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Background:  Increased waist circumference and high triglycerides, a condition known as hypertriglyceridemic waist syndrome, reliably identify HIV^– patients with significant cardiovascular risk. We investigated whether these simple parameters may identify HIV⁺ males who also have other established cardiovascular risk markers.

Methods:  From a cohort of 96 male patients we obtained DXA scans (Lunar) for body composition analysis, and concurrently available fasting lipid and glucose homeostasis (fasting blood glucose) parameters. We identified 15 patients with both a waist circumference > 90 cm and triglycerides > 2.0 mmol/L (group I) and 18 patients with waist circumference < 90 cm and triglycerides < 2.0 (group II). Data were collected for HIV-related variables, body composition, and metabolic parameters. Inter-group differences were analyzed by t-test and χ² test with Yates Correction.

Results:  Between group I and II, mean age (49 vs 53 years), HAART duration (76 vs 89 months), current CD4 counts (430 vs 490/mL), log₁₀ HIV viral load (2.4 vs 2.5 copies/mL), patients with undetectable viral load (61% vs 47%) and ART history were similar. Analysis of metabolic parameters revealed expected differences between group I and II in triglycerides (1.6 ± 0.5 mmol/L vs 4.5 ± 3.2, p < 0.001). In addition, total cholesterol (4.7 ± 0.8 mmol/L vs 5.9 ± 1.0, p < 0.0001), total cholesterol/HDL (3.8 ± 0.9 vs 5.2 ± 1.0, p < 0.001), fasting blood glucose (4.6 ± 0.7 mmol/L vs 5.7 ± 2.3, p = 0.085), and HOMA (2.2 ± 1.1 vs 3.2 ± 1.5, p < 0.03), an insulin-resistance marker, were all elevated in group II vs group I. Body composition comparisons between group I and II showed the expected difference in waist circumference (86 cm ± 3 vs 97 ± 6, p < 0.0001). Differences were also seen in:  body mass index (23 ± 2 vs 25 ± 2, p < 0.02); total trunk fat (25 ± 3 g vs 28 ± 4, p = 0.068); percentage of trunk fat/total trunk mass (20 ± 4% vs 24 ± 7%, p < 0.05); and percentage of trunk fat/total body fat (54 ± 9% vs 59 ± 7%, p = 0.068). Analysis of ATP-III based criteria for diagnosing metabolic syndrome, revealed, in group II vs group I:  waist circumference > 102 cm in 5 of 15 vs 0 of 18, p = 0.008; triglycerides > 1.7 mmol/L in 15 of 15 vs 9 of 18, p = 0.001; HDL < 1.03 mmol/L in 4 of 15 vs 3 of 18, p = NS; blood pressure > 130/80 in 8 of 15 vs 3 of 18, p = 0.026; and fasting blood glucose > 6.1 mmol/L in 8 of 15 vs 1 of 18, p = 0.002. Importantly, more patients in group II than Group I (6 of 15 vs 0 of 18, p < 0.02) met diagnostic criteria for metabolic syndrome.

Conclusions:  As in HIV^– patients, elevated waist circumference and triglycerides accurately identify treated HIV⁺ males with abnormal lipid, glucose, and body composition markers associated with elevated cardiovascular risk, and who have a higher prevalence of metabolic syndrome, which also confers a significant cardiovascular risk.

Keywords: cardiovascular risk; body composition; metabolic