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J Acquir Immune Defic Syndr. 2015 Jan 1;68(1):73-80. doi: 10.1097/QAI.0000000000000397.

Changes in metabolic syndrome status after initiation of antiretroviral therapy.

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*Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, MA; †Department of Surgery, University of Washington School of Medicine, Seattle, WA; ‡Harborview Medical Center, Seattle, WA; §Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University, Baltimore, MD; ‖AIDS Clinical Trials Unit, University of North Carolina, Chapel Hill, NC; ¶Division of Pediatric Infectious Diseases and Rheumatology, Case School of Medicine, Cleveland, OH; #Division of Infectious Diseases, Department of Medicine, Weill Cornell Medical College, New York, NY; **Hawaii Center for AIDS, University of Hawaii, Honolulu, HI; and ††University of California San Diego, San Diego, CA.



Data on changes in metabolic syndrome (MetS) status in HIV-infected adults on antiretroviral therapy (ART) are limited.


MetS was assessed at ART initiation and every 48 weeks on ART in ART-naive HIV-infected individuals from the AIDS Clinical Trials Group Longitudinal Linked Randomized Trials (ALLRT) cohort. MetS, defined using the Adult Treatment Panel III criteria, required at least 3 of the following: elevated fasting glucose, hypertension, elevated waist circumference, elevated triglycerides, low high-density lipoprotein (HDL) cholesterol. Prevalence of MetS and the individual criteria were compared between ART initiation and during follow-up using McNemar test.


At ART initiation, 450 (20%) ALLRT participants had MetS. After 96 weeks of ART, 37% of the 411 with MetS at ART initiation and with available data at this time point did not meet the MetS criteria. Among these participants, there was a dramatic decline in the proportion with low HDL (95% versus 26%, P < 0.0001). Among the 63% who continued to meet MetS criteria at week 96, the proportion with ≥4 criteria was higher at week 96 compared to at the time of ART initiation (48% versus 40%, P = 0.03); at week 96, the proportion with high triglycerides was greater (87% versus 69%, P < 0.0001) as was the proportion with high glucose (59% versus 42%, P < 0.0001).


One in 5 ART-naive subjects met criteria for MetS at ART initiation. Although more than half of these individuals continued to have MetS after 96 weeks of ART, 37% with MetS at ART initiation no longer met criteria for MetS; this decrease was driven largely by increases in HDL cholesterol.

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