez D, Cotrim HP, Pires L, Cunha V, Coelho V, Brites C, Daltro C. Metabolic Syndrome in HIV-patients in Antiretroviral Therapy. Curr HIV Res 2020; 18:388-395. [PMID: 32516101 DOI: 10.2174/1570162x18666200609115615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/29/2020] [Accepted: 05/20/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The global prevalence of metabolic syndrome (MS) among people living with HIV/AIDS varies from 20% to 33%. OBJECTIVE to estimate the prevalence of metabolic syndrome and associated factors in a group of HIV-infected patients on antiretroviral therapy. METHODS This is a cross-sectional study with HIV-infected patients from a reference center in Bahia, Brazil. We evaluated clinical, socio-demographic and anthropometric data. MS was defined according to the guidelines of International Diabetes Federation. RESULTS We evaluated 152 patients with mean age of 47.3±11.6 years, 59.2% male. The main comorbidities detected were diabetes (3.3%) hypertriglyceridemia (9.3%) and metabolic syndrome (MS,38.2%). Patients with MS were predominantly women (55.2% vs 31.9%; p=0.005), older [52.1 (10.4) vs 44.3 (11.3); p<0.001], and had overweight (74.1% vs 23.4%; p<0.001). After multivariate analysis MS remained associated with age (OR = 1.076; 95% CI: 1.030 - 1.125), female sex (OR = 2.452; 95% CI: 1.114 - 5.374) and family history of hypertension (OR = 3.678; 95% CI: 1.431 - 9.395). CONCLUSION Almost half of the HIV-infected patients in Bahia presents with MS which seems to be driven by classical risk factors.
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Affiliation(s)
- Daniel Vargas-Pacherrez
- LAPI, Laboratório de Pesquisa em Infectologia. Complexo Hospitalar Professor Edgard Santos, Faculdade de Medicina da Bahia - Universidade Federal da Bahia (UFBA), Bahia, Brazil,Communicable Diseases and Environmental - Pan American Health Organization, Altamira - Caracas 1060, Venezuela
| | - Helma P Cotrim
- LAPI, Laboratório de Pesquisa em Infectologia. Complexo Hospitalar Professor Edgard Santos, Faculdade de Medicina da Bahia - Universidade Federal da Bahia (UFBA), Bahia, Brazil
| | - Leonardo Pires
- LAPI, Laboratório de Pesquisa em Infectologia. Complexo Hospitalar Professor Edgard Santos, Faculdade de Medicina da Bahia - Universidade Federal da Bahia (UFBA), Bahia, Brazil
| | - Vitor Cunha
- LAPI, Laboratório de Pesquisa em Infectologia. Complexo Hospitalar Professor Edgard Santos, Faculdade de Medicina da Bahia - Universidade Federal da Bahia (UFBA), Bahia, Brazil
| | - Vitor Coelho
- LAPI, Laboratório de Pesquisa em Infectologia. Complexo Hospitalar Professor Edgard Santos, Faculdade de Medicina da Bahia - Universidade Federal da Bahia (UFBA), Bahia, Brazil
| | - Carlos Brites
- LAPI, Laboratório de Pesquisa em Infectologia. Complexo Hospitalar Professor Edgard Santos, Faculdade de Medicina da Bahia - Universidade Federal da Bahia (UFBA), Bahia, Brazil,CoBraH Study Group - Universidade Federal da Bahia (UFBA), Bahia, Brazil
| | - Carla Daltro
- LAPI, Laboratório de Pesquisa em Infectologia. Complexo Hospitalar Professor Edgard Santos, Faculdade de Medicina da Bahia - Universidade Federal da Bahia (UFBA), Bahia, Brazil,Escola de Nutrição - Universidade Federal da Bahia (UFBA), Bahia, Brazil
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12
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Determinants of Metabolic Syndrome and 5-Year Cardiovascular Risk Estimates among HIV-Positive Individuals from an Indian Tertiary Care Hospital. AIDS Res Treat 2020; 2020:5019025. [PMID: 33194228 PMCID: PMC7641704 DOI: 10.1155/2020/5019025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 08/17/2020] [Accepted: 09/30/2020] [Indexed: 11/18/2022] Open
Abstract
Longer survival due to use of antiretroviral therapy (ART) has made human immunodeficiency virus- (HIV-) infected individuals prone to chronic diseases such as diabetes, hypertension, and cardiovascular diseases (CVD). Metabolic syndrome (MS), a constellation of risk factors which increase chances of the cardiovascular disease and diabetes, can increase the morbidity and mortality among this population. Hence, the present study was conducted with the objectives of estimating the prevalence and determinants of MS among ART naïve and ART-treated patients and assess their 5-year CVD risk using the reduced version of Data Collection on Adverse Effects of Anti-HIV Drugs (D : A : D) risk prediction model (D : A : D(R)). This hospital-based cross-sectional study included 182 adults aged ≥ 18 years. MS was defined using the National Cholesterol Education Program-Adult Treatment Panel-3 (NCEP ATP-3) criteria. Univariate and multivariate logistic regressions were done to identify the factors associated with MS. Prevalence of MS was 40.1% (95% confidence interval (CI) = 33.0%-47.2%). About 24.7% of the participants had at least a single criterion for MS. Age >45 years (adjusted odds ratio (AOR) = 2.3; 95% CI = 1.1-4.9, p < 0.018) and body mass index (BMI) > 23 kg/m2 (AOR = 6.4; 95% CI = 3.1-13.1, p < 0.001) were positively associated with MS, whereas daily consumption of high sugar items was inversely associated (AOR = 0.2; 95% CI = 0.1-0.5, p < 0.001). More than 50% of the participants were found to have moderate or high 5-year CVD risk. Observed prevalence of MS among HIV patients was higher than other studies done in India. Considering a sizeable number of participants to be having moderate to high CVD risk, culturally appropriate lifestyle interventions need to be planned.
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13
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Bune GT, Yalew AW, Kumie A. Predictors of Metabolic Syndrome Among People Living with HIV in Gedeo-Zone, Southern-Ethiopia: A Case-Control Study. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2020; 12:535-549. [PMID: 33116916 PMCID: PMC7547778 DOI: 10.2147/hiv.s275283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/10/2020] [Indexed: 12/29/2022]
Abstract
Background Intensive access to antiretroviral therapy improved the prognosis of HIV. As a result, a non-communicable disease risk marker known as metabolic syndrome (MS) has emerged. It is a public health issue in sub-Saharan Africa including Ethiopia. However, there is little literature on predictors of MS among people living with HIV (PLHIVs) in the study area context. Purpose To identify predictors of metabolic syndrome among PLHIVs, Gedeo Zone, Southern-Ethiopia. Methods Health institutions-based unmatched case–control study was conducted. All HIV-infected adult persons who are receiving routine care in the randomly selected two hospitals and two health centers of the Gedeo zone, southern Ethiopia were involved in the study, conducted from December 29th, 2017, to January 22nd, 2019. PLHIVs diagnosed with MS using ATP III criteria were considered as a case, and subjects free of MS in the survey were enrolled as controls. Binary logistic regression was employed to identify predictors of MS. Results A total of 633 (139 cases and 494 controls) PLHIVs were included in the study. The multivariable analysis result found that age (AOR=1.09, 95% CI (1.05–1.12)); educational status being completed secondary school (AOR=0.22, 95% CI (0.02–0.42)); occupational status being of students (AOR=0.11, 95% CI (0.24–0.51)); wealth index being in the middle quintile (AOR=0.22, 95% CI (0.06–0.79)); ART status exposed to ART (AOR=3.07, 95% CI (1.37–6.89)); total physical activity state being physically active (AOR=0.36, 95% CI (0.16–0.79)), and engaged in low levels physical activity (AOR=3.83, 95% CI (1.46–10.05)) were the factors significantly associated with MS. Conclusion While education, occupation, wealth index, antiretroviral therapy status, total physical activity, and lower physical activity levels were concluded by the study as modifiable predictors of metabolic syndrome, age was found as a non-modifiable independent risk of metabolic syndrome. There is a need for an ongoing effort to realize an integrated care plan that addresses both the routine care and regular screening programs to reduce the risks associated with MS and its traits in these subjects.
