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Multiple Factors Predict Metabolic Syndrome in Women With HIV
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Mark Mascolini
XVI International AIDS Conference, Toronto
August 17, 2006
Taking d4T, having a higher CD4 count or a higher viral load, smoking, and weighing more all independently raised the risk of metabolic syndrome in US women with HIV infection [1]. Light to moderate drinking and taking nevirapine lowered the risk of the syndrome, which is marked by a wide waist, abnormal lipids, hypertension, and glucose irregularities.
This analysis of 668 HIV-infected and 1726 uninfected women by the Women's Interagency HIV Study (WIHS) traced higher metabolic syndrome rates in the HIV group mainly to out-of-line lipids.
WIHS regularly monitors a cohort of women with or at risk of HIV infection at six inner-city sites across the United States. The current analysis involved women who gave one or more fasting blood samples between October 2000 and October 2004.
While 22% of women without HIV met the study definition of metabolic syndrome, 33% of the HIV group did, a highly significant difference (P < 0.0001). The same proportion in the HIV and non-HIV groups, 42%, had a waist circumference above 88 cm, and similar proportions (18% with HIV and 19% without HIV) had an elevated fasting glucose. The HIV group had higher rates of triglycerides above 150 mg/dL (35% versus 16%), "good" high-density lipoprotein cholesterol below 50 mg/dL (63% versus 40%), and high blood pressure (32% versus 26%) (P < 0.0001 for the last three comparisons).
Multivariate analysis determined that numerous variables independently affected the risk of metabolic syndrome in women with HIV. On the plus side, light drinking of alcohol lowered the risk 19% (P = 0.05) and moderate drinking lowered the risk 38% (P < 0.05). Compared with antiretroviral-naive women, those who took nevirapine had a 25% lower risk of metabolic syndrome (P < 0.05). Ritonavir-boosted protease inhibitors had no impact on syndrome risk.
Treatment with d4T, on the other hand, raised the metabolic syndrome risk 29% compared with women who never took antiretrovirals (P < 0.05). Compared with black women, whites had a 90% higher risk and Hispanics a 50% higher risk (P < 0.0001 for both comparisons). Current smokers had a 29% higher risk (P < 0.05) than women who never smoked, but risk did not differ between women who quit smoking and those who never smoked.
Higher weight, measured as body mass index, inexorably inflated the risk of metabolic syndrome. Compared with women whose body mass index lay below 20 kg/m2, those at 21 to 25 kg/m2 had an 80% higher risk (P < 0.05), those at 26 to 30 kg/m2 had an 8.1 times higher risk (P < 0.0001), and those above 30 kg/m2 had a 28.3 times higher risk (P < 0.0001).
Both a higher CD4 count and a higher viral load made the metabolic syndrome more likely. A T-cell count above 350 cells/mm3 upped the risk 20% (P = 0.05). While a load of 10,001 to 50,000 copies/mL boosted the risk 20% (P = 0.05), a load above 50,000 copies/mL made the metabolic syndrome 36% more likely (P < 0.05).
Reference
1. Sobieszczyk ME, Hoover DR, Anastos K, et al. Prevalence and predictors of metabolic syndrome among HIV-positive and negative women. XVI International AIDS Conference. August 13-18. Toronto. Abstract WEPE0147.
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