Adipokine profiles and lipodystrophy in HIV-infected children during the first 4 years on highly active antiretroviral therapy

Abstract

ObjectiveThe aim of the study was to evaluate the evolution of plasma adipokines and lipodystrophy in protease inhibitor-naïve vertically HIV-infected children on highly active antiretroviral therapy (HAART). Patients and methodsWe carried out a multicentre retrospective study of 27 children during 48 months on HAART. Every 3 months, CD4+ T-cells, CD8+ T-cells, viral load (VL), cholesterol, triglycerides, lipoproteins and adipokines were measured. Diagnoses of lipodystrophy were based on clinical examinations. ResultsWe found hypercholesterolaemia (4200 mg/dL) in 9.5, 30.4, 21.7, 14.3 and 13.3% of the subjects at months 0, 12, 24, 36 and 48, respectively, and hypertriglyceridaemia ( 4170 mg/dL) in 14.3, 8.3, 13, 4.5 and 0% at the same time-points. During follow-up, and especially at the end of the study, we found an increase in plasma resistin levels and significant increases in total plasminogen activator inhibitor type 1, adiponectin, and leptin levels (Po0.05). We also observed slight increases in the leptin/adiponectin ratio, homeostatic model assessment, and C-peptide values during the first months of treatment followed by a moderate decrease or stabilization after 24 months on HAART. At the end of the study, 12 of the 27 children (44.4%) had lipodystrophy, 10 (37%) had lipoatrophy, and 11 (40.7%) had lipohypertrophy; and only three of the 27 children (11.1%) were diagnosed with lipoatrophy and lipohypertrophy with scores ! 2.Conclusions HIV-infected children showed an increase in serum adipokine levels, but this was not associated with the emergence of lipodystrophy during 48 months on HAART.

Longitudinal assessment of metabolic abnormalities in adolescents and young adults with HIV-infection acquired perinatally or in early childhood

“…This could reflect restoration of fat stores previously depleted with lipoatrophy, but may also indicate unhealthy gains in adiposity. Leptin, an adipokine involved in glucose homeostasis, particularly in the context of lipoatrophy [36, 37], was not measured, and its role in youth with HIV is less clear [38, 39]. As previously suggested by Blass et al[40] and seen in the present study, emergent obesity in HIV cohorts may be driving the increase in fasting glucose levels, an indicator of pre-diabetes.…”

The Pathophysiology of HIV-/HAART-Related Metabolic Syndrome Leading to Cardiovascular Disorders: The Emerging Role of Adipokines

“…In one of these studies the prevalence of any body change was 62% in protease inhibitor (PI)-experienced patients, 33% in PI-naive patients and 21% in antiretroviral-naive patients [17]. There seems to be a lower prevalence of morphological body shape and fat redistribution changes in HIV-infected children, while an increase in serum adipokine levels has been additionally described [18]. According to the European Paediatric Lipodystrophy Group, approximately a quarter of children and adolescents show signs of lipodystrophy, similar to those described in adults [19].…”

Metabolic disorders in vertically HIV-infected children: future adults at risk for cardiovascular disease

“…Most studies on this subject come from geographic areas other than Spain and those performed in this setting include small patient numbers (3,10,14) . To defi ne the status of our pediatric patients in this regard, this study was designed to assess the prevalence of metabolic disorders and related risk factors in a large cohort of vertically HIV-infected Spanish children with lengthy antiretroviral drug exposure.…”