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Affiliation(s)
| | | | - Abera Kumie
- Schools of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
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14
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Russell E, Albert A, Côté H, Hsieh A, Nesbitt A, Campbell AR, Maan EJ, Brophy J, Pick N, Murray M. Rate of dyslipidemia higher among women living with HIV: A comparison of metabolic and cardiovascular health in a cohort to study aging in HIV. HIV Med 2020; 21:418-428. [PMID: 32168418 DOI: 10.1111/hiv.12843] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Combination antiretroviral therapy has largely restored the lifespan of persons living with HIV. Data suggest early comorbidities of aging in this population. Past studies focused on men; limited data exist regarding the prevalence of dyslipidaemia in women living with HIV (WLWH). We investigated the prevalence of cardiometabolic abnormalities among WLWH and HIV-negative women in the Children and Women: Antiretrovirals and Markers of Aging (CARMA) cohort, and their relationships to cellular aging markers. METHODS We conducted a cross-sectional analysis of nonpregnant female patients (156 WLWH and 133 HIV-negative controls, aged 12-69 years) enrolled in CARMA between 2013 and 2017. The Framingham risk score (FRS) and the prevalences of hypertension, diabetes, metabolic syndrome and dyslipideamia were determined using self-report, anthropometrics, chart review and laboratory data. Cellular aging was determined by assessing leukocyte telomere length and blood mitochondrial DNA content. Diagnoses were based on current Canadian guidelines and definitions. RESULTS HIV-infected status was associated with dyslipidaemia [odds ratio (OR) 2.89; 95% confidence interval (CI) 1.69-5.01], but not diabetes, higher FRS, hypertension or metabolic syndrome. The median age was 43.5 [interquartile range (IQR) 36.8-50.9] years in WLWH and 46.2 (IQR 30.3-54.9) years in HIV-negative controls. WLWH were less likely to be menopausal or use alcohol, and more often had hepatitis C virus infection or a current or past smoking history. Lower mitochondrial DNA content was associated with metabolic syndrome; no other associations were noted between cardiometabolic abnormalities and markers of cellular aging. CONCLUSIONS Despite their relatively young age, almost two-thirds of WLWH had dyslipidaemia, a significantly greater proportion than in controls. Strategies to address dyslipidaemia and decrease smoking rates may improve long-term outcomes among WLWH.
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Affiliation(s)
- Eab Russell
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ayk Albert
- Women's Health Research Institute, British Columbia Women's Hospital, Vancouver, BC, Canada
| | - Hcf Côté
- Women's Health Research Institute, British Columbia Women's Hospital, Vancouver, BC, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ayy Hsieh
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - A Nesbitt
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - A R Campbell
- Women's Health Research Institute, British Columbia Women's Hospital, Vancouver, BC, Canada.,Division of Experimental Medicine, University of British Columbia, Vancouver, BC, Canada.,Oak Tree Clinic, British Columbia Women's Hospital, Vancouver, BC, Canada
| | - E J Maan
- Women's Health Research Institute, British Columbia Women's Hospital, Vancouver, BC, Canada.,Oak Tree Clinic, British Columbia Women's Hospital, Vancouver, BC, Canada
| | - J Brophy
- Division of Infectious Diseases, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - N Pick
- Women's Health Research Institute, British Columbia Women's Hospital, Vancouver, BC, Canada.,Oak Tree Clinic, British Columbia Women's Hospital, Vancouver, BC, Canada.,Division of Infectious Disease, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - McM Murray
- Women's Health Research Institute, British Columbia Women's Hospital, Vancouver, BC, Canada.,Oak Tree Clinic, British Columbia Women's Hospital, Vancouver, BC, Canada.,Division of Infectious Disease, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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15
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Mathebula RL, Maimela E, Ntuli NS. The prevalence of selected non-communicable disease risk factors among HIV patients on anti-retroviral therapy in Bushbuckridge sub-district, Mpumalanga province. BMC Public Health 2020; 20:247. [PMID: 32070315 PMCID: PMC7029468 DOI: 10.1186/s12889-019-8134-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 12/30/2019] [Indexed: 12/16/2022] Open
Abstract
Background The rates of non-communicable diseases (NCD’s) appear to be increasing in human immunodeficiency virus (HIV) infected people as compared to non-HIV infected people and this will have major implications for clinical care. The aim of the current study was to profile selected cardiovascular disease risk factors among HIV patients on anti-retroviral therapy (ART) in Bushbuckridge sub-district. Methods The current study followed a quantitative cross-sectional study design using a questionnaire which was adapted from World Health Organization STEPwise approach to Surveillance (WHO STEPS). Participants were HIV infected people on ART and data was entered into a computer software Microsoft excel, then imported to Stata 12 for analysis. Discussion The overall prevalence of overweight at the initiation of ART amongst the participants was 18.1% and obesity was 11.5% as compared to the time of the study which was 21.4% overweight and 19.6% obese. The average time of ART initiation to study period was 3.6 years. The study findings revealed a significant difference (p-value 0.006) between the baseline and current body mass index at time of study for females. Hypertension was found to be having a significant difference (p-value 0.026 and 0.038) between the baseline and current body mass index at time of study for males and females respectively. The overall prevalence of hypertension was found to be 34.6%, overweight was 21.4% obesity was 19.6%. The overall prevalence of abnormal waist circumference was 31.9% and females had a higher prevalence of 42.5% as compared to 4.4% of males. The overall prevalence of smoking 10.8% and alcohol consumption was 21.7%. Males were 22.5 times more likely to be smokers than females (p < 0.001) and older people were found to be 0.3 times less likely to consume alcohol as compared to young people. Conclusions The high levels of selected risk factors for NCDs among adults on ART in the current study area suggest an urgent need for health interventions to control risk factors in an era of HIV with an aim of reducing multiple morbidity of chronic diseases. Occurrence of NCDs and their risk factors with an aim to achieve positive effects of the long-term ART.
