Human Immunodeficiency Virus (HIV) infection remains a significant global health challenge, with over 38 million people living with the virus as of 2021 [1]. The widespread implementation of antiretroviral therapy (ART) has markedly improved the prognosis of HIV-positive individuals, transforming the infection into a manageable chronic condition and substantially reducing AIDS-related mortality [2]. However, with increased longevity, there is a growing burden of non-communicable comorbidities among people living with HIV (PLHIV), including metabolic syndrome (MetS) and cardiovascular diseases (CVD) [3,4].

Metabolic syndrome is a cluster of metabolic abnormalities, including abdominal obesity, insulin resistance, dyslipidemia, and hypertension, that predispose individuals to type 2 diabetes and cardiovascular complications [5]. PLHIV are at a higher risk of developing MetS due to multiple interlinked factors such as chronic immune activation, HIV-associated inflammation, ART-related side effects, and lifestyle factors [6]. Protease inhibitors (PIs), nucleoside reverse transcriptase inhibitors (NRTIs), and non-nucleoside reverse transcriptase inhibitors (NNRTIs) have all been implicated in contributing to insulin resistance and dyslipidemia, which may further aggravate cardiovascular risk [7,8].

Globally, the prevalence of MetS among PLHIV has been reported to range between 11% and 45%, depending on the population studied, diagnostic criteria used, and ART regimen administered [9]. Indian studies have shown a similarly wide variability, with limited data exploring the combined burden of metabolic and cardiovascular complications in this population [10,11]. Furthermore, studies suggest that lower CD4 counts and longer ART duration may be associated with an increased risk of metabolic complications [11].

Given the evolving landscape of HIV management and the need for holistic care, it is essential to monitor cardiovascular and metabolic health in PLHIV, especially those on long-term ART. This study was conducted to assess the prevalence and correlates of metabolic syndrome and cardiovascular disease risk in HIV-positive individuals receiving ART in a tertiary care hospital in western India.

This observational, prospective study was conducted at the Department of General Medicine, MGM Medical College and Hospital, Kamothe, Navi Mumbai, between October 2022 and June 2024. The study enrolled 60 HIV-positive patients aged 18 years and above, who had been receiving antiretroviral therapy (ART) for at least 12 months. Patients were selected based on convenient sampling. Inclusion criteria included seropositive status confirmed via ELISA/Western Blot, and consistent ART adherence for over a year. Exclusion criteria encompassed individuals with a prior diagnosis of diabetes mellitus, hypertension, dyslipidemia, coronary artery disease, sleep apnea, cancer, or those with poor ART compliance (<90%).

All enrolled participants provided written informed consent. Data were collected using a structured proforma that included demographic details, clinical history, and treatment information. Anthropometric measurements such as weight, height, body mass index (BMI), and waist circumference were recorded. Blood pressure was measured twice at five-minute intervals and averaged. Laboratory investigations included complete blood count (CBC), liver and renal function tests, fasting and postprandial blood glucose, lipid profile, HbA1c, and CD4 counts. Cardiovascular evaluation included 12-lead electrocardiograms (ECG) and two-dimensional echocardiography (2D ECHO). The diagnosis of metabolic syndrome was made using the NCEP ATP III criteria.

Data were entered in Microsoft Excel and analyzed using IBM SPSS Statistics version 25. Continuous variables were presented as mean ± standard deviation or median with interquartile range, while categorical variables were expressed as percentages. Associations between metabolic syndrome and variables such as CD4 count, ART duration, and cardiovascular parameters were evaluated using appropriate statistical tests. A p-value of less than 0.05 was considered statistically significant. Ethical clearance was obtained from the Institutional Ethics Committee prior to the commencement of the study.

The present study included 60 HIV-positive patients receiving antiretroviral therapy to evaluate the prevalence of metabolic syndrome and cardiovascular abnormalities. Baseline demographic, clinical, and biochemical parameters were assessed. The findings are presented in terms of distribution, associations, and patterns observed across metabolic and cardiac evaluations.

Table 1 presents the demographic and clinical characteristics of the 60 HIV-positive patients included in the study. The majority were male (58.3%) and within the 18–40-year age group (58.3%). Most participants had been  on  antiretroviral  therapy  (ART)  for over 3 years

Table 1: Demographic and Clinical Characteristics of the Study Participants (n = 60)

(76.7%). Based on BMI, 38.3% were overweight and 35.0% were obese. A substantial proportion (40%) had CD4 counts >600 cells/mm³. Key metabolic risk factors included elevated triglycerides in 38.3% of patients, systolic blood pressure ≥130 mmHg in 55%, and diastolic BP ≥85 mmHg in 43.3%. Low HDL levels were common, especially among females (80%). Additionally, 18.3% had impaired fasting glucose, and 11.7% were diabetic based on HbA1c. Metabolic syndrome was identified in 28.3% of the study population, indicating a notable cardiometabolic risk burden.

