Cardiometabolic Status of Adults Living with HIV in Colon, Panama

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PROJECT SUMMARY Worldwide, metabolic syndrome (MetS) affects one-quarter of adults, increasing morbidity and mortality due to general causes and especially due to type 2 diabetes mellitus (DM2) and cardiovascular disease (CVD). MetS is becoming hyperendemic and, despite its important health outcomes, it remains underrecognized, underdiagnosed, and undertreated. As adults living with HIV (ALWH) have normalized their lifespan with advancements in antiretroviral therapy (ART), there is an epidemiologic shift towards noncommunicable diseases, such as MetS, with prevalence rates comparable to or higher than the general population. There is considerable paucity of clinical, laboratory, and epidemiologic data on MetS among ALWH in low- and middle-income countries. Panama, a middle-income country, has the highest prevalence rate of HIV in Central America and the third highest in Latin America, but does not routinely keep track of noncommunicable diseases among ALWH. Thus, this study proposes to describe the cardiometabolic profile and 1-year trajectory among ALWH in the Caribbean province of Colón and to determine sociodemographic, laboratory, and therapeutic moderators of such effect. As an exploratory objective, we also will explore the feasibility and sustainability of local, evidence-based guidelines to prevent and treat MetS among ALWH, with the long-term goal of developing a culturally appropriate, evidence-based intervention to prevent, diagnose, treat, and follow-up MetS among ALWH in Panama and adapt it for the rest of Latin America. Such intervention must be informed with the baseline MetS epidemiology and the risk and protective factors among ALWH, while building research and clinical capacity and buy-in from key local stakeholders. Thus, in this study, we aim to: 1. Estimate the overall prevalence and 12-month trajectory of MetS and its five diagnostic criteria (i.e., abdominal obesity, hypertriglyceridemia, reduced HDL cholesterol, hypertension, and hyperglycemia) among ALWH in Colón, Panama. 2. Describe and estimate the overall effect of therapeutic, laboratory, and socio-demographic variables on the prevalence and trajectory of MetS its five diagnostic criteria in ALWH in Colón, Panama. 3. Adapt clinical and preventative MetS guidelines to implement a pilot, clinical workflow for the assessment and treatment of MetS in ALWH in Colón, Panama, and evaluate its feasibility, acceptability, sustainability within the ART Clinic’s local capacity.