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Affiliation(s)
- Rudy Londile Mathebula
- Faculty of Health Sciences, Department of Public Health, University of Limpopo, Polokwane, South Africa.,Department of Health, Tintswalo Hospital, Acornhoek, Bushbuckridge, sub-district Mpumalanga Province, South Africa
| | - Eric Maimela
- Faculty of Health Sciences, Department of Public Health, University of Limpopo, Polokwane, South Africa.
| | - Nthembelihle Samuel Ntuli
- Faculty of Health Sciences, Department of Public Health, University of Limpopo, Polokwane, South Africa
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16
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Melaku T, Chelkeba L, Mekonnen Z, Kumela K. Glycemic Control Among People Living with Diabetes and Human Immunodeficiency Virus in Ethiopia: Leveraging Clinical Care for the Looming Co-Epidemics. Diabetes Metab Syndr Obes 2020; 13:4379-4399. [PMID: 33235478 PMCID: PMC7680108 DOI: 10.2147/dmso.s266105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 10/28/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Antiretroviral therapy has decreased human immunodeficiency virus related mortality. However, the incidence of diabetes mellitus is increasing among people living with human immunodeficiency virus and adds complexity to the standards of care. OBJECTIVE The study was aimed to determine the glycemic control and delivery of clinical care among people living with diabetes and human immunodeficincy virus in Ethiopia. METHODS A comparative prospective cohort study was conducted among patients living with diabetes at follow-up clinics of Jimma Medical Center in two study arms. The first arm was people living with diabetes and human immunodeficiency virus. The second arm was human immunodeficiency virus negative patients living with diabetes. The expanded English version of the summary of diabetes self-care activities scale was used to measure self-care behaviors. In order to identify the predictors of glycemic control, multivariable Cox regression analysis was used. Statistical significance at p-value ≤0.05 was considered. RESULTS A total of 297 eligible participants were followed for one year, with a mean age of 44.35±12.55 years. Males accounted for 55.9%. After one year of follow-up, 61.9% of diabetes people living with human immunodeficiency virus, and 49% of human immunodeficiency virus-negative patients with diabetes poorly met blood glucose target (p=0.037). Female gender [AHR: 2.72; 95% CI (1.21-5.72)], age >31 years [AHR: 2.48; 95% CI (1.34-11.01)], increased waist circumference [AHR: 3.64; 95% CI (2.57-16.12)], overweight [AHR: 3.63; 95% CI (1.65-22.42)], chronic disease comorbidity [AHR: 2.02; 95% CI (1.44-2.84)], human immunodeficiency virus infection [AHR: 3.47; 95% CI (2.03-23.75)], living longer with diabetes (>5 years) [AHR: 3.67; 95% CI (3.26-4.14)] showed a higher risk of blood sugar control failure and were independent predictors of uncontrolled glycemia. Tuberculosis infection increased the risk of uncontrolled blood sugar among people living with diabetes and human immunodeficency virus[AHR:3.82;95% CI(2.86-5.84]. CONCLUSION Significant gaps were observed in achieving the recommended glycemic target and involvement of patients on self-care care behavior in the study area. The co-occurrence of tuberculosis, human immunodeficiency virus, and diabetes is triple trouble needing special attention in their management. It is high time to leverage the clinical care of the looming co-epidemics through chronic comprehensive care clinic.
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Affiliation(s)
- Tsegaye Melaku
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
- Correspondence: Tsegaye Melaku Jimma University, Jimma, EthiopiaTel +251 913765609 Email
| | - Legese Chelkeba
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Zeleke Mekonnen
- School of Medical Laboratory Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Kabaye Kumela
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
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Todowede OO, Mianda SZ, Sartorius B. Prevalence of metabolic syndrome among HIV-positive and HIV-negative populations in sub-Saharan Africa-a systematic review and meta-analysis. Syst Rev 2019; 8:4. [PMID: 30606249 PMCID: PMC6317235 DOI: 10.1186/s13643-018-0927-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 12/19/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Metabolic syndrome (MetS) is a constellation of conditions that increase the risk of cardiovascular diseases. It is an emerging concern in sub-Saharan African (SSA) countries, particularly because of an increasingly aging population and lifestyle changes. There is an increased risk of MetS and its components among people living with Human immune deficiency syndrome (HIV) individuals; however, the prevalence of metabolic syndrome in the SSA population and its differential contribution by HIV status is not yet established. This systematic review and meta-analysis were conducted to estimate the pooled prevalence of metabolic syndrome in people living with HIV and uninfected populations, its variation by sub-components. METHODS We performed a comprehensive search on major databases-MEDLINE (PubMed), EBSCOhost, and Cochrane Database of Systematic Reviews and Web of sciences for original epidemiological research articles that compared proportions of the MetS and its subcomponents between people living with HIV and uninfected patients and published between January 1990-December 2017. The inclusion criteria were adults aged ≥ 18 years, with confirmed HIV status. We assessed the risk of bias using a prevalence studies tool, and random effect meta-analyses were used to compute the pooled overall prevalence. RESULTS A total of four cross-sectional studies comprising 496 HIV uninfected and 731 infected participants were included in the meta-analysis. The overall prevalence of MetS among people living with HIV was 21.5% (95% CI 15.09-26.86) versus uninfected 12.0% (95% CI 5.00-21.00%), with substantial heterogeneity. The reported relative risk estimate for MetS among the two groups was twofold (RR 1.83, 95% CI 0.98-3.41), with an estimated predictive interval of 0.15 to 22.43 and P = 0.055 higher for the infected population. Hypertension was the most prevalent MetS sub-components, with diverse proportions of people living with HIV (5.2-50.0%) and uninfected (10.0-59.0%) populations. CONCLUSIONS The high range of MetS prevalence in the HIV-infected population compared to the uninfected population highlights the possible presence of HIV related drivers of MetS. Also, the reported high rate of MetS, irrespective of HIV status, indicates a major metabolic disorder epidemic that requires urgent prevention and management programs in SSA. Similarly, in the era of universal test and treat strategy among people living with HIV cohorts, routine check-up of MetS sub-components is required in HIV management as biomarkers. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016045727.
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Affiliation(s)
- Olamide O Todowede
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4001, South Africa.
| | - Solange Z Mianda
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4001, South Africa
| | - Benn Sartorius
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4001, South Africa.,Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, USA
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18
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Derose KP, Ríos-Castillo I, Fulcar MA, Payán DD, Palar K, Escala L, Farías H, Martínez H. Severe food insecurity is associated with overweight and increased body fat among people living with HIV in the Dominican Republic. AIDS Care 2018; 30:182-190. [PMID: 28681631 PMCID: PMC5725241 DOI: 10.1080/09540121.2017.1348597] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Food insecurity is an important risk factor for overweight and obesity among low-income populations in high income countries, but has not been well-studied among people living with HIV (PLHIV), particularly in resource-poor settings. To explore the association between food insecurity and overweight and obesity among PLHIV in the Dominican Republic, we conducted a cross-sectional study of 160 HIV-infected adults between March-December 2012 in four geographically-dispersed health centers (Santo Domingo, Puerto Plata, San Juan, and Higuey). We collected information on household food insecurity, anthropometric measurements, and socio-demographic data and ran descriptive and multivariate analyses, controlling for fixed effects of clinics and using robust standard errors. Mean age ± SD of participants was 39.9 ± 10.5 years; 68% were women, and 78% were on antiretroviral therapy (ART). A total of 58% reported severe household food insecurity. After controlling for age, gender, income, having children at home, education, and ART status, severe food insecurity was associated with increased body mass index (BMI) (β = 1.891, p = 0.023) and body fat (β = 4.004, p = 0.007). Age and female gender were also associated with increased body fat (β = 0.259, p < 0.001 and β = 8.568, p < 0.001, respectively) and age and ART status were associated with increased waist circumference (β = 0.279, p = 0.011 and β = 5.768, p = 0.046, respectively). When overweight was examined as a dichotomous variable (BMI ≥ 25.0), severe food insecurity was associated with an increased odds of 3.060 (p = 0.013); no other covariates were independently associated with overweight. The association of severe food insecurity with increased BMI, body fat, and overweight among PLHIV has important implications for clinical care as well as food security and nutrition interventions in resource-poor settings. Integrated programs that combine nutrition education or counseling with sustainable approaches to addressing food insecurity among PLHIV are needed to improve long-term health outcomes of this vulnerable population.
