Investigating the impact of a fixed-dose combination compared to triple therapy on metabolic syndrome in patients on highly active antiretroviral therapy.

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 viii 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.