Metabolic Disorders in HIV-Infected Adolescents Receiving Protease Inhibitors

Abstract

Protease inhibitor (PI) may cause abnormal glucose metabolism, abnormal lipid metabolism, and metabolic syndrome in HIV-infected adults but less well studied in Asian adolescents. This cross-sectional study evaluated anthropometric factors, oral glucose tolerance test, and lipid profiles of perinatally HIV-infected Thai adolescents who had received PI-based antiretroviral therapy for at least 6 months. Eighty adolescents were enrolled [median (IQR) age 16.7 (14.6–18.0) years, 42 males]. Metabolic syndrome, prediabetes, and type 2 diabetes mellitus (T2DM) were found in 8 (10%), 17 (22.1%), and 3 (3.8%) adolescents, respectively. Dyslipidemia was found in 56 (70%) adolescents, with hypertriglyceridemia being the most common type. In multivariate analysis, presence of lipohypertrophy (OR: 25.7, 95% CI: 3.2–202.8; p = 0.002) and longer duration of PI use (OR: 1.04, 95% CI: 1.00–1.08; p = 0.023) were associated with metabolic syndrome. Obesity (OR: 7.71, 95% CI: 1.36–43.7; p = 0.021), presence of lipohypertrophy (OR: 62.9, 95% CI: 4.97–795.6; p = 0.001), and exposure to stavudine for ≥6 months (OR: 8.18, 95% CI: 1.37–48.7; p = 0.021) were associated with prediabetes/T2DM, while exposure to tenofovir for ≥6 months reduced the risk (OR: 0.17, 95% CI: 0.04–0.78; p = 0.022). Metabolic disorders were commonly found in adolescents receiving PI. Careful monitoring and early intervention to modify cardiovascular risk should be systematically implemented in this population particularly those with exposure to stavudine.

Higher Levels of Cystatin C in HIV/AIDS Patients with Metabolic Syndrome

“…In our study, HIV/AIDS patients with MetS showed statistically higher levels of anthropometric parameters such as BMI, and the waist circumference, as well as systolic and diastolic blood pressure, triglycerides, fasting glucose and HOMA‐IR, and lower levels of HDL, when compared with the group of patients without MetS. Most of these parameters are criteria for MetS and are in accord with the evidence existing in the literature . Furthermore, HIV/AIDS patients with MetS showed higher AST levels, when compared with patients without MetS.…”

“…While Santiprabhob et al . suggest that longer duration of cART is associated with MetS, Tiozzo et al . report that Mets is a more disease‐dependent or lifestyle‐dependent constellation of symptoms in people living with HIV.…”

“…Literature data about effect of cART on prevalence of MetS are still inconsistent. While Santiprabhob et al [28] suggest that longer duration of cART is associated with MetS, Tiozzo et al [29] report that Mets is a more disease-dependent or lifestyle-dependent constellation of symptoms in people living with HIV. Furthermore, de Waal et al [30] reported that central fat gain did not seem to be an antiretroviral adverse drug reaction.…”

Metabolic syndrome, biochemical markers, and body composition in youth living with perinatal HIV infection on antiretroviral treatment

“…In this study, the prevalence of metabolic syndrome in PHIV-youths was 10.6%. This was in line with a previous Thai study that reported a 10% prevalence of metabolic syndrome [17]. That study also had a similar number of females and males, however their participants were younger than those in our study, (median age of 16.7 vs. 20.3 years, respectively), had a shorter median duration on ART (114.3 vs. 169 months, respectively), and all participants were receiving PI-based ART as opposed to 32% in our study.…”

HIV, Antiretroviral Therapy and Metabolic Alterations: A Review

“…Some studies also report that newer antiretroviral drugs decrease the prevalence of insulin resistance among HIV(+) patients compared to old therapies [23]. PIs are generally wellknown for these side effects [15,20,[24][25][26]; also, some NRTIs, especially stavudine, may cause long-term metabolic and cardiovascular complications [24]. Another study did not find PIs as an important contributor to CVD [12].…”