Investigating the impact of a fixed-dose combination compared to triple therapy on metabolic syndrome in patients on highly active antiretroviral therapy.
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Date
2017
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Abstract
Introduction: Southern Africa is home to one of the largest populations with Human
Immunodeficiency Virus/ Acquired Immune Deficiency Syndrome (HIV/ AIDS).
Although morbidity and mortality rates have reduced with the advent of Highly Active
Antiretroviral Therapy (HAART), long-term use may lead to metabolic complications
such as insulin resistance, lipodystrophy and dyslipidaemia. These adverse-effects are the
components of metabolic syndrome (MetS), associated with an increased risk of
cardiovascular disease and type 2 diabetes. Continuous efforts are being made to improve
the quality of life of HIV/ AIDS patients whilst controlling the disease state. The
introduction of a fixed-dose combination (FDC) pill (EFV/FTC/TDF) as first-line
treatment ensures a more favourable side-effect profile, decreased pill burden and
improved adherence.
Aims and Objectives: To investigate the incidence and prevalence of metabolic
syndrome in HIV patients on HAART triple therapy compared to a fixed-dose
combination. To investigate the impact of a single pill compared to triple therapy on the
incidence and prevalence of metabolic syndrome in patients on HAART.
Method: Data was collected as a retrospective chart review upon obtaining gatekeeper’s
permission from Addington Hospital. Questionnaires were used as a collection tool for
demographic and anthropometric data in a total of 350 patients. Patients were divided
according to HAART regimens, FDC (A) and triple therapy (B). The joint interim
statement by the International Diabetes Federation Task Force on Epidemiology and
Prevention, National Heart Lung and Blood Institute, American Heart Association, World
Health Organisation, International Atherosclerosis Society and International Association
for the Study of Obesity was used to define the metabolic syndrome.
Results: Of the patients studied, 62.6% were female and 37.4% male. The overall
prevalence of MetS was 16.6%. There was a significant association between HAART
regimen and MetS (p = 0.001). There was a higher prevalence of MetS among triple
therapy patients (23.4%) compared to FDC (9.7%). When adjusted for age, gender,
comorbidities and patient markers, the multivariable logistic regression found HAART
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regimen, glucose, BMI, and the presence of comorbidities to be significant predictors of
MetS.
Conclusion: Patients on triple therapy had 3 times the odds of developing MetS
compared to those on FDC. Increased levels of blood glucose, Low-Density Lipoprotein
cholesterol (LDL-c), systolic and diastolic blood pressure were significantly positively
associated with triple therapy.
Description
Masters Degree. University of KwaZulu-Natal, Durban.