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Metabolic Syndrome Components as Risk Factors for Distal Sensory Polyneuropathy
Beau Ances*1, D Rosario2, F Vaida2, J Marquie-Beck2, R Ellis2, D Simpson3, D Clifford1, J McArthur4, I Grant2, A McCutchan2, and CNS HIV ART Effects Res Metabolic Study Group
1Washington Univ Sch of Med, St Louis, MO, US; 2Univ of California, San Diego Sch of Med, US; 3Mt Sinai Sch of Med, New York, NY, US; and 4Johns Hopkins Univ Sch of Med, Baltimore, MD, US
Background: Combination ART (cART) can induce
metabolic syndrome, a cluster of risk factors that increase atherosclerosis. Distal
sensory polyneuropathy (DSPN) is the most common peripheral nervous system
complication of HIV and cART. We studied the relationship between metabolic
syndrome and HIV-associated DSPN in a cohort of HIV+ participants
followed by Central nervous system (CNS) HIV ART Research (CHARTER) from 2003
to 2007.
Methods: From 1556 participants recruited in 6 US cities, a subgroup of 130 HIV+ participants who had fasting laboratory tests
were neurologically assessed for DSPN, defined as decreased reflexes or
sensation in the lower legs. Metabolic syndrome components included elevated
blood pressure (mean arterial pressure ≥100 mmHg), dyslipidemia (triglycerides
≥150 mg/dL and high-density lipoprotein cholesterol <40 mg/dL),
central obesity (body mass index > 30 kg/m2), glucose intolerance
(plasma glucose ≥ 110 mg/dL], and type 2 diabetes. Metabolic syndrome was
defined by the presence of ≥3 of these criteria. A logarithmic
transformation of each metabolic syndrome component was used due to skewness
and unequal variance. A multivariate logistic
regression controlling for other DSPN risks factors examined associations
between DSPN and each metabolic syndrome component as a continuous variable.
Results: In the subgroup (n = 130), metabolic
syndrome and DSPN were not related (Pearson’s χ2 test = 0.69). Furthermore, after controlling
for age, CD4 current, length of HIV infection, duration of drug use, and past
protease inhibitor use in a multivariate model, Metabolic syndrome did not help
predict DSPN. When each Metabolic syndrome component was assessed, only triglycerides
were a significant risk factor for DSPN. In the entire cohort (n = 1556), DSPN
correlated with self-reported type 2 diabetes (OR = 2.3, p <0.01).
Conclusions: The risk of HIV-associated DSPN was
increased by diabetes and hypertriglyceridemia, but not by other metabolic
syndrome components. These components increase the risk of DSPN in
HIV-uninfected persons as well, so whether or not they interact with HIV to
provide additional risk remains unclear.
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