DOI: http://dx.doi.org/10.18203/2319-2003.ijbcp20172719

Prevalence of obesity, hypertension and metabolic abnormalities in patients receiving long term cART: a case control study from South India

Vasudeva Acharya, Govind Gangadharan

Abstract


Background: Combination antiretroviral therapy (cART) has improved the quality of life and survival of HIV-infected individuals. However, the long term intake of these drugs is associated with multiple metabolic abnormalities eventually leading to increased risk for cardiovascular morbidity and mortality.

Methods: Forty five HIV-infected individuals who are on cART having CD4+ cell count of >200 cells/mm3 for at least 2 years were recruited as cases. Age and gender matched, otherwise healthy individuals were taken as controls. Both cases and controls were compared for the prevalence of obesity, abdominal obesity, hypertension, diabetes mellitus and lipid abnormalities.

Results: We found higher prevalence of obesity (33.3% vs 26.7%), abdominal obesity (33.3% vs 17.8%), hypertension (33.3% vs 20%), impaired fasting glucose (IFG) (37.7% vs 8.9%), diabetes mellitus (26.7% vs 24.4%), high total cholesterol (33.3% vs 22.2%) and low HDL cholesterol (60% vs 46.7%) among cases compared to controls. The statistically significant difference was noted only for IFG (cases = 17, 37.7%, controls = 4, 8.9%, p value = 0.002). Low HDL cholesterol was the most common metabolic abnormality found in 27 (60%) cases and 21 (46.7%) controls.

Conclusions: HIV-infected individuals receiving long term cART have higher prevalence of obesity, hypertension and dysregulations in glucose and lipid metabolism compared to general population and hence, the diagnosis and management of these abnormalities is very important to prevent cardiovascular morbidity and mortality.


Keywords


Combination antiretroviral therapy, Diabetes mellitus, HIV infection, Hypertension, Metabolic disorders

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References


Wand H, Calmy A, Carey DL, Samaras K, Carr A, Law MG, et al. Metabolic syndrome, cardiovascular disease and type 2 diabetes mellitus after initiation of antiretroviral therapy in HIV infection. AIDS. 2007;21(18):2445-53.

Jacobson DL, Tang AM, Spiegelman D, Thomas AM, Skinner S, Gorbach SL, et al. Incidence of metabolic syndrome in a cohort of HIV-infected adults and prevalence relative to the US population (National Health and Nutrition Examination Survey). J Acquir Immnune Defic Syndr. 2006;43(4):458-66.

Jerico C, Knobel H, Montero M, Ordonez-Llanos J, Guelar A, Gimeno JL, et al. Metabolic syndrome among HIV-infected patients: prevalence, characteristics and related factors. Diabetes Care. 2005;28(1):132-7.

Gazzaruso C, Sacchi P, Garzaniti A, Fratino P, Bruno R, Filice G. Prevalence of metabolic syndrome among HIV patients. Diabetes Care. 2002;25(7):1253-4.

Nsagha DS, Weledji EP, Assob NJ, Njunda LA, Tanue EA, Kibu OD, et al. Highly active antiretroviral therapy and dyslipidemia in people living with HIV/AIDS in Fako division, South West region of Cameroon. BMC Cardiovasc Disord. 2015;15:95.

Abede M, Kinde S, Belay G, Gebreegziabxier A, Challa F, Gebeyehu T, et al. Antiretroviral treatment associated hyperglycemia and dyslipidemia among HIV infected patients at Burayu Health Center, Addis Ababa, Ethiopia: a cross sectional comparative study. BMC Res Notes. 2014;7:380.

Mayanja BN, Kasamba I, Levin J, Namakoola I, Kazooba P, Were J, et al. COHORT Profile: The complications of Long-Term Antiretroviral Therapy study in Uganda (CoLTART). A prospective clinical cohort. AIDS Res Ther. 2017;14:26

Prioreschi A, Munthali RJ, Soepnel L, Goldstein JA, Micklesfield LK, Aronoff DM, et al. Incidence and prevalence of type 2 diabetes mellitus with HIV infection in Africa: A systematic review and meta-analysis. BMJ Open. 2017;7(3):e013953.

Enas EA, Singh V, Munjal YP, Gupta R, Patel KC, Bhandari S, et al. Recommendations of the second Indo-US health summit on prevention and control of cardiovascular disease among Asian Indians. Indian Heart Journal. 2008 Dec;61(3):265-74.

Pallela FJ, Phair JP. Cardiovascular disease in HIV infection. Curr Opin HIV AIDS. 2011;6(4):266-71.

Kaplan RC, Kingsley LA, Gange SJ, Benning L, Jacobson LP, Lazar J, et al. Low CD+ T cell count as a major atherosclerosis risk factor in HIV-infected women and men. AIDS. 2008;22(13):1615-24.

Bradbury RA, Samaras K. Antiretroviral therapy and the human immunodeficiency virus-improved survival but at what cost? Diabetes Obes Metab. 2008;10:442-50.

Bergersen BM, Sandvik L, Dunlop O, Birkeland K, Bruun JN. Prevalence of hypertension in HIV-positive patients on highly active retroviral therapy (HAART) compared with HAART-naive and HIV-negative controls: results from a Norwegian study of 721 patients. Eur J Clin Microbiol Infect Dis. 2003;22(12):731-6.

Calza L, Colangeli V, Maqistrelli E, Rossi N, Roselli Del Turco E, et al. Prevalence of metabolic syndrome in HIV infected patients naïve to antiretroviral therapy or receiving a first line treatment. HIV Clin Trials. 2017;19:1-8.

Hernandez-Romieu AC, Garg S, Rosenberg ES, Thompson-Paul AM, Skarbinski J. Is diabetes prevalence higher among HIV-infected individuals compared with the general population? Evidence from MMP and NHANES 2009-2010. BMJ Open Diabetes Res Care. 2017;5(1):e 000304.