The assessment of metabolic syndrome in UK patients with HIV using two different definitions: CREATE 2 study

Abstract

Objective:

To determine the prevalence and clinical associations of the metabolic syndrome (M-IRS) in an HIV cohort.

Methods and design:

Data was collected prospectively on demographics, anthropometry, HIV disease, drug regimens and cardiometabolic risk factors using a two-centre cross-sectional cohort study design. M-IRS was diagnosed by National Cholesterol Education Program (NCEP) and International Diabetes Federation (IDF) criteria.

Results:

The prevalence of M-IRS in 678 subjects was 14% by NCEP and 10% by IDF. One feature of the M-IRS was present in 68%, while 37% had two or more features. Increased waist circumference was found in 32% by NCEP or by IDF criteria, hypertriglyceridaemia in 32%, reduced HDL-C in 27%, 18% had raised systolic blood pressure and 13% had dysglycaemia. Protease inhibitor (PI) usage was similar in both M-IRS categories (43 vs. 38%; p = 0.38) but increased use of efavirenz was seen in M-IRS (47 vs. 36%; p = 0.07) and nevirapine in the non-M-IRS groups (10 vs. 20%; p = 0.05). Multiple drug therapies were associated with raised triglyceride levels while nevirapine therapy was associated with raised HDL-C and abacavir with dysglycaemia.

Conclusions:

The prevalence of M-IRS in this HIV cohort was similar to the general population and independent of current or previous highly active antiretroviral therapy (HAART) or its duration. Given the relationship between individual drugs and features of M-IRS its significance must be interpreted in the light of probable accrual bias in prescribing. Prospective studies are required to ascertain the cardiometabolic risk factors to include in a prognostically useful HIV disease-specific definition of M-IRS.

Key words::

• Cardiovascular risk
• Diabetes
• Guideline
• HIV
• Insulin resistance
• Metabolic syndrome

Transparency

Declaration of funding

This study was supported by unrestricted educational grants of equal value from Abbott, Gilead, Roche and Tibotec Pharmaceuticals.

Declaration of financial/other relationships

B.S.P. has disclosed that he has sat as a consultant on advisory boards for Abbott, GlaxoSmithKline and Tibotec Pharmaceuticals. A.S.W. has disclosed that he has received grant support, lecture honoraria and travel grants from Abbott, AstraZeneca, Fournier-Solvay, Gilead, GlaxoSmithKline, Merck kGA, Merck-Sharp & Dohme, Roche, Pfizer, sanofi-aventis and Takeda pharmaceuticals.

Some peer reviewers receive honoraria from CMRO for their review work. One peer reviewer of this paper disclosed that he/she has received support over the past 12 months from NovoNordisk, Lilly, sanofi-aventis, Bristol Myers-Squibb and Takeda.

Acknowledgment

The authors have disclosed that they had no outside editorial assistance in preparing this manuscript.