Longitudinal Changes in Subclinical Vascular Disease in Ugandan Youth With Human Immunodeficiency Virus

Abstract

Introduction The risk of cardiovascular disease (CVD) and prospective investigations in youth living with perinatally acquired HIV (PHIV) in sub-Saharan Africa are lacking. Methods A prospective observational cohort study was performed in 101 PHIV and 97 HIV-, 10-18 years of age, from 2017-2021 at the JCRC in Uganda. PHIVs were on ART with HIV-1 RNA level ≤400 copies/mL. Common carotid artery intima-media thickness (IMT) and pulse wave velocity (PWV) were evaluated at baseline and 96 weeks. Groups were compared using unpaired t test and potential predictors of IMT and PWV were assessed using quantile regression. Results Of the 198 participants recruited at baseline, 168 (89 PHIV, 79 HIV-) had measurements at 96 weeks. Median (Q1, Q3) age was 13 years (11,15); 52% were females; 85% had viral load < 50 copies/mL and remained undetectable at week 96. Baseline mean common carotid IMT was slightly higher in PHIVs compared to controls (p < 0.01), and PWV did not differ between groups(p = 0.08). At week 96, IMT decreased and PWV increased in PHIV (p≤0.03); IMT increased in HIV- (p = 0.03) with no change in PWV (p = 0.92). In longitudinal analyses in PHIV, longer ART duration was associated with lower PWV (β=0.008, 95% CI -0.008, 0.003), and abacavir use with greater IMT (β=0.043, 95% CI 0.012, 0.074). Conclusions In healthy Ugandan PHIV, with viral suppression on ART, common carotid IMT did not progress over 2 years. Prolonged and early ART may prevent progression of subclinical vascular disease, while prolonged use of abacavir may increase it.

Are we closer to better understanding risk factors for insulin resistance among children and adolescents with perinatally acquired HIV?

“…Although we know that youth and adults with HIV are at a greater risk for metabolic and cardiovascular complications compared with those without HIV, we have yet to uncover the complex underpinnings of the relationships between inflammation, immune activation, and metabolic complications. We would be remiss if we did not acknowledge the wealth of data regarding inflammation, immune activation, metabolic measures, and intestinal integrity that the authors have contributed to the literature from this observational cohort of PHIV and HIV-children in Kampala, Uganda [15][16][17][18]. This cohort of youth with PHIV, like many others with HIV, has evidence of increased immune activation that persists over time, which may be associated with intestinal integrity and microbial translocation.…”