ICAAC: HIV Patients in 50s Have No Unusually High Metabolic Syndrome Prevalence

SAN FRANSICO, Oct. 3 -- HIV patients in their 50s do not have a higher prevalence of metabolic syndrome than others of that age, researchers reported here.

The prevalence of metabolic syndrome seemed no higher in HIV-positive patients 50 to 59 than the national average (24% versus 32%), Katayoun Rezai, M.D., of Stroger Hospital of Cook County in Chicago, and colleagues, said at the Interscience Conference on Antimicrobial Agents and Chemotherapy.

Though treatment for HIV can alter lipid profiles, traditional cardiovascular risk factors seem to be most important in HIV infected patients, they found.

Metabolic syndrome and the 10-year Framingham cardiovascular risk were not significantly associated with age, ethnicity, duration of HIV infection, use of protease inhibitors or highly-active antiretroviral therapy, CD4 count, or hepatitis C virus status, said the Chicago group.

About half of the predominantly African-American cohort had at least a 10% 10-year Framingham cardiovascular risk while 13% had at least a 20% 10-year Framingham cardiovascular risk.

Hypertension was present in 44% and diabetes in 13%, which likely reflects the demographics of the older, mostly African-American cohort, the authors said. Elevated lipids were present in 29%, though many participants were on lipid lowering drugs, said coauthor Oluwatoyin M. Adeyemi, M.D., also of the Stroger Hospital of Cook County.

More than half were current smokers (65%) and 55% of those with the metabolic syndrome smoked.

"Cigarette smoking, a modifiable risk factor, needs to be addressed in the aging HIV population," the authors said.

The observational study included 121 HIV-positive patients at least 50 years old (median 54, 79% male) attending a comprehensive outpatient care center for HIV, AIDS and other infectious diseases.

Eighty-three percent of the cohort was African American, 9% were Hispanic, and 6% Caucasian, which contrasts with the primarily Caucasian population looked at in previous studies describing cardiovascular risk in HIV positive patients.

The median duration of HIV diagnosis was 12 years and 57% were coinfected with hepatitis C virus, which may lower lipids and therefore lead to a lower rate of the metabolic syndrome, Dr. Adeyemi said.

Most (84%) were on highly-active antiretroviral therapy, half were on a protease inhibitor and 69% had a history of protease inhibitor use.

Significantly more men than women had an elevated Framingham cardiovascular risk (61% versus 8% for 10% or more 10-year risk, 17% versus 0% for 20% or more 10-year risk). Patients with the metabolic syndrome were more likely to have at least a 20% Framingham cardiovascular risk (23% versus 8%, P=0.04).