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Affiliation(s)
| | - Israel Ríos-Castillo
- Food and Agriculture Organization (FAO) of the United Nations, Sub-Regional Office for Mesoamerica, Panama City, Panama
| | - María Altagracia Fulcar
- United Nations World Food Programme, Dominican Republic Country Office, Santo Domingo, Dominican Republic
| | - Denise D. Payán
- RAND Corporation, Santa Monica, CA, USA
- UCLA Fielding School of Public Health, Los Angeles, CA USA
| | - Kartika Palar
- Division of HIV/AIDS, University of California, San Francisco, CA, USA
| | - Lisbeth Escala
- United Nations World Food Programme, Regional Bureau for Latin America and the Caribbean, Panama City, Panama
| | - Hugo Farías
- United Nations World Food Programme, Regional Bureau for Latin America and the Caribbean, Panama City, Panama
| | - Homero Martínez
- RAND Corporation, Santa Monica, CA, USA
- Hospital Infantil de Mexico “Dr. Federico Gomez”, Mexico City, Mexico
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19
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Muhammad FY, Gezawa ID, Uloko A, Yakasai AM, Habib AG, Iliyasu G. Metabolic syndrome among HIV infected patients: A comparative cross sectional study in northwestern Nigeria. Diabetes Metab Syndr 2017; 11 Suppl 1:S523-S529. [PMID: 28410829 DOI: 10.1016/j.dsx.2017.03.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 03/31/2017] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The increasing availability of antiretroviral drugs has made HIV-positive patients to live longer, and conditions that are associated with longevity such as metabolic syndrome and other cardiovascular related conditions have become relevant in them. This is less well studied among African populations. Therefore the study aimed at estimating and comparing the prevalence of and associated risk factors for the metabolic syndrome (MS) among African HIV infected patients. METHOD In this comparative cross-sectional study, we analyzed the data of 300 participants matched for age and gender who satisfied the inclusion criteria with half of the subjects on HAART, while the other half was HAART naïve. The MS was diagnosed using ATP-III criteria. RESULTS The mean age of the patients was 34.8±9.9years. The majority of the patients were females 64%. The prevalence of MS among HAART-exposed patients was found to be 19.3%, while it was 5.3% among HAART naïve patients (p=0.001). Raised triglyceride and elevated blood pressure were the criteria with the highest occurrence among HAART-exposed, 82.8% for each. Advanced age, longer duration of HIV diagnosis and HAART exposure, increased BMI, weight gain after HAART exposure, exposure to PIs and increased mean CD4 cell count were found to be significantly associated with MS (p<0.05). However, only age (OR 4.3, 95% CI 1.6-11.8, p=0.005) and BMI (OR 4.2, 95% CI 1.5-11.9, p=0.007) were found to be independently associated with the development of MS. CONCLUSION Exposure to HAART particularly protease inhibitor based regimen increases the risk of MS among HIV-infected patients.
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Affiliation(s)
| | - Ibrahim Danjummai Gezawa
- Endocrine Unit, Department of Medicine, Aminu Kano Teaching Hospital, P.M.B. 3452, Kano, Nigeria.
| | - Andrew Uloko
- Endocrine Unit, Department of Medicine, Aminu Kano Teaching Hospital, P.M.B. 3452, Kano, Nigeria.
| | - Ahmad Maifada Yakasai
- Infectious Disease Unit, Department of Medicine, Aminu Kano Teaching Hospital, P.M.B. 3452, Kano, Nigeria.
| | - Abdulrazaq Garba Habib
- Infectious Disease Unit, Department of Medicine, Aminu Kano Teaching Hospital, P.M.B. 3452, Kano, Nigeria.
| | - Garba Iliyasu
- Infectious Disease Unit, Department of Medicine, Aminu Kano Teaching Hospital, P.M.B. 3452, Kano, Nigeria.
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Guidelines on the management of arterial hypertension and related comorbidities in Latin America. J Hypertens 2017; 35:1529-1545. [DOI: 10.1097/hjh.0000000000001418] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Akl LD, Valadares ALR, Moraes MJD, Pinto-Neto AM, Lagrutta B, Costa-Paiva L. Metabolic syndrome in HIV-infected middle-aged women on antiretroviral therapy: prevalence and associated factors. Braz J Infect Dis 2017; 21:263-269. [PMID: 28284656 PMCID: PMC9427828 DOI: 10.1016/j.bjid.2017.02.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 11/23/2016] [Accepted: 02/21/2017] [Indexed: 01/06/2023] Open
Abstract
Objectives To determine the prevalence of metabolic syndrome (MetS) and its associated factors in a group of HIV-infected middle-aged women. Methods Cross-sectional study including 273 HIV-infected climacteric women of 40–60 years of age under care in two HIV outpatient reference centers in Brazil. Metabolic syndrome diagnosis was based on 2006 International Diabetes Federation criteria. Sociodemographic, clinical and behavioral factors were evaluated as well as HIV infection-related parameters. Results Mean age was 47.7 years; 59.1% of women were premenopausal, 91% were on antiretroviral therapy. Current CD4 count was >500 cells/mm3 in 61.7%, current viral load undetectable in 76.9% of women, and a quarter had previous diagnosis of aids. The prevalence of metabolic syndrome in the subgroup of menopausal women was 46.9%. Univariate analysis showed an association between metabolic syndrome and age ≥50 years (p = 0.002), schooling <8 years (p = 0.003), post-menopause (p < 0.001), body mass index (BMI) >25 kg/m2 (p < 0.001), and FSH ≥40 mIU/mL (p = 0.002). In the multivariate analysis only increased BMI (PR = 1.09; 95% CI: 1.05–1.13; p < 0.001) and FSH levels ≥40 mIU/mL (PR = 1.66; 95% CI: 1.14–2.40; p = 0.008) maintained statistical significance. There was no association between PI use or any other factor related to HIV-infection and MetS in any of the analyses performed. Conclusion High BMI and FSH levels compatible with menopause were the only factors associated with MetS in these middle aged HIV-infected women. In the context of well-controlled, early treated HIV infection, traditional rather than HIV-related factors were associated with MetS.
