Metabolic abnormalities among HIV-infected patients: The rational of national health security for people living with HIV

Main Article Content

Duangjai Duangrithi
Khuntikun Polsracoo
Titiwut Bhuddhataweekul


HIV, HAART, metabolic syndrome, NRTIs, NNRTIs


In the era of highly active antiretroviral therapy (ART), traditional risk factors for metabolic syndrome are presented as increasing age. In low- and middle-income countries, the restricted benefit package of national health security for human immunodeficiency virus (HIV) does not facilitate the early detection of metabolic disorders. In order to assess the rational of national health security for metabolic abnormalities among people living with HIV (PLHIV), this retrospective study aims to determine the occurrence of metabolic abnormalities and its predicting factors. The study was approved by the hospital ethics committee and conducted at the internal medicine clinic, Pathum Thani Hospital, Thailand. Patients with HIV having had at least 1 year of first-line ART, and having their fasting glucose, fasting lipid profile, and blood pressure assessed before ART were recruited into the study. Those with any abnormal metabolic component prior to ART or absent history of ART were excluded. The metabolic abnormalities were defined as any of the following: elevated triglyceride, reduced high-density lipoprotein (HDL), elevated blood pressure, elevated fasting glucose, or on drug treatment for these metabolic abnormalities. The occurrence of metabolic abnormalities was found in 102 of 340 patients (30.0%). Hypertension (11.4%) was the most common abnormality. Age became the single predictor of metabolic abnormalities (odds ratio [OR] = 1.03, 95% confidence interval [CI] = 1.00–1.06). Aging patients with HIV should be the target group for monitoring and treating metabolic abnormalities. The revision of the benefit package on metabolic abnormalities is urgently needed to promote a better quality of life.
Abstract 1066 | PDF Downloads 255 HTML Downloads 155 XML Downloads 34


1. Global HIV & AIDS statistics -2018 fact sheet. (accessed on: February 24, 2020).

2. Global information and education on HIV and AIDS. HIV and AIDS in Thailand. https://www. (accessed on: February 24, 2020).

3. Country factsheets Thailand 2018. https://www. (accessed on: February 25, 2020).

4. Jacobson DL, Tang AM, Spiegelman D, et al. Incidence of metabolic syndrome in a cohort of HIV-infected adults and prevalence relative to the US population (National Health and Nutrition Examination Survey). J Acquir Immune Defic Syndr 2006;43(4):458–66. http://dx.doi. org/10.1097/01.qai.0000243093.34652.41

5. Kramer AS, Lazzarotto AR, Sprinz E, Manfroi WC. Metabolic abnormalities, antiretroviral therapy and cardiovascular disease in elderly patients with HIV. Arq Bras Cardiol 2009;93(5):519–26. http://

6. Gill J, May M, Lewden C, et al. Causes of death in HIV-1-infected patients treated with antiretroviral therapy, 1996–2006: Collaborative analysis of 13 HIV cohort studies. Clin Infect Dis 2010;50(10):1387–96.

7. Paula AA, Falcao MC, Pacheco AG. Metabolic syndrome in HIV-infected individuals: Underlying mechanisms and epidemiological aspects. AIDS Res Ther 2013;10:32.

8. Grunfeld C, Kotler DP, Arnett DK, et al. Contribution of metabolic and anthropometric abnormalities to cardiovascular disease risk factors. Circulation 2008;118:e20–8. http://dx.doi. org/10.1161/CIRCULATIONAHA.107.189623

9. Mbunkah HA, Meriki HD, Kukwah AT, et al. Prevalence of metabolic syndrome in human immunodeficiency virus – Infected patients from the South-West region of Cameroon, using the adult treatment panel III criteria. Diabetol Metab Syndr 2014;6(1):92.

10. Nguyen KA, Peer N, Mills EJ, Kengne AP. A meta-analysis of the metabolic syndrome preva-lence in the global HIV-infected population. PLoS One 2016;11(3):e0150970. journal.pone.0150970

11. World Health Organization. Updated recommen-dations on first-line and second-line antiretroviral regimens and post-exposure prophylaxis and recommendations on early infant diagnosis of HIV: Interim guidelines. Supplement to the 2016 consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. Geneva: World Health Organization, 2018. http:// (accessed on: December 27, 2019).

