Epidemiological aspects of Metabolic Syndrome and associated factors in HIV-infected patients in Georgia in the era of highly active antiretroviral therapy
Project Status: 3 Approved without Funding
Duration in months: 24 months
Objective
The purpose of this project is to study the prevalence of metabolic syndrome (MetS) in Georgian HIV-infected patients on HAART, to provide evidence-based information about the necessity of screening for Metabolic Syndrome , to assess cost-effectiveness of three different international screening criteria for further adoption in this population and for future implementation to develop integrated management strategy for HIV infected patients with metabolic syndrome to prevent development of CVD and DMT2 for those who are “at risk”. Specific aims of the study include:
Report prevalence and associated risk factors of MetS in Georgian HIV positive patients; Estimate the incidence of MetS in treatment naive HIV patients using three international criteria (WHO and ATP III and IDF); Explore association between Mets and different antiretroviral treatment regimens Assess cost-effectiveness of three different international screening criteria for MetS (WHO and ATP III and IDF); Develop integrated management strategy for HIV infected patients with metabolic syndrome to prevent CVD and DMT2 and Provide evidence based recommendations and policy brief for the Government of Georgia, including patients’ education scheme/plan to increase awareness of MetS and associated risk factors among HIV positive patients Current Situation on the country
HIV is a global Health problem. According to World Health Organization (WHO), the estimated number of Ppeople living with HIV worldwide is 37 million and about 2.1 million people get infected every year. Georgia is an Eastern European country with an estimated number of population of 3.7 million; the prevalence of HIV in the country is estimated at about 0.5% in general population. According to the data obtained by the Infectious Diseases, AIDS and Clinical Immunology Research Center (IDACIRC), which is the main institution in the country responsible for HIV diagnosis, treatment and monitoring of HIV/AIDS patients, officially registered number of HIV/AIDS patients reached 6500 at the end of December 2017. By SPECTRUM analyses the actual estimated number of HIV patients in the country is 12600. Life expectancy and quality of life in those infected with HIV have improved dramatically after the introduction of effective antiretroviral therapy (ART). Indeed, the introduction and widespread use of highly active antiretroviral therapy (HAART) in the mid 1990’s has led HIV-infected individuals to experience a dramatic decline in immunodeficiency-related events, including causes of death. As a consequence, life-expectancy increased, but 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 as well. These features can lead to obesity, diabetes mellitus and ultimately cardiovascular diseases (CVD). In addition, long-term HAART has been associated with a variety of metabolic abnormalities. Cardio-metabolic risk factors are of increasing concern in HIV-infected individuals. CVD is among the top ten causes of death in HIV patients in Georgia.
Currently, the literature investigating the association between HAART use and MetS in different countries is very scarce. There are very limited number of research activities performed in Caucasus region to study prevalence of MetS and influence of HAART on MetS among HIV positive individuals.
Studies conducted among general population in Georgia showed that prevalence of metabolic syndrome is about 18% and prevalence of Diabetes Mellitus Type 2 is about 8%. These conditions are the main contributors to cardiovascular morbidity and mortality. 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 as well as in Georgia. Nevertheless, the risk of not being on HAART is overwhelmingly greater than the metabolic adverse events in terms of morbidity and mortality events. Several studies suggest that MetS has become common in people living with HIV compared to the general population. Therefore, the emerging problem of MetS in a given population highlights the need for preventive and management strategies, and enables healthcare services planning.
As it was mentioned above, Georgia is a country with a concentrated HIV epidemic with a growing number of HIV positive patients and “treat all” (treat all HIV positive patients regardless CD4 cell count and viral load) strategy is implemented in the country. The study evaluating development of MetS in HIV infected patients will be performed for the first time in Georgia. The proposed study will provide evidence-based information to develop comprehensive and integrated management strategy for implementation of MetS screening in HIV patients in the medical settings of Georgia, also promoting to educate patients and increase awareness of MetS in HIV individuals. The final achievement of the project targets to reduce the risk of CVD and DMT2 and related mortality in HIV patients. Study findings will be presented at international conferences and articles will be published in peer reviewed international journals. This study will be the first research in Georgia which makes a step toward recognition of MetS in HIV patients in the country in order to prevent major causes of mortality.
