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.
Highlights
Metabolic syndrome, a syndrome of dyslipidemia, insulin resistance, and abdominal obesity, has long been recognized as an important metabolic complication associated with human immunodeficiency virus (HIV) disease and its treatment
The adjusted hazard ratio for metabolic syndrome was 0.65 prior to 36 months of follow-up ( p = 0.21), and 2.31 after 36 months of follow-up ( p = 0.02). This is the first study to explore the impact of metabolic syndrome and its individual criteria on all-cause mortality in an HIV-infected population
We found that when mortality was examined as a function of the time of follow-up, metabolic syndrome and high triglycerides were both associated with an increased risk of death after 36 months of follow-up
Summary
A syndrome of dyslipidemia, insulin resistance, and abdominal obesity, has long been recognized as an important metabolic complication associated with human immunodeficiency virus (HIV) disease and its treatment. Many studies have reported a high prevalence of metabolic syndrome in HIV-infected populations from different countries, ranging between 18–52.2%.1–6. In HIVnegative populations, metabolic syndrome has been shown to increase the risk of cardiovascular events, cardiovascular mortality, and all-cause mortality.[7,8,9,10,11,12,13] The potential health impact of metabolic syndrome on HIV-infected populations is not as clearly understood. Studies have shown that HIV-infected patients with metabolic syndrome are more likely to have subclinical carotid artery atherosclerosis, a surrogate marker of cardiovascular disease, than those without metabolic syndrome.[14,15,16] there have been few published reports to date that have explored the impact of metabolic syndrome on mortality in HIV-infected populations
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