High Prevalence of Metabolic Syndrome and Cardiovascular Disease Risk among People with HIV on Stable ART in Southwestern Uganda

The objectives of this study were to determine the epidemiology and correlates of cardiovascular disease (CVD) risk among Ugandans on first-line antiretroviral therapy (ART). 

We conducted a cross-sectional study at an HIV clinic in southwestern Uganda. We enrolled adult patients on non-nucleoside-based ART regimens for a minimum of 2 years. We collected anthropometric and clinical measurements, smoking history, and blood for fasting lipid profile and blood sugar (FBS). 

Outcomes of interest were

1. presence of metabolic syndrome (at least two of: FBS >100 mg/dL, blood pressure of ≥130/85 mmHg, triglycerides ≥150 mg/dL, HDL <40 mg/DL, or waist circumference ≥94 cm in males or ≥80 cm in females); and 
2. a Framingham score correlating to >5% 10-year CVD risk. 

Of the 250 participants enrolled, metabolic syndrome was detected in 145/250 (58%) of participants (62% in females and 50% in males). Forty-three participants (17%) had a Framingham risk correlating to a 5% or greater risk for CVD within 10 years (26% in males and 13% in females). In multivariate analyses, being female (AOR 3.13; 95% CI: 1.0-9.70; p = 0.04) and over 40 years of age (AOR 1.78; 95% CI: 1.00-3.17; p = 0.05) was independently associated with having metabolic syndrome. 

We found no independent risk factors for a Framingham risk score 10-year risk exceeding 5%, or associations between ART regimen and CVD risk profiles. We conclude that metabolic abnormalities are common among patients on first-line ART in rural Uganda, and appear to be more common in women than men.

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By:   Muyanja D1, Muzoora C1, Muyingo A1, Muyindike W2, Siedner MJ3,4.

• 1 Department of Internal Medicine, Mbarara University of Science and Technology , Mbarara, Uganda .
• 2 Department of Internal Medicine, Mbarara Regional Referral Hospital , Mbarara, Uganda .
• 3 Department of Infectious Disease and Center for Global Health, Massachusetts General Hospital , Boston, Massachusetts.
• 4 Harvard Medical School , Boston, Massachusetts.

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