Prevalence of metabolic syndrome in HIV-infected patients naive to antiretroviral therapy or receiving a first-line treatment

Figures & data

Table 1 Sociodemographic, clinical, and laboratory characteristics of the 586 enrolled patients stratified by the antiretroviral therapy status

	All patients	cART-naive patients	On cART patients	p value*
	(n = 586)	(n = 98)	(n = 488)
Males [No. (%)]	479 (81.7)	82 (83.7)	397 (81.3)	0.667
Mean age [years (SD)]	45.2 (17.4)	44.1 (15.9)	46.7 (18.5)	0.529
white race [No. (%)]	564 (96.2)	92 (93.9)	472 (96.7)	0.409
Current smokers [No. (%)]	349 (59.6)	55 (56.1)	294 (60.2)	0.094
Mean duration of HIV infection [years (SD)]	8.3 (2.4)	3.8 (1.4)	9.2 (2.9)	0.021
Mean nadir CD4 T lymphocyte count [cells/mm^3 (SD)]	372 (159)	547 (208)	235 (109)	<0.001
Mean current CD4 T lymphocyte count [cells/mm^3 (SD)]	437 (231)	589 (251)	648 (294)	<0.001
Patients with plasma HIV RNA <50 copies/mL [No. (%)]	480 (81.9)	9 (9.2)	471 (96.5)	0.66
Mean current plasma HIV RNA in patients with detectable viremia [log10 copies/mL (SD)]	3.66 (0.38)	4.34 (0.56)	3.42 (0.21)	0.032
Mean zenit plasma HIV RNA [log10 copies/mL (SD)]	4.97 (0.98)	4.89 (0.82)	5.04 (0.95)	0.064
HIV stage [No. (%)]
Asymptomatic	383 (65.3)	98 (100)	285 (58.4)	<0.001
Symptomatic non-AIDS	147 (25.1)	0	147 (30.1)	<0.001
AIDS	56 (9.6)	0	56 (11.5)	<0.001
Patients treated with [No. (%)]:
2 NRTIs + 1 NNRTI	219 (37.4)	0	219 (44.9)	n.a.
2 NRTIs + 1 PI	167 (28.5)	0	167 (34.2)	n.a.
2 NRTIs + 1 INSTI	102 (17.4)	0	102 (20.9)	n.a.
Mean duration of antiretroviral therapy in patients on cART [years (SD)]	4.3 (1.9)	0	4.3 (1.9)	n.a.
Patients with lipodystrophy syndrome [No. (%)]:	90 (15.3)	6 (6.1)	84 (17.2)	0.721
Fat loss	4 (0.7)	1 (1)	3 (0.6)	0.897
Fat accumulation	86 (14.7)	5 (5)	81 (16.6)	0.721
Patients with chronic HCV infection [No. (%)]	45 (7.7)	8 (8.2)	37 (7.6)	0.365
Patients with chronic HBV infection [No. (%)]	13 (2.2)	1 (1)	12 (2.5)	0.188
Mean total cholesterol [mg/dL (SD)]	221 (51)	188 (43)	227 (58)	0.018
Mean HDL cholesterol [mg/dL (SD)]	43 (9)	48 (8)	41 (11)	0.044
Mean LDL cholesterol [mg/dL (SD)]	131 (35)	112 (27)	138 (39)	0.019
Mean triglycerides [mg/dL (SD)]	244 (87)	207 (81)	256 (93)	0.006
Mean glucose [mg/dL (SD)]	94 (36)	92 (38)	95 (32)	0.068
Mean systolic blood pressure [mmHg (SD)]	126 (25)	122 (29)	127 (24)	0.074
Mean diastolic blood pressure [mmHg (SD)]	76 (16)	74 (14)	78 (18)	0.118
Mean waist circumference [cm (SD)]	87.1 (16.3)	84.2 (15.8)	88.7 (17.6)	0.039
Mean BMI [kg/m^2 (SD)]	24.1 (6.4)	23.8 (5.9)	24.4 (5.6)	0.067

Values are presented as mean + standard deviation (SD) and frequency (%).

* p value defines the level of significance in the comparison between cART naive and on cART patients.

cART, combination antiretroviral therapy; NRTIs, nucleoside reverse transcriptase inhibitors; NNRTIs, non-nucleoside reverse transcriptase inhibitors; PIs, protease inhibitors; n.a., not applicable; HCV, hepatitis C virus; HBV, hepatitis B virus; HDL, high-density lipoprotein; LDL, low-density lipoprotein; BMI, body mass index.