12. Butt AA, McGinnis K, Rodriguez-Barradas MC, et al. HIV Infection and the risk of diabetes mellitus. AIDS 2009;23(10):1227–34. http://dx.doi. org/10.1097/QAD.0b013e32832bd7af

13. Zou W, Berglund L. HIV and highly active antiretroviral therapy: Dyslipidemia, met-abolic aberrations, and cardiovascular risk. Prev Cardiol 2007;10(2):96–103. http://dx.doi. org/10.1111/j.1520-037X.2007.03071.x

14. Aberg JA, Gallant JE, Ghanem KG, et al. Primary care guidelines for the management of persons infected with HIV: 2013 update by the HIV medicine association of the Infectious Diseases Society of America. CID 2014;58:e1–34. http://dx.doi. org/10.1093/cid/cit665

15. Maggi1 P, Biagio AD, Rusconi S, et al. Cardiovascular risk and dyslipidemia among persons living with HIV: A review. BMC Infect Dis 2017;17:551. s12879-017-2626-z

16. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). 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 Dec;106(25):3143– 421.

17. Beer L, Mattson CL, Bradley H, et al. Understanding cross-sectional racial, ethnic, and gender disparities in antiretroviral use and viral suppression among HIV patients in the United States. Medicine (Baltimore) 2016;95(13):e317.

18. Teekawong C, Apidechkul T, Cassely M, Chansareewittaya K. Prevalence and factors associated with metabolic syndrome among HIV/AIDS infected patients who use ARV, Nan Province, 2015–2016. Siriraj Med J 2017;69(6):319–29.

19. Jantarapakde J, Phanuphak N, Chaturawit C, et al. Prevalence of metabolic syndrome among antiretroviral naive and antiretroviral-experienced HIV-1 infected Thai adults. AIDS Patient Care STDs 2014;28(7):331–40. apc.2013.0294

20. Alvarez C, Salazar R, Galindez J, et al. Metabolic syndrome in HIV-infected patients receiving antiretroviral therapy in Latin America. Braz J Infect Dis 2010;14(3):256–63. http://dx.doi. org/10.1016/S1413-8670(10)70053-2

21. Dohou H, Shm D, Codjo Hl, et al. Prevalence and factors associated with metabolic syndrome in people living with HIV in Parakou in 2016. SM Atheroscler J 2017;1(1):1005.

22. Wilson SE. Marriage, gender and obesity in later life. Econ Hum Biol 2012;10(4):431–53. http://dx.

23. Bhanushali CJ, Kumar K, Wutoh AK, et al. Association between lifestyle factors and metabolic syndrome among African Americans in the United States. J Nutr Metab 2013;2013:516475.

24. Park HS, Oh SW, Cho S-I, Choi WH, Kim YS. The metabolic syndrome and associated lifestyle factors among South Korean adults. Int J Epidemiol 2004;33(2):328–36. http://dx.doi. org/10.1093/ije/dyh032

25. Bosho DD, Dube L, Mega TA, et al. Prevalence and predictors of metabolic syndrome among people living with human immunodeficiency virus (PLHIV). Diabetol Metab syndr 2018;10:10. http://

26. Oh SW, Yoon YS, Lee ES, et al. Association between cigarette smoking and metabolic syndrome. Diabetes Care 2005;28(8):2064–6. http://

27. Slagter SN, van Vliet-Ostaptchouk JV, Vonk JM, et al. Combined effects of smoking and alcohol on metabolic syndrome: The LifeLines cohort study. PLoS One 2014;9(4):e96406. http://dx.doi. org/10.1371/journal.pone.0096406

28. Freiberg MS, Cabral HJ, Heeren TC, et al. Alcohol consumption and the prevalence of the metabolic syndrome in the U.S. Diabetes Care 2004;27(12):2954– 9.