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Affiliation(s)
- Lívia D Akl
- Hospital Eduardo de Menezes (HEM), Belo Horizonte, MG, Brazil
| | - Ana L R Valadares
- Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil; Universidade José do Rosário Vellano (Unifenas), Belo Horizonte, MG, Brazil.
| | | | | | - Bianca Lagrutta
- Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
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Martin-Iguacel R, Negredo E, Peck R, Friis-Møller N. Hypertension Is a Key Feature of the Metabolic Syndrome in Subjects Aging with HIV. Curr Hypertens Rep 2016; 18:46. [PMID: 27131801 PMCID: PMC5546311 DOI: 10.1007/s11906-016-0656-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
With widespread and effective antiretroviral therapy, the life expectancy in the HIV population has dramatically improved over the last two decades. Consequently, as patients are aging with HIV, other age-related comorbidities, such as metabolic disturbances and cardiovascular disease (CVD), have emerged as important causes of morbidity and mortality. An overrepresentation of traditional cardiovascular risk factors (RF), toxicities associated with long exposure to antiretroviral therapy, together with residual chronic inflammation and immune activation associated with HIV infection are thought to predispose to these metabolic complications and to the excess risk of CVD observed in the HIV population. The metabolic syndrome (MS) represents a clustering of RF for CVD that includes abdominal obesity, hypertension, dyslipidemia and insulin resistance. Hypertension is a prevalent feature of the MS in HIV, in particular in the aging population, and constitutes an important RF for CVD. Physicians should screen their patients for metabolic and cardiovascular risk at the regular visits to reduce MS and the associated CVD risk among people aging with HIV, since many of RF are under-diagnosed and under-treated conditions. Interventions to reduce these RF can include lifestyle changes and pharmacological interventions such as antihypertensive and lipid-lowering therapy, and treatment of glucose metabolism disturbances. Changes in antiretroviral therapy to more metabolic neutral antiretroviral drugs may also be considered.
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Affiliation(s)
- Raquel Martin-Iguacel
- Infectious Diseases Department, Odense University Hospital, Sdr Boulevard 29, 5000, Odense C, Denmark.
| | - Eugènia Negredo
- "Lluita contra la SIDA" Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Universitat de Vic-Universitat Central de Catalunya, Barcelona, Spain
| | - Robert Peck
- Department of Internal Medicine, Weill Bugando School of Medicine, PO Box 5034, Mwanza, Tanzania
- Center for Global Health, Weill Cornell Medical College, New York, NY, USA
| | - Nina Friis-Møller
- Infectious Diseases Department, Odense University Hospital, Sdr Boulevard 29, 5000, Odense C, Denmark
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Hirigo AT, Tesfaye DY. Influences of gender in metabolic syndrome and its components among people living with HIV virus using antiretroviral treatment in Hawassa, southern Ethiopia. BMC Res Notes 2016; 9:145. [PMID: 26945987 PMCID: PMC4779577 DOI: 10.1186/s13104-016-1953-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 02/23/2016] [Indexed: 01/04/2023] Open
Abstract
Background Data regarding the influences of gender in metabolic syndrome (MetS) among patients using antiretroviral treatment (ART) in Ethiopia is scarce. The aim of this study was to assess the influences of gender in MetS and its components among HIV-infected patients receiving ART. Methods A cross-sectional study was conducted between February 2012 and April 2013. Data on demographic, clinical and anthropometric characteristics were collected from 185 HIV patients using ART. Glucose and lipid profiles were measured from overnight fast blood. The International Diabetes Federation (IDF) and United States national cholesterol education program: adult treatment (US NCEP-ATP) panel III criteria were used to define MetS. Result A total number of 185 (36.8 % males and 63.2 % females) participants were recruited in this study. The overall prevalence of MetS was 24.3 and 17.8 %, diagnosed using IDF and NCEP-ATP criteria respectively. Using IDF criteria, MetS was significantly higher in females compared to males (33.3 vs. 8.8 %; p = <0.0001) respectively. Low HDL-c and central obesity were significantly higher MetS components in female compared to males (p = 0.003); and (p = <0.0001, using IDF and NCEP-ATP criteria) respectively. BMI >25 kg/m2 was significantly associated with MetS in both IDF and NCEP-ATP criteria: unadjusted (UOR) and adjusted odds ratio (AOR) with 95 % CI were 3.0 (1.3–6.5) and 3.8 (1.5–9.8); as well as 3.2 (1.4–7.4) and 3.4 (1.4–7.4) respectively. Furthermore age >40 years was significantly associated with MetS using NCEP-ATP: UOR and AOR (95 % CI) were 3.1 (1.2–8.3), and 3.8 (1–13.70) respectively. Conclusion Comprehensive medical care approach including with MetS components are a crucial instruments in order to minimize the risk of developing cardiovascular diseases in HIV-infected patients using ART.
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Affiliation(s)
- Agete Tadewos Hirigo
- Department of Medical Laboratory Sciences, Hawassa University College of Medicine and Health Science, P.O. Box 1560, Hawassa, Ethiopia.
| | - Demo Yemane Tesfaye
- Department of Medical Laboratory Sciences, Hawassa University College of Medicine and Health Science, P.O. Box 1560, Hawassa, Ethiopia.
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López-Jaramillo P, Sánchez RA, Diaz M, Cobos L, Bryce A, Parra-Carrillo JZ, Lizcano F, Lanas F, Sinay I, Sierra ID, Peñaherrera E, Bendersky M, Schmid H, Botero R, Urina M, Lara J, Foss MC, Márquez G, Harrap S, Ramírez AJ, Zanchetti A. [Latin American consensus on hypertension in patients with diabetes type 2 and metabolic syndrome]. ACTA ACUST UNITED AC 2015; 58:205-25. [PMID: 24863082 DOI: 10.1590/0004-2730000003019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 03/06/2014] [Indexed: 12/30/2022]
Abstract
The present document has been prepared by a group of experts, members of cardiology, endocrinology, internal medicine, nephrology and diabetes societies of Latin American countries, to serve as a guide to physicians taking care of patients with diabetes, hypertension and comorbidities or complications of both conditions. Although the concept of metabolic syndrome is currently disputed, the higher prevalence in Latin America of that cluster of metabolic alterations has suggested that metabolic syndrome is a useful nosography entity in the context of Latin American medicine. Therefore, in the present document, particular attention is paid to this syndrome in order to alert physicians on a particular high-risk population, usually underestimated and undertreated. These recommendations result from presentations and debates by discussion panels during a 2-day conference held in Bucaramanga, in October 2012, and all the participants have approved the final conclusions. The authors acknowledge that the publication and diffusion of guidelines do not suffice to achieve the recommended changes in diagnostic or therapeutic strategies, and plan suitable interventions overcoming knowledge, attitude and behavioural barriers, preventing both physicians and patients from effectively adhering to guideline recommendations.