Table 2 Prevalence of metabolic syndrome diagnosed by the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATPIII) or by the International Diabetes Federation (IDF) criteria and prevalence of its clustering components among the 586 enrolled patients stratified by the antiretroviral therapy status

	All patients	cART-naive patients	On cART patients	p value*
	(n = 586)	(n = 98)	(n = 488)
Metabolic syndrome diagnosed by the
NCEP ATPIII criteria [No. (%)]	109 (18.6)	7 (7.1)	102 (20.9)	0.014
IDF criteria [No. (%)]	94 (16)	5 (5.1)	89 (18.2)	0.005
Diagnostic criteria:
0 [No. (%)]	125 (21.3)	36 (36.7)	89 (18.2)	0.022
1 [No. (%)	205 (35)	39 (39.8)	166 (34)	0.041
2 [No. (%)]	147 (25.1)	16 (16.3)	131 (26.8)	0.009
>2 [No. (%)]	109 (18.6)	7 (7.1)	102 (20.9)	0.014
Increased waist circumference [No. (%)]	100 (17.1)	7 (7.1)	93 (19.1)	<0.001
Increased blood pressure [No. (%)]	112 (19.1)	16 (16.3)	96 (19.7)	0.088
High triglycerides [No. (%)]	234 (39.9)	18 (18.4)	216 (44.3)	<0.001
Low HDL cholesterol [No. (%)]	215 (36.7)	14 (14.3)	201 (41.1)	<0.001
High glucose [No. (%)]	57 (9.7)	8 (8.1)	49 (10)	0.062

Values are presented as frequency (%).

* p value defines the level of significance in the comparison between cART naive and on cART patients.

cART, combination antiretroviral therapy; NCEP ATPIII, National Cholesterol Education Program Adult Treatment Panel III; IDF, International Diabetes Federation; HDL, high-density lipoprotein.

Table 3 Univariate and multivariate logistic regression analysis assessing predictors of metabolic syndrome

Variables	Univariate analysis		Multivariate analysis
	OR (95% CI)	p value	OR (95% CI)	p value
Age >55 years	1.29 (1.09 to 1.57)	0.033	1.23 (0.87 to 1.51)	0.058
Duration of HIV infection >5 years	2.81 (2.18 to 3.66)	0.004	2.95 (2.33 to 4.07)	0.029
AIDS diagnosis	0.98 (0.74 to 1.28)	0.072
Current CD4 T lymphocytes <200 cells/mm^3	1.09 (0.73 to 1.55)	0.086
Nadir CD4 T lymphocytes <200 cells/mm^3	2.35 (1.87 to 2.94)	0.011	2.27 (1.73 to 2.79)	0.037
Current HIV RNA >100,000 copies/mL	1.12 (0.81 to 1.38)	0.418
Zenit HIV RNA >100,000 copies/mL	1.02 (0.71 to 1.68)	0.275
Chronic HCV infection	1.14 (0.81 to 1.56)	0.311
BMI >25 kg/m^2	3.45 (2.88 to 4.26)	<0.001	3.61 (2.79 to 4.17)	0.008
Smoking	1.42 (0.91 to 1.89)	0.069
Lipodystrophy	1.37 (0.92 to 1.78)	0.288
Duration of cART >3 years	3.56 (2.74 to 4.11)	<0.001	3.44 (2.62 to 3.89)	<0.001
Current use of:
Tenofovir	1.13 (0.83 to 1.49)	0.408
Abacavir	0.94 (0.53 to 1.34)	0.322
One NNRTI	0.86 (0.52 to 1.27)	0.165
Rilpivirine	0.73 (0.43 to 0.92)	0.084
Efavirenz	0.94 (0.77 to 1.42)	0.288
One PI	1.76 (1.21 to 2.23)	0.045	1.85 (1.38 to 2.49)	0.041
Darunavir/ritonavir	1.82 (1.17 to 2.39)	0.004	1.89 (1.27 to 2.55)	0.014
Atazanavir/ritonavir	1.56 (1.04 to 1.89)	0.041	1.61 (1.13 to 1.97)	0.039
One INSTI	0.61 (0.37 to 0.92)	0.040	0.55 (0.29 to 0.86)	0.037
Raltegravir	0.56 (0.31 to 0.87)	0.026	0.51 (0.22 to 0.78)	0.017
Elvitegravir/cobicistat	0.78 (0.44 to 1.09)	0.064
Dolutegravir	0.67 (0.42 to 0.98)	0.046	0.77 (0.49 to 1.07)	0.061

Note: OR, odds ratio; 95% CI, 95% confidence interval; AIDS, acquired immune deficiency syndrome; BMI, body mass index; cART, combination antiretroviral therapy; HCV, hepatitis C virus; NNRTI, non nucleoside reverse transcriptase inhibitor; PI, ritonavir-boosted protease inhibitor; INSTI, integrase strand transfer inhibitor.