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      The extents of metabolic syndrome among Antiretroviral Therapy exposed and ART naïve adult HIV patients in the Gedeo-zone, Southern-Ethiopia: a comparative cross-sectional study

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          Abstract

          Background

          HIV infection and Antiretroviral Therapy (ART) has been associated with metabolic syndrome (MS). The prevalence of MS varies substantially between populations and is not yet well-known in sub-Saharan Africa (SSA), including Ethiopia. The current study aims to estimate and evaluate the magnitude of MS among ART exposed and ART naïve HIV-infected patients.

          Methods

          A comparative cross-sectional design was employed among the randomly chosen PLHIVs from two hospitals and two health centers, found in the Gedeo zone, southern-Ethiopia. Data collection was run beginning from December 29th, 2017 up to January 22nd − 2019, using the WHO steep tool; eventually, the completed data entered into Epidata (V-3.1) and exported to SPSS (V − 22) for analysis. The revised international diabetes federation criterion was used to define MS and its components. The mean, standard deviations and proportions were used as a descriptive summary. Categorical data and the proportion of MS in the two groups were compared using binary logistic regression, and results were reported statistically significant with p-value is less than 5%.

          Results

          A total of 633 ( n = 422 on ART and n = 211 ART-naive) PLHIVS was involved, with an overall response rate of 96.2%. The cumulative proportion of MS was 42.5%(95% CI: 39.2–45.7), with 43.4%(95% CI: 39.1–47.4) among ART exposed and 40.8% (95% CI: 35.5–46.0) among ART naïve patients ( P > 0.005). However, the difference was not statistically significant and signified that ART has no association with an increased proportion of MS.

          Conclusion

          Overall this study demonstrated the presence of an elevated degree of overall MS among PLHIVs. Besides, although the difference was not statistically significant, a relatively higher proportion of MS was realized in the ART exposed than ART naïve groups. Implicated that at the time of the entire test and treatment approaches employed in this target group, routine screening of MS incorporated through HIV care and management system will be a vibrant action.

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          Most cited references22

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          Immune Activation, Inflammation, and Non-AIDS Co-Morbidities in HIV-Infected Patients under Long-Term ART

          Despite effective antiretroviral therapy (ART), people living with HIV (PLWH) still present persistent chronic immune activation and inflammation. This condition is the result of several factors including thymic dysfunction, persistent antigen stimulation due to low residual viremia, microbial translocation and dysbiosis, caused by the disruption of the gut mucosa, co-infections, and cumulative ART toxicity. All of these factors can create a vicious cycle that does not allow the full control of immune activation and inflammation, leading to an increased risk of developing non-AIDS co-morbidities such as metabolic syndrome and cardiovascular diseases. This review aims to provide an overview of the most recent data about HIV-associated inflammation and chronic immune exhaustion in PLWH under effective ART. Furthermore, we discuss new therapy approaches that are currently being tested to reduce the risk of developing inflammation, ART toxicity, and non-AIDS co-morbidities.
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            Metabolic syndrome in HIV-infected individuals: underlying mechanisms and epidemiological aspects

            The success of highly active antiretroviral therapy (HAART) has determined a dramatic decline in AIDS- and immunodeficiency-related causes of death in the HIV-infected population. As life-expectancy increases, such individuals have become gradually exposed not only to the effects of aging itself, but also to the influence of environmental risk factors, which are known to act in the general population. These features can lead to obesity, diabetes mellitus and ultimately cardiovascular diseases (CVD). Metabolic complications and abnormal fat distribution were frequently observed after a few years of antiretroviral therapy and, as the array of antiretroviral drugs became broader, long term metabolic alterations are becoming far more common worldwide. Nevertheless, the risk of not being on HAART is overwhelmingly greater than the metabolic adverse events in terms of morbidity and mortality events. HIV/HAART-induced metabolic unbalances overlap in some extent the components of Metabolic Syndrome (MetS) and its high rates in the HIV population place infected individuals in an elevated CVD risk category. MetS can explain at least in part the emergence of CVD as the major morbidity and mortality conditions in the HIV population. In this review we convey information on the underlying aspects of MetS during HIV infection, highlighting some physiopathological and epidemiological features of this comorbidity along with the role played by HIV itself and the synergy action of some antiretroviral drugs. Considerations on MetS management in the HIV population are also depicted.
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              The global burden of HIV and prospects for control

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                Author and article information

                Contributors
                girmatenkolu1973@gmail.com
                alemayehuwy@yahoo.com
                aberakumie2@yahoo.com
                Journal
                Arch Public Health
                Arch Public Health
                Archives of Public Health
                BioMed Central (London )
                0778-7367
                2049-3258
                7 May 2020
                7 May 2020
                2020
                : 78
                : 40
                Affiliations
                [1 ]GRID grid.472268.d, ISNI 0000 0004 1762 2666, School of Public Health, , Dilla University, ; Dilla, Ethiopia
                [2 ]GRID grid.7123.7, ISNI 0000 0001 1250 5688, Schools of Public Health, , Addis Ababa University/AAU, ; Addis Ababa, Ethiopia
                Article
                420
                10.1186/s13690-020-00420-3
                7203886
                31908777
                75593a7c-054e-47eb-9f56-61624cb646b8
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 9 October 2019
                : 14 April 2020
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100007941, Addis Ababa University;
                Award ID: not Applicable
                Categories
                Research
                Custom metadata
                © The Author(s) 2020

                Public health
                metabolic syndrome,human immunodeficiency virus,people living with hiv,antiretroviral therapy (art) exposed,art naïve

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