Table 2 summarizes the echocardiographic and electrocardiographic findings among the 60 HIV-positive patients. Echocardiography revealed that diastolic dysfunction was the most common abnormality, observed in 40% of patients, followed by systolic dysfunction (15%), pericardial effusion (11.7%), and left ventricular hypertrophy (10%). A normal echocardiographic study was noted in 23.3% of cases. On ECG, the most frequent abnormality was sinus bradycardia (23.3%), followed by sinus tachycardia (16.7%), prolonged QTc interval (11.7%), low voltage complexes and ST-T changes (8.3% each), and atrial fibrillation in 3.4%. Only 28.3% had a normal ECG. These findings highlight a significant prevalence of subclinical cardiovascular involvement in HIV-infected individuals on ART.

Table 3 shows the association between the duration of ART and CD4 count with the presence of metabolic syndrome  in  HIV-positive   patients.   Although   a  higher

Table 2: Distribution of Echocardiographic and Electrocardiographic Findings Among HIV-Positive Patients (n = 60)

Table 3: Association Between Duration of ART and CD4 Count with Presence of Metabolic Syndrome Among HIV-Positive Patients

proportion of metabolic syndrome cases were observed in patients on ART for more than 3 years (64.7%), the association was not statistically significant (p = 0.19). In contrast, CD4 count demonstrated a significant association with metabolic syndrome (p = 0.04). Patients with CD4 counts >600 cells/mm³ constituted the largest group among those with metabolic syndrome (52.9%), while none of the patients with CD4 ≤200 cells/mm³ had metabolic syndrome. These findings suggest that improved immune reconstitution (higher CD4 counts) may be associated with increased metabolic risk, possibly due to prolonged ART exposure and its metabolic effects.

This study highlights a significant burden of metabolic syndrome and cardiovascular abnormalities among HIV-positive individuals on antiretroviral therapy (ART). The prevalence of metabolic syndrome in our cohort was 28.3%, which aligns with earlier Indian studies reporting rates between 20–40% depending on the diagnostic criteria and population studied [10,12]. Most patients in our study had been on ART for more than three years, and while duration of ART did not show a statistically significant association with metabolic syndrome, a trend toward higher prevalence with prolonged ART was observed, suggesting the cumulative metabolic impact of therapy over time.

Our findings demonstrated that higher CD4 counts were significantly associated with the presence of metabolic syndrome. This is consistent with the hypothesis that immune reconstitution and prolonged survival may unmask or promote metabolic complications, particularly in the context of ART-induced lipodystrophy and dyslipidemia [6,11]. Notably, the majority of patients with metabolic syndrome had CD4 counts above 600 cells/mm³. These results emphasize the need for proactive metabolic screening, even in clinically stable patients with good immune recovery.

Cardiovascular involvement was also prominent, with echocardiographic abnormalities observed in nearly 77% of the study population. Diastolic dysfunction was the most common echocardiographic finding, present in 40% of patients, followed by systolic dysfunction and pericardial effusion. Similar findings have been documented in previous studies, suggesting that HIV infection and ART contribute to myocardial remodeling, chronic inflammation, and subclinical cardiac dysfunction [13,14]. On electrocardiography, sinus bradycardia and tachycardia were frequent, along with repolarization abnormalities, consistent with earlier studies linking ART, particularly protease inhibitors, with QT interval prolongation and autonomic dysfunction [15].

These findings reinforce the growing recognition of non-infectious comorbidities in people living with HIV. As ART continues to extend life expectancy, integrating routine cardiovascular and metabolic risk assessment into HIV care becomes imperative. Early identification of at-risk individuals may enable timely lifestyle interventions and pharmacologic strategies to mitigate long-term complications.

In conclusion, this study highlights a significant prevalence of metabolic syndrome and cardiovascular abnormalities among HIV-positive individuals on long-term antiretroviral therapy. Diastolic dysfunction, dyslipidemia, and elevated blood pressure were among the most common findings, indicating the growing burden of non-communicable diseases in this population. A statistically significant association between higher CD4 counts and metabolic syndrome suggests that as immune recovery improves, the risk of metabolic complications may also rise, likely due to cumulative ART exposure and lifestyle factors. These findings underscore the importance of integrating regular metabolic and cardiovascular screening into routine HIV care to enable early intervention and reduce long-term morbidity and mortality.

Conflict of Interest

The authors declare that there is no conflict of interest related to this study.

Funding Source

This study did not receive any external funding. 

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