MetS may develop in people living with HIV on combination ART

People living with HIV (PLHIV) who had ever taken combination antiretroviral therapy (cART) may be at a higher risk of metabolic syndrome (MetS), according to a recent Singapore study.

“MetS is common in PLHIV, and it is expected that the prevalence will increase with progressive ageing of the HIV positive population,” the researchers said. “Regular monitoring and assessment of metabolic components, surveillance of drug effects, and behavioural interventions are needed to optimize management and prevention of metabolic disorders in PLHIV.”

Drawing from the Clinical HIV Programme of the National Centre for Infectious Diseases in Singapore, a total of 2,231 PLHIVs were enrolled in the study. All participants were at least 18 years of age, cART-experienced, and were seeking follow-up between 2015 and 2017.  MetS was defined as having three or more of the following conditions: hypertriglyceridaemia, high-density lipoprotein (HDL) hypocholesterolaemia, obesity, hypertension, and diabetes.

Majority of the participants were men (93.9 percent) and of Chinese ethnicity (78.0 percent). Sexual exposure (96.5 percent) was the main mode of HIV transmission. Most patients (95.1 percent) were not virologically suppressed, with >200 copies/mL. Median cART duration was 68 months.

Metabolic abnormalities were prevalent: 68.8 percent of participants had at least one and 1.0 percent had all five MetS components. HDL hypocholesterolaemia was the most common abnormality, which was present in 60.2 percent of the participants. This was followed by hypertriglyceridaemia in 45.5 percent. [PLoS One 2021;16:e0252320]

MetS—the concomitant presence of any three components—was detected in 23.6 percent (n=526) of the participants; all of them had HDL hypocholesterolaemia, 91.3 percent had hypertriglyceridaemia, and 90.7 percent had hypertension.

Compared those without the condition, PLHIVs with MetS were more likely to have been exposed to protease inhibitors (33.5 percent vs 27.1 percent; p=0.006). Duration of cART was also significantly longer among those with MetS (median 86.0 vs 62.0 months; p<0.0005).

When looking at the different subclasses, use of both nucleoside reverse transcriptase inhibitors (NRTIs; 85.2 vs 60.4 months; p<0.0005) and non-NRTIs (68.5 vs 51.3 months; p<0.0005) was significantly longer in PLHIVs with MetS.

“We estimated that nearly one-quarter of treatment-experienced PLHIV on follow-up for HIV care in 2015–2017 had MetS,” the researchers said, suggesting that the “longer life expectancy of PLHIV and long-term use of cART have raised the concern of increased cardiovascular risk.”

Nevertheless, several study limitations warrant close inspection. For instance, its single-centre design may mean that its sample may not have been representative of the whole PLHIV population in the country, limiting the generalizability of its results. Important information that may also affect MetS risk—such as smoking and alcohol drinking, physical activity, and diet—are unavailable in the clinical database and missing from the present analysis.