Lipid and glucose alterations in perinatally-acquired HIV-infected adolescents and young adults

Abstract

BackgroundSuccessful antiretroviral therapy (ART) has dramatically reduced mortality among HIV-infected children. However, there is growing concern about long-term effects associated to ART. The aim of this study was to determine the prevalence of metabolic abnormalities in a cohort of perinatally HIV-infected adolescents and young adults and to identify associated factors.MethodsWe present results from a cross-sectional analysis including individuals 12 to 20 years of age, from a prospective, longitudinal cohort of perinatally-acquired HIV-infected children, adolescents and young adults in Madrid. Clinical and immunological data were recorded and complete lipid and glycemic profiles were determined.ResultsNinety-nine adolescents were included, with a median age of 15.3 years [13.6-16.7]. Patients with abnormal levels of lipids were as follows: 27.2% total cholesterol ≥200 mg/dl, 25.9% LDL cholesterol (LDL-c) ≥ 130 mg/dl, 14.1% HDL-C < 35 mg/dl and 39.8% triglycerides ≥ 150 mg/dl. Current use of protease inhibitors (PI) was associated with higher triglyceride values (p = 0.022). Four (4.6%) patients showed fasting glucose ≥ 100 mg/dl and 30.6% presented with insulin resistance (IR) (HOMA-IR over the 90th centile). In the multivariate logistic regression analysis adjusted for sex, age, weight, Tanner stage, protease inhibitors (PI) and nucleoside reverse transcriptase inhibitors (NRTI) treatment length and CD4 nadir, IR was associated with higher waist circumference Z score; OR: 3.92(CI95%: 1.15-13.4) (p = 0.03).ConclusionThere was a high prevalence of insulin resistance and lipid abnormalities in this cohort of perinatally-acquired HIV-infected adolescents. A simple clinical measurement like waist circumference Z score might be a reliable marker and predictor of insulin resistance in these patients.

Complications of Treatment in Youth with HIV

“…[4]. In this study, 4.6% had fasting glucose levels >100 mg/dL, and 30.6% had evidence of insulin resistance, based on a homeostatic model assessment of insulin resistance (HOMA-IR) level exceeding the 90 th percentile for sex and Tanner stage.…”

“…In contrast, another cross-sectional analysis of 99 HIV-infected children and young adults aged 12–20 years conducted in Spain noted an overall high prevalence of dyslipidemia (40% with hypertriglyceridemia, 27% with elevated total cholesterol, 26% with elevated LDL cholesterol, and 14% with low HDL cholesterol) [4]. The authors did not find an association between HDL cholesterol and ART treatment, but they did find an association between higher levels of TG and protease inhibitor (PI) use.…”

Insulin resistance in HIV-infected youth is associated with decreased mitochondrial respiration

“…Between the two groups, there were no observed differences in the use of, ever use, and exposure to cART, suggesting that treatment is unlikely to have a substantial influence on our findings. However, protease inhibitors, which more than 60% of the patients in both groups were receiving, have been linked to IR [21,22]. …”

Profilo lipidico e terapia antiretrovirale in una coorte di bambini, adolescenti e giovani adulti con infezione da HIV a trasmissione verticale.

“…Inoltre il rischio di patologia cardiovascolare è più elevato nei pazienti afro-americani rispetto ai caucasici e in bambini con familiarità per patologia cardiovascolare (16). La dislipidemia correlata alla cART è stata proposta come fattore determinante nella patogenesi della malattia cardiovascolare nei pazienti con infezione da HIV ed è stata descritta in coorti di bambini e adolescenti trattati con questo tipo di terapia, sebbene la prevalenza di questi disordini differisca significativamente tra gli studi (10)(11)(12)17). L'uso di diverse combinazioni farmacologiche secondo le diverse linee guida nazionali e la diversa disponibilità di farmaci possono spiegare alcune di queste differenze; anche fattori socio-demografici, soprattutto quelli correlati alla dieta, possono essere in parte responsabili di queste divergenze nei risultati.…”