Objective Metabolic complications of HIV pose challenges for health maintenance among young adults who acquired HIV in early childhood. Materials/Methods Between 7/2004–7/2009 we evaluated 47 HIV-infected subjects who acquired HIV in early life. Participants completed glucose tolerance testing, insulin, lipid, urine albumin and creatinine determinations and DXA scans. Longitudinal data were available for 39 subjects; duration of follow-up was 26.4±16.8 months. Results At baseline, participants were 17.1±3.9y and duration of antiretroviral therapy was 12.7±3.4y. CD4 count was 658±374 cells/mm3 and 55% had undetectable viral load. Impaired glucose tolerance (IGT) was present in 15%; 33% had insulin resistance (HOMA-IR>4.0). Further, 52% had triglycerides ≥150 mg/dL, 36% had HDL-c <40 mg/dl, 18% had LDL-c ≥130 mg/dL and 25% had total cholesterol ≥200 mg/dL. Microalbuminuria was present in 15% of participants and was inversely correlated with CD4% (p=0.001). During follow-up more than one third remained insulin resistant; lipid parameters tended to improve. There were significant increases in BMI (p=0.0002), percent leg fat (p=0.008) and trunk fat (p=0.002). Conclusions IGT, insulin resistance, dyslipidemia and microalbuminuria are common among young adults with HIV. Long-term exposure to therapy may translate into substantial persistent metabolic risk.

Background Traditional measures of cardiac function are now often normal in adolescents and young adults treated with antiretroviral therapy for human immunodeficiency virus (HIV) infection. There is, however, evidence of myocardial abnormalities in adults with HIV. Cardiac strain analysis may detect impairment in cardiac function that may be missed by conventional measurements in this population. Methods This was a retrospective study in which echocardiograms of HIV-infected subjects (n = 28) aged 7 to 29 years who participate in a natural history study of HIV acquired early in life were analyzed and compared with matched controls. Standard echocardiographic measures, along with speckle tracking–derived strain and strain rate, were assessed. Results Among the HIV-infected subjects, the median CD4 count was 667 cells/mm3, and the mean duration of antiretroviral therapy was 14.6 years. Ejection fractions and fractional shortening were normal. There were no significant differences in measures of systolic or diastolic function between the groups. The HIV-infected group had borderline increased left ventricular mass indices. Global longitudinal and circumferential strain and strain rate, as well as global radial strain rate, were significantly impaired in the HIV-infected group compared with controls. There were no associations identified between left ventricular mass index or strain indices and current CD4 count, CD4 nadir, HIV viral load, or duration of antiretroviral therapy. Conclusions HIV-infected participants demonstrated impaired strain and strain rate despite having normal systolic function and ejection fractions. Strain and strain rate may prove to be prognostic factors for long-term myocardial dysfunction. Therefore, asymptomatic children and young adults with long-standing HIV infection may benefit from these more sensitive measures.

Background-Traditional measures of cardiac function are now often normal in adolescents and young adults treated with antiretroviral therapy for human immunodeficiency virus (HIV) infection. There is, however, evidence of myocardial abnormalities in adults with HIV. Cardiac strain analysis may detect impairment in cardiac function that may be missed by conventional measurements in this population. Methods-This was a retrospective study in which echocardiograms of HIV-infected subjects (n = 28) aged 7 to 29 years who participate in a natural history study of HIV acquired early in life were analyzed and compared with matched controls. Standard echocardiographic measures, along with speckle tracking-derived strain and strain rate, were assessed. Results-Among the HIV-infected subjects, the median CD4 count was 667 cells/mm 3 , and the mean duration of antiretroviral therapy was 14.6 years. Ejection fractions and fractional shortening were normal. There were no significant differences in measures of systolic or diastolic function between the groups. The HIV-infected group had borderline increased left ventricular mass indices. Global longitudinal and circumferential strain and strain rate, as well as global radial strain rate, were significantly impaired in the HIV-infected group compared with controls. There were no associations identified between left ventricular mass index or strain indices and current CD4 count, CD4 nadir, HIV viral load, or duration of antiretroviral therapy. Conclusions-HIV-infected participants demonstrated impaired strain and strain rate despite having normal systolic function and ejection fractions. Strain and strain rate may prove to be prognostic factors for long-term myocardial dysfunction. Therefore, asymptomatic children and young adults with long-standing HIV infection may benefit from these more sensitive measures.

We completed a cross-sectional study of individuals infected with HIV in early childhood using cardiac MRI and MRA. Coronary artery abnormality (CAA) was defined by the presence of luminal narrowing and irregularity of the coronary vessel wall. More than 50% of participants (14/27) had evidence of CAA. Individuals had a high rate of CAA, suggesting possible early atherosclerosis.

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