29. Zabetian A, Hadaegh F, Sarbakhsh P, et al. Weight change and incident metabolic syndrome in Iranian men and women; a 3 year follow-up study. BMC Public Health 2009;9:138. http://dx.doi. org/10.1186/1471-2458-9-138

30. Fitch KV, Anderson EJ, Hubbard JL, et al. Effects of a lifestyle modification program in HIV-infected patients with the metabolic syndrome. AIDS 2006;20(14):1843–50. aids.0000244203.95758.db

31. Lichtenstein KA, Armon C, Buchacz K, et al. Low CD4+ T cell count is a risk factor for cardiovascular disease events in the HIV outpatient study. Clin Infect Dis 2010;51(4):435–47. http://dx.doi. org/10.1086/655144

32. Santiprabhob J, Tanchaweng S, Maturapat S, et al. Metabolic disorders in HIV-infected adolescents receiving protease inhibitors. BioMed Res Int 2017;2017(12):1–14. 7481597

33. Leitner JM, Pernerstorfer-Schoen H, Weiss A, et al. Age and sex modulate metabolic and cardiovascular risk markers of patients after 1 year of highly active antiretroviral therapy (HAART). Atherosclerosis 2006;187(1):177–85. http://dx.doi. org/10.1016/j.atherosclerosis.2005.09.001

34. Palacios R, Merchante N, Macias J, et al. Incidence of and risk factors for insulin resistance in treatment-naive HIV-infected patients 48 weeks after starting highly active antiretroviral therapy. Antivir Ther 2006;11(4):529–35.

35. Pendse R, Gupta S, Yu D, Sarkar S. HIV/AIDS in the South-East Asia region: progress and challenges. J Virus Erad 2016;2:1–6. http://dx.doi. org/10.1016/S2055-6640(20)31092-X

36. Jevtovic DJ, Dragovic G, Salemovic D, et al. The metabolic syndrome, an epidemic among HIV-infected patients on HAART. Biomed 2009;63(5):337–42.

37. Crane HM, Grunfeld C, Willig JH, et al. Impact of NRTIs on lipid levels among a large HIV-infected cohort initiating antiretroviral therapy in clinical care. Aids 2011;25(2):185–95. http://dx.doi. org/10.1097/QAD.0b013e328341f925

38. Abebe M, Kinde S, Belay G, et al. Antiretroviral treatment associated hyperglycemia and dyslipidemia among HIV infected patients at Burayu Health Center, Addis Ababa, Ethiopia: A cross-sectional comparative study. BMC Res Notes 2014;7:380.

39. Garcia-Benayas T, Rendon AL, Rodriguez-Novoa S, et al. Higher risk of hyperglycemia in HIV-infected patients treated with didanosine plus tenofovir. AIDS Res Hum Retroviruses 2006;22(4):333–7.

40. Husain NE, Noor SK, Elmadhoun WM, et al. Diabetes, metabolic syndrome and dyslipidemia in people living with HIV in Africa: Re-emerging challenges not to be forgotten. HIV/AIDS (Auckl) 2017;9:193–202. S137974

41. Okello S, Kanyesigye M, Muyindike WR, et al. Incidence and predictors of hypertension in adults with HIV-initiating antiretroviral therapy in southwestern Uganda. J Hypertens 2015;33(10):2039–45. http://

42. Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/ AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2019;139:e1082–143. http://

43. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in adults and adolescents living with HIV. Department of Health and Human Services. http:// AdolescentGL.pdf (accessed on: February 24, 2020).

44. International Association of Providers of AIDs Care, IAPAC Protocols for the Integrated Management of HIV and Noncommunicable Diseases. 2018. (accessed on: December 17, 2019).

45. Dube MP, Stein JH, Aberg JA, et al. Guidelines for the evaluation and management of dyslipidemia in human immunodeficiency virus (HIV)–infected adults receiving antiretroviral therapy: Recommendations of the HIV Medicine Association of the Infectious Disease Society of America and the adult AIDS Clinical Trials Group. CID 2003;37:613–27. http://dx.doi. org/10.1086/378131

46. Reiner Z, Catapano AL, De Backer G, et al. ESC/ EAS guidelines for the management of dyslipidae-mias: The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). Eur Heart J 2011;32(14):1769–818. http://

47. Department of Disease Control, Ministry of Public Health. Thailand national guidelines on HIV/AIDS treatment and prevention. 2017. view=article&id=79&Itemid=86 (accessed on: March 14, 2020).