Metabolic syndrome among people with Human Immunodeficiency Virus on Anti-retroviral Therapy at Princess Marina Hospital in Gaborone-Botswana

Abstract

Botswana was the first country in Africa to aim to give antiretroviral treatment to all its HIV positive deserving citizens in 2001. This brought about a significant improvement in survival and quality of life of HIV infected patients as well as a dramatic decrease in the incidence of opportunistic infections. However, although many reports about metabolic abnormalities and abnormal body fat distribution among people on ART have been published elsewhere, little is known about this in Botswana. The purpose of this study was to investigate the prevalence and factors associated with development of metabolic syndrome among people with HIV on ART at the IDCC Clinic at Princess Marina Hospital, Gaborone, Botswana. Methods This was a cross-sectional study based on patient interviews and review of records. A structured questionnaire and a data collection form were used to collect data on demographic, socioeconomic, lifestyle, clinical and laboratory data. Metabolic Syndrome was defined using the International Diabetes Federation (IDF) criteria. Patients who consented to participate were interviewed and their records were reviewed to collate data. Only patients that had been on treatment from January to December 2010 were included. Results A total of 190 subjects participated in the study, 141 (74.2%) females and 49 (25.8%) males. The age of the participants ranged from 24 to 71 with a median age of 40.5 years (IQR: 35 – 49). The overall prevalence of metabolic syndrome in this study was 11%. Metabolic syndrome was associated with traditional risk factors such as hypertension and high triglycerides; but with some unique features such as age, current employment and current NRTI use were also identified. In the bivariate analysis to identify the determinants of metabolic syndrome, the odds for developing MS were higher among participants who were married, employed, on a salary and used ART regimens containing NRTIs. High cholesterol, fasting blood glucose and triglycerides were also associated with the development of metabolic syndrome. There was a significant association with age as people over 45 years were significantly shown to have metabolic syndrome than the younger ones. The median age of participants who had metabolic syndrome was higher at 45 years (IQR: 39 – 53 years) that those without metabolic syndrome at 40 years (IQR: 34 – 48). Married participants were 13 times more likely to develop MS than their unmarried counterparts [OR (95%CI)]: 13 (1.91 - 88.35), p=0.009]. Participants who were employed and had a salary as their source of income were 27.54 times more likely to develop MS although the difference was not statistically significant. The type of regimen affected the prevalence of metabolic syndrome; in fact Up to 17 of the 21 participants with metabolic syndrome used a combination of drugs with NRTIs and NNRTIs as well as PI in 8 cases. So the use of a protease inhibitor based ART regimen increased the odds of developing MS by 51.57 times [OR (95%CI)]: 51.57 (1.55 – 1709.64), p=0.027]; while in case of NRTIs the odds were 78.53 times more for the likelihood to develop MS [OR (95%CI)]: 78.53 (1.10 – 5565.50), p=0.044]. Although there was no significant association between the duration of ART and the development of metabolic syndrome; the median duration of ART among participants with metabolic syndrome was higher at 68 months (IQR: 51 – 80) compared to those without metabolic syndrome at 56 months (IQR: 40 – 68). With regard to sex, 16.3% of the male participants had metabolic syndrome compared to 9.2% among the females; but the difference was not statistically significant. Conclusion In conclusion, the prevalence of metabolic syndrome was low, affecting only 11% of the study participants. The factors associated with the occurrence of the syndrome were the male sex, the long duration on treatment, being married, employed, and over 45 years old. The most significant factors were being on NRTIs and PIs containing regimens. These findings suggest that patients on antiretroviral treatment with the above characteristics should be monitored regularly for metabolic syndrome.