Metabolic Syndrome in HIV/HCV Co-infected Patients.

• Type of Material: Article
• Authors: Lauren Collins, Emory University; Ruth O. Adekunle, Emory University; Emily Cartwright, Emory University
• Language: English
• Date: 2019-12
• Publisher: Springer Link
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: 2019
• Final Published Version (URL): http://dx.doi.org/10.1007/s40506-019-00207-3
• Title of Journal or Parent Work: Curr Treat Options Infect Dis
• Volume: 11
• Issue: 4
• Start Page: 351
• End Page: 371
• Grant/Funding Information: The authors’ research activities are supported, in part, by grants from the National Institutes of Health/National Center for Advancing Translational Sciences (NCATS) (TL1TR002382, UL1TR002378).
• Keywords: age-associated comorbidities; Human immunodeficiency virus; metabolic syndrome; direct-acting antivirals; antiretroviral therapy; chronic hepatitis C virus
• Research Categories: Biology, Virology; Health Sciences, Public Health

Abstract

PURPOSE OF REVIEW: We review the scope and burden of metabolic syndrome in HIV/HCV co-infected patients, risk factors and potential mechanisms driving the increased cardio-metabolic risk in this population, and discuss relevant clinical considerations for management in the era of highly effective antiretroviral therapy (ART) and curative anti-HCV direct-acting antivirals. RECENT FINDINGS: HIV/HCV co-infected patients are at elevated risk of metabolic syndrome, attributed to (1) patient-specific factors, (2) viral-mediated effects, and (3) ART exposure. Risk factors for cardio-metabolic disorders are common in this population and include poor socioeconomic conditions, substance use, cardiovascular comorbidities, and liver/kidney disease. Chronic HIV/HCV infection induces an inflammatory and immune activated state in the host leading to alterations in glucose and lipid metabolism. Selection of life-saving ART must carefully consider the differential metabolic risk associated with each drug class and agent, such as dyslipidemia, hyperglycemia and insulin resistance, weight gain and hypertension. Emerging evidence supports metabolic derangements in chronic HCV may be improved by viral eradication with direct-acting antivirals, however, additional study in HIV/HCV co-infected patients is needed. SUMMARY: Future research programs should aim to better characterize metabolic syndrome in HIV/HCV co-infected patients with the goal of improved screening, treatment and prevention.