Background:  There is a high prevalence of metabolic syndrome in HIV⁺ populations. Previous studies have shown an increased risk for all-cause mortality in HIV^– subjects with metabolic syndrome. We evaluated the risk of mortality associated with metabolic syndrome and its 5 components in an HIV⁺ cohort.

Methods: The Nutrition for Healthy Living study was a prospective study of nutrition and metabolic risk factors in HIV from 1995 to 2005. We retrospectively analyzed data from visits between September 2000 and January 2004. Metabolic syndrome was defined using current National Cholesterol Education Program guidelines. Baseline data were taken from the first visit in which the diagnosis of metabolic syndrome was made or, for those without metabolic syndrome, from the first visit on or after September 1, 2000. Follow-up time was calculated as the time to death or the last review of death registry data on November 30, 2005. Cox hazard ratios for survival were estimated for metabolic syndrome and separately for each of its 5 components:  low HDL, hypertriglyceridemia, high serum glucose, abdominal obesity, and high blood pressure.

Results: Preliminary results are presented. For the 557 subjects included, mean age was 43.7, 181 (32.5%) were women, and 277 (41.7%) had metabolic syndrome. Median HDL was 39 mg/dL (61% had low serum HDL) and median triglycerides were 155 mg/dL (51.9% had hypertriglyceridemia). There were 62 (11.1%) deaths during the study period with a median time to censor of 53.2 months. Those who died had a lower mean CD4 count (306 vs 469 counts/mL, p < 0.001), and a lower serum albumin (3.62 vs 3.95 g/dL, p <0.001). Of the 5 components of metabolic syndrome, 2 were significantly associated with mortality: low serum HDL (adjusted hazard ratio [HR] 2.21, 95%CI 1.17 to 4.18) and high serum triglycerides (HR 1.79, 95%CI 1.01 to 3.15). There was no significant difference in gender, race, or smoking history in the model. There was no significant association seen between mortality and overall metabolic syndrome (HR 1.45, 95%CI 0.84 to 2.53).

Conclusions: Low serum HDL and hypertriglyceridemia are known HIV-related metabolic abnormalities. We demonstrate that they are also independent risk factors for mortality in HIV. In contrast to previous HIV^– cohorts, there does not appear to be an increased risk of mortality associated with metabolic syndrome for those infected with HIV after a 4- to 5-year follow-up. Further research is needed to see whether modifying serum HDL and triglycerides will improve survival in HIV⁺ populations.