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In the era of highly active antiretroviral therapy (ART), traditional risk factors for metabolic syndrome are presented as increasing age. In lowand middle-income countries, the restricted benefit package of national health security for human immunodeficiency virus (HIV) does not facilitate the early detection of metabolic disorders. In order to assess the rational of national health security for metabolic abnormalities among people living with HIV (PLHIV), this retrospective study aims to determine the occurrence of metabolic abnormalities and its predicting factors. The study was approved by the hospital ethics committee and conducted at the internal medicine clinic, Pathum Thani Hospital, Thailand. Patients with HIV having had at least 1 year of first-line ART, and having their fasting glucose, fasting lipid profile, and blood pressure assessed before ART were recruited into the study. Those with any abnormal metabolic component prior to ART or absent history of ART were excluded. The metabolic abnormalities were defined as any of the following: elevated triglyceride, reduced high-density lipoprotein (HDL), elevated blood pressure, elevated fasting glucose, or on drug treatment for these metabolic abnormalities. The occurrence of metabolic abnormalities was found in 102 of 340 patients (30.0%). Hypertension (11.4%) was the most common abnormality. Age became the single predictor of metabolic abnormalities (odds ratio [OR] = 1.03, 95% confidence interval [CI] = 1.00–1.06). Aging patients with HIV should be the target group for monitoring Metabolic abnormalities among HIV-infected patients e79 J Popul Ther Clin Pharmacol Vol 27(3):e78–e87; 21 August 2020. This article is distributed under the terms of the Creative Commons Attribution-Non Commercial 4.0 International License. ©2020 Duangjai Duangrithi et al. INTRODUCTION Human immunodeficiency virus (HIV) attacks the body’s immune system, specifically the CD4 cells. In 2017, 36.9 million people globally were living with HIV, and 59% of all people living with HIV (PLHIV) were provided with antiretroviral therapy (ART).1 Thailand, one of the countries with the highest prevalence of HIV in Asia and the Pacific, accounts for 9% of the region’s total population of PLHIV.2 HIV incidence per 1000 population was 0.09 [0.08 – 0.10]. PLHIV were 480,000, and 75% of them are on ART.3 The incidence rate of metabolic syndrome (MetS) in patients on ART was 1.2 per 100 person-months, and most of them had a low level of high-density lipoprotein (HDL).4 The development of highly active antiretroviral therapy (HAART), a treatment regimen of combined ART, improved the quality of life and increased the life expectancy of PLHIV.5 Only 49.6% of the deaths were due to acquired immunodeficiency syndrome while the rest was due to age-related illness, especially cardiovascular disease.6 This increases the importance of agerelated illness among these patients.6 In the era of HAART, several traditional risk factors of MetS are presented, which finally lead to MetS, cardiovascular events, and mortality.5,7 In addition, both HIV infection and ART can cause metabolic abnormalities.8 The previous study showed that the highest prevalence of metabolic component in patients treated with the first-line HAART group and the ARTnaive group were 53.2 and 14.8%, respectively.9 Prevalence of MetS in PLHIV, ranging from 11.2 up to 45.4%, was reported,7 and 24.2% of patients on first-line HAART regimens were diagnosed with MetS.9 Furthermore, MetS prevalences across subgroups were as follows; 23.7 and 26.7% in men and women, respectively, and 25.8, 17.2, and 17.9% in protease inhibitor (PI) users, nonnucleoside reverse transcriptase inhibitor (NNRTI) users, and nucleoside reverse transcriptase inhibitors (NRTI) users, respectively. However, there is no significant difference in the prevalence of MetS in high or low proportion of smokers, 8% versus 22.2%, P = 0.193.10 Dyslipidemia, insulin resistance, and diabetes mellitus (DM) have been observed among patients treated with HAART, especially PIs.5 Furthermore, the annual cumulative incidence of events related to coronary artery disease was significantly higher in patients treated with PI than patients treated with other ART.5 Therefore, the World Health Organization (WHO) recommended first-line ART regimens for adults consisting of two NRTIs plus one NNRTI.11 However, it was reported that NRTI and NNRTI can increase the risk of DM.12 Dyslipidemia has been observed in NNRTI-based therapy, although to a lesser degree when compared to PI.13 Therefore, prevention of MetS by monitoring metabolic components appears to be an effective strategy. However, there are some limitations in this regard in lowand middle-income countries. According to the universal health coverage in Thailand, the benefit package for patients with HIV is the free basic medical services available to all HIV patients. The basic blood chemistry testing, consisting of fasting plasma glucose (FPG) , serum total cholesteral, and serum triglyceride, have been performed in patients with HIV taking into consideration age and comorbidities as follows: age <35 years without any comorbidity: annually; age and treating metabolic abnormalities. The revision of the benefit package on metabolic abnormalities is urgently needed to promote a better quality of life.

Metabolic abnormalities among HIV-infected patients: The rational of national health security for people living with HIV