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Affiliation(s)
- Patricio López-Jaramillo
- Fundación Oftalmológica de Santander FOSCAL, Universidad de Santander UDES, Bucaramanga, Colômbia
| | - Ramiro A Sánchez
- Unidad de Metabolismo e Hipertensión Arterial, Hospital Universitario, Fundación Favaloro, Buenos Aires, Argentina
| | | | | | | | | | - Fernando Lizcano
- Asociación Colombiana de Endocrinología, Universidad de la Sabana, Bogotá, Colômbia
| | | | - Isaac Sinay
- Instituto Cardiológico de Buenos Aires, Buenos aires, Argentina
| | - Iván D Sierra
- Asociación Latinoamericana de Diabetes, Bogotá, Colômbia
| | | | | | - Helena Schmid
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
| | | | - Manuel Urina
- Sociedad Colombiana de Cardiología, Bogotá, Colômbia
| | - Joffre Lara
- Sociedad Ecuatoriana de Aterosclerosis, Guayaquil, Equador
| | | | | | | | - Agustín J Ramírez
- Unidad de Metabolismo e Hipertensión Arterial, Hospital Universitario, Fundación Favaloro, Buenos Aires, Argentina
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Tiozzo E, Konefal J, Adwan S, Martinez LA, Villabona J, Lopez J, Cutrono S, Mehdi SMA, Rodriguez A, Woolger JM, Lewis JE. A cross-sectional assessment of metabolic syndrome in HIV-infected people of low socio-economic status receiving antiretroviral therapy. Diabetol Metab Syndr 2015; 7:15. [PMID: 25763112 PMCID: PMC4356056 DOI: 10.1186/s13098-015-0008-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 02/11/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Metabolic syndrome (MetS) is a constellation of symptoms used as a measure to identify patients at increased risk for cardiovascular disease, type 2 diabetes, and all-cause mortality. The results of prolonged life expectancy and cumulative toxic effects of antiretroviral therapy increase the chance that HIV can cause clinical abnormalities, including MetS. METHODS We evaluated 89 people living with HIV (PLWH; mean age 48 ± 7 years; mean duration of HIV infection 17 ± 12 years; 47% men; 66% African-American, 22% Hispanic, and 10% non-Hispanic white; and 84% unemployed) enrolled in a community-based exercise training and nutrition education program targeting individuals of low socio-economic status (SES). The prevalence of MetS characteristics and the factors associated with the presence of MetS were analyzed. RESULTS One in three (33%; 12 men and 17 women) PLWH met ATPIII criteria for MetS. In our cohort, MetS was driven by high waist circumference and elevated blood pressure. In addition, higher use of protease inhibitors, elevated hemoglobin A1c (HbA1c), greater self-reported daily caloric intake and consumption of carbohydrates, sugar, added sugar, and higher glycemic load were found among the individuals with MetS, compared to those without it. Elevated HbA1c and high total sugar consumption were the strongest predictors and accounted for 30% of the occurrence of MetS. CONCLUSIONS The overall prevalence of MetS in our PLWH cohort receiving antiretroviral therapy is higher than previously reported in the general population and in other PLWH cohorts. Additional work is needed to determine whether MetS is a more disease dependent or lifestyle dependent condition in PLWH.
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Affiliation(s)
- Eduard Tiozzo
- />Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Clinical Research Building, 1120 NW 14th Street, Miami, FL 33136 USA
| | - Janet Konefal
- />Department of Family Medicine and Community Health, University of Miami Miller School of Medicine, Miami, FL USA
| | - Sarah Adwan
- />Department of Kinesiology and Sport Sciences, University of Miami, Miami, FL USA
| | | | - Juan Villabona
- />Department of Biology, Miami-Dade College, Miami, FL USA
| | - Johanna Lopez
- />Department of Dietetics, Florida International University, Miami, FL USA
| | - Stacy Cutrono
- />Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL USA
| | - Syed Muhammad Ahsan Mehdi
- />Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Clinical Research Building, 1120 NW 14th Street, Miami, FL 33136 USA
| | - Allan Rodriguez
- />Department of Medicine, University of Miami Miller School of Medicine, Miami, FL USA
| | - Judi M Woolger
- />Department of Medicine, University of Miami Miller School of Medicine, Miami, FL USA
| | - John E Lewis
- />Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Clinical Research Building, 1120 NW 14th Street, Miami, FL 33136 USA
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Drelichowska J, Kwiatkowska W, Knysz B, Witkiewicz W. Metabolic syndrome in HIV-positive patients. HIV & AIDS REVIEW 2015. [DOI: 10.1016/j.hivar.2014.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Tesfaye DY, Kinde S, Medhin G, Megerssa YC, Tadewos A, Tadesse E, Shimelis T. Burden of metabolic syndrome among HIV-infected patients in Southern Ethiopia. Diabetes Metab Syndr 2014; 8:102-107. [PMID: 24907175 DOI: 10.1016/j.dsx.2014.04.008] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND HIV infection and highly active antiretroviral therapy (HAART) can induce metabolic disturbances including lipodystrophy, dyslipidemia, and insulin resistance, which are reminiscences of metabolic syndrome (MS). However, little is known regarding the magnitude of MS in Ethiopian HIV population. This study, aimed to estimate the prevalence of MS among HIV positive patients with and without HAART. METHODS A cross-sectional study was conducted at Hawassa University Referral Hospital, southern Ethiopia between February 2012 and April 2013. Data on demographic and anthropometric characteristics were collected from a total of 374 HIV positive participants (188 on ART and 186 on Pre-ART) using WHO stepwise approach. Fasting blood glucose, total cholesterol, triglyceride, HDL-cholesterol and LDL-cholesterol was measured. The International Diabetes Federation (IDF) and the National Cholesterol Education Program: Adult Treatment Panel III (ATP) Criteria were used to define MS. RESULT Of the 374 study participants 68% were females, and 50.3% were receiving ART. Using the IDF criteria, metabolic syndrome was diagnosed in 25% of patients receiving ART compared to 22.5% of the ART naïve group (OR: 1.14 CI: 0.71-1.84). Using the ATP criteria, the prevalence of MS was 18.1% in the ART groups compared to 15.6% in ART naïve group (OR: 1.20, CI: 0.69-2.06). Patients receiving ART had significantly elevated Cholesterol, triglyceride, glucose and LDL-c levels but lower CD4(+) cell counts than the Pre-ART groups. Being a female, having BMI of at least 25, older age (i.e. age≥45 years) and having total cholesterol of at least 200mg/dl were significantly associated with the presence of MS. Using the ATP criteria to define MS, taking d4T-3TC-EFV regimen was significantly associated with higher odds of MS. CONCLUSION Almost a quarter of HIV patients on ART developed metabolic syndrome. Furthermore patients on ART had elevated lipid profile and glucose metabolism disturbance than the ART naïve.
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Affiliation(s)
- Demo Yemane Tesfaye
- Hawassa University, College of Medicine and Health Science, Department of Medical Laboratory Sciences, Ethiopia.
| | - Samuel Kinde
- Addis Ababa University, College of Health Sciences, Ethiopia.
| | - Girmay Medhin
- Addis Ababa University, Aklilu Lemma Institute of Pathobiology, Ethiopia.
| | | | - Agete Tadewos
- Hawassa University Referral Hospital, Hawassa University, Ethiopia.
| | - Endale Tadesse
- Hawassa University, College of Medicine and Health Science, Department of Medical Laboratory Sciences, Ethiopia.
| | - Techalew Shimelis
- Hawassa University, College of Medicine and Health Science, Department of Medical Laboratory Sciences, Ethiopia.
