Abnormal cardio-metabolic risk profile is increasingly of concern in people living with human immunodeficiency virus (HIV) infection. However, the burden and differential contribution, if any, of HIV specific factors, are poorly understood. We conducted a systematic review and meta-analysis to estimate the global prevalence of metabolic syndrome (MS) in people with HIV, and the variation by HIV severity, treatment, definition criteria and other major predictive characteristics.Design and method:
We performed a comprehensive search on major databases for original research articles published between 1998–2015. Pooled prevalence estimates overall and by specific groups and subgroups were computed using random effects models, with variance stabilisation via arc-sine transformations.Results:
In all 65 studies across five continents comprising 55094 HIV-infected participants aged 17–73 years (median age 41 years) were included. The overall prevalence of MS according to the following criteria was: ATPIII-2001:16.7% (95%CI: 14.6–18.8), IDF-2005: 18% (14.0–22.4), ATPIII-2004–2005: 24.6% (20.6–28.8), Modified ATPIII-2005: 27.9% (6.7–56.5), JIS-2009: 29.6% (22.9–36.8), and EGIR: 31.3% (26.8–36.0). Within some criteria of MS, the prevalence was significantly higher in women than in men (IDF-2005: 23.2% vs. 13.4, p = 0.030), in ART compared to non-ART users (ATPIII-2001: 18.4% vs. 11.8%, p = 0.001), and significantly varied by time-period of study publication, participants age, severity and diagnosed duration of HIV infection, and non-nucleoside reverse transcriptase inhibitors (NNRTIs) use. Across criteria, there were significant differences in MS prevalence by sub-group categories such as in men, the Americas, older publications, regional studies, younger adults, smokers, ART-naïve participants, NNRTIs users, participants with shorter duration of diagnosed infection and across the spectrum of HIV severity. Substantial heterogeneities across and within criteria were not fully explained by major study characteristics, while evidence of publication bias was marginal.Conclusions:
The prevalence of MS in people with HIV is within the range of reports from the general population, highlighting the commonality of drivers of the condition. This emphasises the need for holistic management of the HIV-infected individual with the inclusion of cardio-metabolic assessments. Approaches for screening and mitigating disease risk associated with MS in the general population will likely provide similar benefits in people with HIV.