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Open Access Highly Accessed Research article

Impact of Lipodystrophy on the prevalence and components of metabolic syndrome in HIV-infected patients

Paula Freitas1*, Davide Carvalho1, Selma Souto1, Ana Cristina Santos2, Sandra Xerinda3, Rui Marques3, Esteban Martinez4, António Sarmento5 and José Luís Medina1

Author Affiliations

1 Endocrinology, Diabetes and Metabolism Department of Centro Hospitalar São João, E.P.E., University of Porto Medical School, Alameda Hernani Monteiro, 4200 - 319 Porto, Portugal

2 Clinical Epidemiology, Predictive Medicine and Public Health Department, University of Porto Medical School, Porto, Portugal and University of Porto Institute of Public Health, Alameda Hernani Monteiro, 4200 - 319 Porto, Portugal

3 Infectious Disease Department of Centro Hospitalar São João, E.P.E., Alameda Hernani Monteiro, 4200 - 319 Porto, Portugal

4 Infectious Diseases Department, Hospital Clinic, University of Barcelona, C/Villarroel 170, Barcelona 08036, Spain

5 Infectious Disease Department of Centro Hospitalar São João, E.P.E, University of Porto Medical School, Alameda Hernani Monteiro, 4200 - 319 Porto, Portugal

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BMC Infectious Diseases 2011, 11:246  doi:10.1186/1471-2334-11-246

Published: 20 September 2011

Abstract

Background

In HIV-infected patients, combination antiretroviral therapy (cART) is associated with clinical lipodystrophy (CL) and metabolic abnormalities (MA). This study aimed to evaluate the prevalence of the metabolic syndrome (MS) and its components, and to determine whether patients with or without CL had a different prevalence of MA.

Methods

We evaluated 345 HIV-infected patients on cART using two different MS definitions (NCEP-ATPIII-2005 and IDF-2005) and the Framingham risk score.

Results

CL was present in 58.7% of the patients. The prevalence of the MS was 52.2% (ATPIII) and 43.2% (IDF), and it was not significantly different between patients with (W) or without (WT) CL, regardless of the definition used (ATPIII WCL 52.9% vs WT CL 51.1%; p = 0.738; IDF WCL 41.3% vs WTCL 46.0%; p = 0.379). Moderate concordance was observed between the 2 definitions (kappa = 0.484; p < 0.001) and after gender stratification there was good concordance in women (kappa = 0.759; p < 0.001). Patients with CL had lower waist circumference and HDL-C and higher triglycerides levels. In women, CL was significantly associated with MS, hypertriglyceridemia and low HDL cholesterol independently of age, cART and BMI. Patients with CL had a significantly higher risk of coronary heart disease at 10 years, measured by the Framingham risk score, than patients without CL. Those with CL and with MS had higher frequencies of moderate and high risk categories than those without MS.

Conclusions

The prevalence of the MS was high in these HIV-infected patients with an age average of 40 years and this finding could explain why HIV patients have an increased risk for cardiovascular disease (CVD).

Keywords:
Metabolic syndrome; Cardiovascular Risk; Lipodystrophy; HIV infection