Low serum carnitine in HIV-infected children on antiretroviral treatment

Abstract

Objective: HIV-infection and antiretroviral therapies are associated with energy dysfunction and lipid metabolism in adults. Our aim was to detect a possible carnitine deficiency in HIV-infected children on antiretroviral treatments. We analysed the relation among serum carnitine, its amino-acid precursors (methionine and lysine), clinical evaluation and antiretroviral therapy. Design and setting: Cross-sectional study performed in a tertiary care hospital. Subjects: A total of 79 HIV-infected children on antiretroviral therapy, monitored prospectively in our hospital. Interventions: Antiretroviral therapy included nucleoside analogues plus protease inhibitors and/or non-nucleoside analogues. Carnitine was analysed by an enzymatic-spectrometric procedure, and amino acids by ion exchange chromatography. Reference values of carnitine and amino acids were established in apparently healthy children who underwent presurgical analysis for minor surgery. Results: Serum free and total carnitine, acylcarnitines, methionine and lysine were significantly lower in HIV-infected children compared with our reference values for similar ages (Po0.0001; Student's t-test). Low carnitine values were observed in 37% of our HIV-infected children. A significantly positive correlation was observed between serum total carnitine and methionine or lysine (Po0.0001 and P ¼ 0.005, respectively; Pearson test). No relation was observed between serum carnitine and clinical stage of HIV infection, immunological or nutritional status or lipodystrophy. Free and total carnitine were significantly lower (P ¼ 0.002 and 0.033, respectively) in HIV-infected patients on protease inhibitors (N ¼ 56) compared with those on other treatments (N ¼ 23). Conclusions: Low serum carnitine concentration was observed in 37% of our HIV-infected children on antiretroviral therapy. Malabsorption or defective synthesis may also account for the low serum carnitine values detected in these patients. Sponsorship: Grant FIS 99/1270.

Proteomics approach to understand reduced clearance of mycobacteria and high viral titers during HIV–mycobacteria co‐infection

“…Apart from these principal mechanisms that were discussed above, the proteomic data also pointed out several interesting axes that can be deliberated to understand the synergistic impact of HIV and mycobacteria, such as carnitine‐ O ‐palmitoyltransferase, which was absent in the fractions from BCG suggesting low levels of this enzyme during mono‐infection. Carnitine deficiency promotes HIV propagation (De Simone et al , ; Vilaseca et al , ). Co‐infection showed increased expression of peroxiredoxin proteins, which are known to quench the reactive oxygen species (Tavender and Bulleid, ) and thus neutralize the microbicidal effects of ROS.…”

Immunometabolic Reprogramming in Response to HIV Infection Is Not Fully Normalized by Suppressive Antiretroviral Therapy

“…Although there is a sufficient carnitine pool in healthy individuals, PWH are at a greater risk of carnitine deficiency due to the malabsorption of nutrients, renal disease with subsequent higher carnitine elimination, increased metabolic demands that result from higher circulating fatty acid levels, and reduced endogenous biosynthesis [47]. Indeed, adults and children with HIV infection exhibit lower levels of total circulating carnitines [48][49][50]. In a study, the dietary supplementation of 2 g of L-carnitine for 8 months improved fatty acid oxidation, with reduced levels of circulating free fatty acids in PWH with lipodystrophy receiving ART [51]; however, more investigation is required to conclude these promising findings, whether carnitine supplementation may improve fatty acid oxidation metabolism associated with dyslipidemia among PWH.…”

Dynamics of the infant gut microbiota in the first 18 months of life: the impact of maternal HIV infection and breastfeeding

“…Carnitine is involved in β-oxidation of fatty acids and plays other important roles in metabolism [ 72 ]. Carnitine deficiency has previously been reported to occur in adult patients with HIV [ 73 , 74 ] and children [ 75 ], and may reflect gastrointestinal malabsorption. Acylcarnitine is present in relatively high levels in the brain [ 76 ] and can readily cross the blood–brain barrier [ 77 ].…”