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López-Jaramillo P, Sánchez RA, Díaz M, Cobos L, Bryce A, Parra-Carrillo JZ, Lizcano F, Lanas F, Sinay I, Sierra ID, Peñaherrera E, Benderky M, Schmid H, Botero R, Urina M, Lara J, Foos MC, Márquez G, Harrap S, Ramírez AJ, Zanchetti A. Consenso latinoamericano de hipertensión en pacientes con diabetes tipo 2 y síndrome metabólico. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2014; 26:85-103. [DOI: 10.1016/j.arteri.2013.11.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 11/26/2013] [Indexed: 12/14/2022]
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Neto MG, Zwirtes R, Brites C. A literature review on cardiovascular risk in human immunodeficiency virus-infected patients: implications for clinical management. Braz J Infect Dis 2013; 17:691-700. [PMID: 23916459 PMCID: PMC9427374 DOI: 10.1016/j.bjid.2013.05.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Revised: 02/06/2013] [Accepted: 05/08/2013] [Indexed: 01/01/2023] Open
Abstract
Introduction In recent years, there has been growing concern about an increasing rate of cardiovascular diseases in human immunodeficiency virus-infected patients, which could be associated with side effects of highly active antiretroviral therapy. It is likely that the metabolic disorders related to anti-human immunodeficiency virus treatment will eventually translate into a increased cardiovascular risk in patients submitted to such regimens. Objective To evaluate if human immunodeficiency virus-infected patients receiving highly active antiretroviral therapy are at higher risk of cardiovascular diseases than human immunodeficiency virus infected patients not receiving highly active antiretroviral therapy, or the general population. Research design and methods We conducted a computer-based search in representative databases, and also performed manual tracking of citations in selected articles. Result The available evidence suggests an excess risk of cardiovascular events in human immunodeficiency virus-infected persons compared to non-human immunodeficiency virus infected individuals. The use of highly active antiretroviral therapy is associated with increased levels of total cholesterol, triglycerides, low-density lipoprotein and morphological signs of cardiovascular diseases. Some evidence suggested that human immunodeficiency virus-infected individuals on highly active antiretroviral therapy regimens are at increased risk of dyslipidemia, ischemic heart disease, and myocardial infarction, particularly if the highly active antiretroviral therapy regimen contains a protease inhibitor. Conclusion Physicians must weigh the cardiovascular risk against potential benefits when prescribing highly active antiretroviral therapy. Careful cardiac screening is warranted for patients who are being evaluated for, or who are receiving highly active antiretroviral therapy regimens, particularly for those with known underlying cardiovascular risk factors. A better understanding of the molecular mechanisms responsible for increased risk of cardiovascular diseases in human immunodeficiency virus-infected patients will lead to the discovery of new drugs that will reduce cardiovascular risk in human immunodeficiency virus-infected patients receiving highly active antiretroviral therapy.
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Maloberti A, Giannattasio C, Dozio D, Betelli M, Villa P, Nava S, Cesana F, Facchetti R, Giupponi L, Castagna F, Sabbatini F, Bandera A, Gori A, Grassi G, Mancia G. Metabolic syndrome in human immunodeficiency virus-positive subjects: prevalence, phenotype, and related alterations in arterial structure and function. Metab Syndr Relat Disord 2013; 11:403-11. [PMID: 23885973 DOI: 10.1089/met.2013.0008] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV) infection itself and highly active antiretroviral treatment (HAART) have been proposed to be associated with a higher prevalence of metabolic syndrome, but, to date, prevalence and phenotype of metabolic syndrome among HIV subjects and the related structural and functional vascular alterations are not conclusively defined. METHODS We analyzed the data of 108 HIV-infected subjects without known cardiovascular risk factors: 72 were on HAART (group A, age 46.5±7.5 years, clinical blood pressure 125.7/74.9±11.6/7.8 mmHg) and there 36 in a naïve group (group B, age 40.7±7.9 years, blood pressure 126/75.8±9.8/7.7 mmHg). A total of 224 healthy subjects served as controls (group C, age 44.9±6.9 years, blood pressure 123.7/75.7±9.8/7.1 mmHg). Arterial stiffness was measured by aorto-femoral pulse wave velocity (PWV, sfigmocor), and carotid intima media thickness (IMT) was measured by a semiautomatic echotracking system (Esaote-WTS). RESULTS Metabolic syndrome was more frequent in HIV-positive subjects than in controls (19.4%, 13.8%, 4.5% for groups A, B, and C; P<0.001), with no significant difference between HAART and naïve. In metabolic syndrome subjects, group A displayed lipid profile alterations more frequently (91%, 50%, 57% for groups A, B, and C; P<0.05), whereas others metabolic syndrome components were equally represented in the three groups. In metabolic syndrome subjects, IMT was similar [556±108, 542±164, and 564±110.4 μm for groups A, B, and C; P=not significant (NS)], whereas PWV was significantly greater in HAART subjects when compared with controls (10.8±1.8, 9.±1.1, 9.3±1 cm/sec for groups A, B, and C; P=0.02 for A vs. C). Moreover, in this group (metabolic syndrome+HAART), PWV was higher than in subjects on HAART but without metabolic syndrome. CONCLUSIONS HIV subjects showed a higher prevalence and a different pattern of metabolic syndrome components. HAART, more than HIV infection per se, appeared to be responsible for the increased prevalence of metabolic syndrome and arterial function derangement.
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Latin American consensus on hypertension in patients with diabetes type 2 and metabolic syndrome. J Hypertens 2013; 31:223-38. [PMID: 23282894 DOI: 10.1097/hjh.0b013e32835c5444] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The present document has been prepared by a group of experts, members of cardiology, endocrinology and diabetes societies of Latin American countries, to serve as a guide to physicians taking care of patients with diabetes, hypertension and comorbidities or complications of both conditions. Although the concept of 'metabolic syndrome' is currently disputed, the higher prevalence in Latin America of that cluster of metabolic alterations has suggested that 'metabolic syndrome' is a useful nosographic entity in the context of Latin American medicine. Therefore, in the present document, particular attention is paid to this syndrome in order to alert physicians on a particularly high-risk population, usually underestimated and undertreated. These recommendations result from presentations and debates by discussion panels during a 2-day conference held in Bucaramanga, in October 2012, and all the participants have approved the final conclusions. The authors acknowledge that the publication and diffusion of guidelines do not suffice to achieve the recommended changes in diagnostic or therapeutic strategies, and plan suitable interventions overcoming knowledge, attitude and behavioural barriers, preventing both physicians and patients from effectively adhering to guideline recommendations.
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Abstract
HIV-associated lipodystrophy syndrome (HALS), comprising metabolic and morphological alterations, is a known side effect of highly active antiretroviral therapy (HAART). Evidence for the role of nutrition in the management of the systemic parameters of HALS is currently limited. In the present paper we review the current knowledge base surrounding HALS, focusing particularly on the role of nutrition in mitigating the systemic parameters of the syndrome. Reported prevalence of HALS was found to vary from 9 to 83 % due to lack of a standardised definition, as well as variations in assessment methods and in the study population used. HALS is associated with both morphological (lipoatrophy, lipohypertrophy) and metabolic (dyslipidaemia, glucose intolerance, diabetes, hypertension, endothelial dysfunction and atherosclerosis) alterations, which may occur singly or in combination, and are associated with an increased risk of CVD. HAART-induced adipocyte inflammation, oxidative stress and macrophage infiltration, as well as altered adipocyte function and mitochondrial toxicity, have been shown to be central to the development of HALS. The adipocyte, therefore, represents a plausible target for treatment. Pharmacological and surgical treatment interventions have shown effect. However, their use is associated with numerous adverse effects and complications. Targeted lifestyle interventions may provide a useful alternative for managing HALS owing to their safety and tolerability. A Mediterranean-style diet has been found to be effective in improving the systemic parameters of HALS. Furthermore, the effects of n-3 PUFA supplementation are encouraging and future randomised controlled trials investigating the beneficial effects of n-3 PUFA in HALS are justified.
