Metabolic changes: defining the syndrome

The ‘metabolic syndrome’ is an interrelated collection of metabolic abnormalities which increase the risk of cardiovascular disease, including abnormal lipid and glucose levels, insulin resistance and obesity. The WHO definition of the metabolic syndrome in HIV-negative people is:

• Fasting plasma glucose > 6.1mmol (110mg/dl), plus at least two of the following:
• Serum triglycerides above 1.69mm (150mg/dl) or serum HDL cholesterol below 0.9 mm (35mg/dl).
• Blood pressure above 140 / 90mmHg. (See “Antiretroviral therapy and risk of high blood pressure” (LINK))
• Abdominal obesity defined as waist to hip ratio above 0.90, waist girth above 94cm or BMI above 30 in men.

While there is some disagreement about the specific metabolic changes which occur in people on HAART, several cohort studies have suggested that many individuals receiving HAART suffer from the metabolic syndrome, regardless of clinically visible body fat changes. Several of these abnormalities, including high triglyceride levels and high baseline cholesterol, have been shown to predict the development of body fat changes in people receiving HAART.