Metabolic Syndrome, Diabetes, and Cardiovascular Risk in HIV
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HIV infection and its treatment have been associated with adipose tissue changes and disorders of glucose and lipid metabolism. The proportion of HIV-infected adults over the age of 50 is also growing placing HIV-infected adults at particular risk for metabolic perturbations and cardiovascular disease. The metabolic syndrome in HIV-infected adults has been increasingly studied but whether HIV is associated with greater risk remains unclear, likely because of the interplay of host, viral and antiretroviral factors that are associated with the components of the metabolic syndrome. The relationship between HIV and diabetes mellitus (DM) risk has also been debated. While the Framingham Risk Score is a well-accepted measure of 10-year cardiovascular risk in the general population, it may not accurately predict risk in the HIV setting due to HIV-related factors such as inflammation that are not accounted for. We summarize the recent literature on metabolic syndrome, DM, and cardiovascular risk in HIV-infected adults.
KeywordsHIV Metabolic syndrome Diabetes Cardiovascular risk Framingham risk score Lipodystrophy syndrome
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Conflict of Interest
Linda M. Nix declares that she has no conflict of interest.
Phyllis C. Tien reports grants from NIH, personal fees from BMS, personal fees from Genentech, and personal fees from Gilead outside the submitted work.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: •• Of major importance
- 8.Smith G. Statement of Senator Gordon H. Smith. Aging Hearing. HIV over fifty: exploring the new threat. Washington, DC: Senate Committee on Aging; 2005.Google Scholar
- 9.Reaven GM. Banting lecture 1988. Role Insulin Resist Hum Dis Diabetes. 1988;37(12):1595–607.Google Scholar
- 12.Grundy SM, Hansen B, Smith Jr SC, et al. Clinical management of metabolic syndrome: report of the American Heart Association/National Heart, Lung, and Blood Institute/American Diabetes Association conference on scientific issues related to management. Circulation. 2004;109(4):551–6.PubMedCrossRefGoogle Scholar
- 30.Worm SW, Sabin CA, Reiss P, et al. Presence of the metabolic syndrome is not a better predictor of cardiovascular disease than the sum of its components in HIV-infected individuals: data collection on adverse events of anti-HIV drugs (D:A:D) study. Diabetes Care. 2009;32(3):474–80.PubMedCentralPubMedCrossRefGoogle Scholar
- 36.Vu CN, Ruiz-Esponda R, Yang E, et al. Altered relationship of plasma triglycerides to HDL cholesterol in patients with HIV/HAART-associated dyslipidemia: further evidence for a unique form of metabolic syndrome in HIV patients. Metab Clin Exp. 2013;62(7):1014–20.PubMedCentralPubMedCrossRefGoogle Scholar
- 42.••Rasmussen LD, Mathiesen ER, Kronborg G, Pedersen C, Gerstoft J, Obel N. Risk of diabetes mellitus in persons with and without HIV: a Danish nationwide population-based cohort study. PLoS One. 2012;7(9):e44575. Large population based study of DM risk in HIV-infected adults and uninfected adults that found higher DM risk in HIV in the period 1996-1998, but lower risk in the period 1999-2010 suggesting that newer ART might be less metabolically toxic.PubMedCentralPubMedCrossRefGoogle Scholar
- 43.Brar I, Shuter J, Thomas A, Daniels E, Absalon J. A comparison of factors associated with prevalent diabetes mellitus among HIV-Infected antiretroviral-naive individuals versus individuals in the National Health and Nutritional Examination Survey cohort. J Acquir Immune Defici Syndr (1999). 2007;45(1):66–71.CrossRefGoogle Scholar
- 46.Tien PC, Schneider MF, Cox C, Karim R, Cohen M, Sharma A, et al. Association of HIV Infection with incident diabetes mellitus: impact of using hemoglobin A1C as a criterion for diabetes. J Acquir Immune Defic Syndr. 2012;61(3):334–40.Google Scholar
- 47.Tripathi A, Liese AD, Jerrell JM, et al. Incidence of diabetes mellitus in a population-based cohort of HIV-infected and non-HIV-infected persons: the impact of clinical and therapeutic factors over time. Diabet Med: J Br Diabet Assoc. 2014.Google Scholar
- 51.ADA. Diagnosis and Classification of diabetes mellitus. Diabetes Care. 2010;33(1S):S62–69S.Google Scholar
- 56.Third Report of the National Cholesterol Education Program (NCEP). Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002;106(25):3143–421.Google Scholar
- 57.Lichtenstein KA, Armon C, Buchacz K, et al. Provider compliance with guidelines for management of cardiovascular risk in HIV-infected patients. Prev Chron Dis. 2013;10:E10.Google Scholar
- 59.••Freiberg MS, Chang CC, Kuller LH, et al. HIV infection and the risk of acute myocardial infarction. JAMA Int Med. 2013;173(8):614–22. Large study of U.S. based-veterans that found that HIV infection is associated with a 50% greater risk of acute myocardial infection even after controlling for Framingham risk factors, comorbidities, and substance use.CrossRefGoogle Scholar
- 63.••Mateen FJ, Post WS, Sacktor N, et al. Long-term predictive value of the Framingham Risk Score for Stroke in HIV-positive vs HIV-negative men. Neurology. 2013;81(24):2094–102. Large prospective observational cohort study of men from the Multicenter AIDS Cohort Study that found that HIV-uninfected men had a higher 10-year FRS-Stroke score (FRS-S) than HIV-infected men, but HIV-infected had two-fold higher incidence of first-ever strokes and were on average younger than the HIV-uninfected men who had first-ever strokes.PubMedCentralPubMedCrossRefGoogle Scholar