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Jarrett OD, Wanke CA, Ruthazer R, Bica I, Isaac R, Knox TA. Metabolic syndrome predicts all-cause mortality in persons with human immunodeficiency virus. AIDS Patient Care STDS 2013; 27:266-71. [PMID: 23651103 DOI: 10.1089/apc.2012.0402] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We examined the association between metabolic syndrome (MS) and its individual defining criteria on all-cause mortality in human immunodeficiency virus (HIV)-infected persons. We used data from 567 HIV-infected participants of the Nutrition for Healthy Living study with study visits between 9/1/2000 and 1/31/2004 and determined mortality through 12/31/2006. MS was defined using modified National Cholesterol Education Program guidelines. Cox proportional hazards for all-cause mortality were estimated for baseline MS status and for its individual defining criteria. There were 83 deaths with median follow-up of 63 months. Baseline characteristics associated with increased risk of mortality were: older age in years (univariate hazard ratio [HR] 1.04, p<0.01), current smoking (HR 1.99, p=0.02), current heroin use (HR 1.97, p=0.02), living in poverty (HR 2.0, p<0.01), higher mean HIV viral load (HR 1.81, p<0.01), and having a BMI <18 (HR 5.84, p<0.01). For MS and its criteria, only low HDL was associated with increased risk of mortality on univariate analysis (HR 1.84, p=0.01). However, metabolic syndrome (adjusted HR 2.31, p=0.02) and high triglycerides (adjusted HR 3.97, p<0.01) were significantly associated with mortality beyond 36 months follow-up. MS, low HDL, and high triglycerides are associated with an increased risk of mortality in HIV-infected individuals.
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Affiliation(s)
- Olamide D. Jarrett
- Department of Medicine, University of Illinois at Chicago School of Medicine, Chicago, Illinois
| | - Christine A. Wanke
- Department of Medicine, Tufts Medical Center, Boston, Massachusetts
- Nutrition/Infection Unit, Department of Public Health and Family Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Robin Ruthazer
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | - Ioana Bica
- Department of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Rita Isaac
- RUHSA Department, Christian Medical College, Vellore, India
| | - Tamsin A. Knox
- Department of Medicine, Tufts Medical Center, Boston, Massachusetts
- Nutrition/Infection Unit, Department of Public Health and Family Medicine, Tufts University School of Medicine, Boston, Massachusetts
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Metabolic syndrome before and after initiation of antiretroviral therapy in treatment-naive HIV-infected individuals. J Acquir Immune Defic Syndr 2013; 61:381-9. [PMID: 22828718 DOI: 10.1097/qai.0b013e3182690e3c] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Metabolic syndrome (MetS) is a cluster of risk factors for cardiovascular disease and diabetes, many of which are associated with HIV and antiretroviral therapy (ART). We examined prevalence and incidence of MetS and risk factors for MetS in ART-naive HIV-infected individuals starting ART. METHODS MetS, defined by the Adult Treatment Panel III criteria, was assessed at and after ART initiation in HIV-infected individuals who enrolled in selected AIDS Clinical Trials Group trials and were followed long-term after these trials as part of the AIDS Clinical Trials Group Longitudinal Linked Randomized Trials cohort. Cox proportional hazards models were used to examine risk factors of incident MetS. Adjusted hazard ratios (aHRs) and 95% confidence intervals (CI) are reported. RESULTS At ART initiation, the prevalence of MetS was 20%. After ART initiation, the incidence of MetS was 8.5 per 100 person-years. After adjusting for demographics and body mass index, the risk of MetS was decreased for CD4+ T-cell counts >50 cells per cubic millimeter (aHR = 0.62, 95% CI = 0.43 to 0.90 for CD4 >500), and the risk was increased for HIV-1 RNA >400 copies per milliliter (aHR = 1.55 (95% CI = 1.25 to 1.92) and use of a protease-inhibitor (PI)-based regimen [relative to no PI use, aHR = 1.25 (95% CI = 1.04 to 1.51) for any PI use]. CONCLUSIONS In HIV-infected individuals on ART, virologic suppression and maintenance of high CD4+ T-cell counts may be potentially modifiable factors that can reduce the risk of MetS. The effect of MetS on the risk of cardiovascular disease and diabetes needs to be evaluated.
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Gomez-Duarte OG. Síndrome metabólico y complicaciones durante anestesia general. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2012. [DOI: 10.1016/s0120-3347(12)70019-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Gomez-Duarte OG. Metabolic Syndrome and General Anesthesia Complications. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2012. [DOI: 10.1016/s2256-2087(12)70019-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Genetic polymorphisms in estrogen receptors and sexual dimorphism in fat redistribution in HIV-infected patients on HAART. AIDS 2012; 26:19-26. [PMID: 22011627 DOI: 10.1097/qad.0b013e32834db3ac] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To investigate genetic single nucleotide polymorphisms (SNPs) in estrogen receptor-α (ERα) (ESR1, rs2234693, rs1801132, rs7757956 and rs2813544) and ERβ (ESR2, rs3020450, rs7154455 and rs4986938) genes and relate them to the adverse effects lipodystrophy, dyslipidemia and metabolic syndrome as well as to differences in their prevalence between sexes in HIV-infected individuals on HAART. DESIGN Cross-sectional study. METHODS Blood samples and anthropometric measurements were collected from 614 patients at reference services in the cities of Porto Alegre, Pelotas and Rio Grande in Brazil. The SNPs were genotyped by real-time PCR. RESULTS The lipodystrophy subtype frequencies in patients of different sexes showed statistically significant differences; the atrophic pattern was more prevalent in men, and the hypertrophic pattern was more prevalent in women. Furthermore, metabolic syndrome prevalence was higher in women than in men. The ESR1 rs2813544 G-allele was associated with higher measurements of several anthropometric variables in women: BMI, total subcutaneous fat and subcutaneous fat of limbs. Additionally, patients who were AA homozygous for ESR2 rs3020450 presented an increased risk for developing lipoatrophy (prevalence ratio 1.37, 95% confidence interval 1.09-1.73, P = 0.007). CONCLUSION Significant differences in lipodystrophy and metabolic syndrome prevalence were detected between sexes. Moreover, the ESR1 gene (rs2813544) presented significant sex-specific associations with anthropometric variables, and the ESR2 gene (rs3020450) was associated with an increased risk of developing lipoatrophy. Our results suggest that these genes are in part responsible for the sexual dimorphism in fat tissue redistribution and patterns of lipodystrophy.
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Signorini DJHP, Monteiro MCM, Andrade MDFCD, Signorini DH, Eyer-Silva WDA. What should we know about metabolic syndrome and lipodystrophy in AIDS? Rev Assoc Med Bras (1992) 2012. [DOI: 10.1016/s0104-4230(12)70157-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Metabolic Syndrome and General Anesthesia Complications Síndrome metabólico y complicaciones durante anestesia general. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2012. [DOI: 10.1097/01819236-201240020-00002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Pontes Signorini DJH, Miranda Monteiro MC, de Andrade MDFC, Signorini DH, Eyer-Silva WDA. What should we know about metabolic syndrome and lipodystrophy in AIDS? Rev Assoc Med Bras (1992) 2012. [DOI: 10.1590/s0104-42302012000100017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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