Metabolic Syndrome in HIV- Infected Patients from MTCT-Plus, Thai Outpatient Population J. JANTARAPAKDE1,2,*, C. CHATURAWIT1,2, S. PENGNONYANG1,2, W. PIMA1, S. TEERATAKULPISARN1, N. PHANUPHAK1, P. PHANUPHAK1 Abstract no. A [1]Thai Red Cross AIDS Research Centre, Bangkok, Thailand, [2]Thai-Australian Collaboration In HIV Nutrition (TACHIN), Bangkok, Thailand * Corresponding author

Background The ‘metabolic syndrome’ is a group of risk factors for development of cardiovascular diseases (CVD) and type 2 diabetes. HIV infection itself and the use of highly active anti-retroviral therapy (HAART) are associated with these risk factors. With the increasing life expectancy of HIV-infected patients, many countries will face the problems of how to best screen and manage these risk factors to prevent unnecessary long- term morbidities and mortalities related to CVD.

Methods Metabolic syndrome was defined as having  3 of the following 5 components: abdominal obesity (men ≥ 90 cm, women ≥ 80 cm), hypertriglyceridemia (≥150 mg/dl), low HDL (men < 40 mg/dl, women < 50 mg/dl), high blood pressure ≥ 130/85 mmHg), and high fasting plasma glucose (FPG ≥ 100 mg/dl). Patients, aged  18 years, visited MTCT-Plus outpatient clinic during 1 January - 31 December 2008 were eligible for the study if they were screened for all 5 components. Patients who were referred to nutritionist/dieticians also had detailed diet and exercise data collection.

Results Among 206 patients included into the analyses, 24.3 % were men and 81.6% were receiving HAART (74.8% on nevirapine/ efavirenz- based regimens). Mean age was 34.1 years. High BMI was found in 38.3%. Among 156 women, 46.8% had abdominal obesity, 30.1% had low-HDL cholesterol, 17.9% had hypertriglyceridemia, 4.5% had high blood pressure, and 7.1% had hyperglycemia.The numbers were 18.0%, 28.0%, 48%, 28%, and 16%, respectively in men.

Results Prevalence of metabolic syndrome Risk factors of metabolic syndrome by multivariate logistic regression were CD4  350 cell/mm3 (OR = 4.4 [95% CI ], P = 0.05), HDL cholesterol < 45 mg/dl (OR = 6.4 [95% CI = 2.0-=20.6], P < 0.01) and BMI  23 kg/m2 (OR = 6.2 [95% CI = ], P = < 0.01). The prevalence of metabolic syndrome was 8.7%. Interestingly, 31.1% had at least two features of metabolic syndrome.

Results Prevalence of metabolic syndrome risk factor (%) Abdominal obesity High TGLow HDLHigh BPHigh FBS Figure 1 CD4 level and prevalence of metabolic syndrome risk factor Total CD4<350 CD4  350

Results Low HDLHigh BPHigh FBS Abdominal obesity Prevalence of metabolic syndrome risk factor (%) High TG Figure 2 BMI level and prevalence of metabolic syndrome risk factor BMI < 23 BMI  23 Total

Results Dietary intake and exercise Among 48 patients with available data on diet and exercise, 85.4% had no exercise, 33.3% had high energy intake, 64.6% had high carbohydrate intake, 37.5% had low protein intake and 68.7% had high fat intake. In Univariate logistic regression, those with metabolic syndrome do not have significant correlation with exercise, high energy intake or high carbohydrate, protein and fat intake. However, those with at least two features of metabolic syndrome have significant correlation with high fat intake (OR = 4.7 [95% CI = ], P = 0.04) but not with other factors.

Conclusion The prevalence of metabolic syndrome in Thai HIV-infected patients was not high as compared with Thai general population. However, the prevalence of low HDL, abdominal obesity, and hypertriglyceridemia was very high. Interventions should be given to reduce these risk factors and to screen for metabolic syndrome among those with risk factors such as high BMI, low HDL, and high CD4 count.