Morphologic and metabolic abnormalities in vertically HIV-infected children and youth

Abstract

Objective-To compare the distribution of lipid and glucose abnormalities and altered fat distribution among vertically HIV-infected subjects and controls.Design-Cross-sectional multicenter study in HIV-infected (HIVpos) subjects 7-24 years, stratified by Tanner stage and protease inhibitor (PI) use (PI; N=161 and non-PI; N=79) and seronegative controls (HIVneg; N=146).Methods-Measurements included fasting lipids, glucose, insulin, 2-h oral glucose tolerance test, dual-energy X-ray absorptiometry, anthropometry, and ART and medical histories. Multiple linear regression models were used to compare distributions between HIVpos and HIVneg.Results-Both HIVpos groups had long exposures to ART. PI and non-PI had similar current CD4 count and HIV RNA, but PI had lower nadir CD4, higher peak HIV RNA, and more advanced CDC disease stage. In adjusted analyses, both HIVpos groups had significantly lower mean z-scores for height, weight, BMI, and total and limb fat, compared with HIVneg. Mean triglycerides were significantly higher and HDL cholesterol lower in both HIVpos groups relative to HIVneg. PI also had significantly higher mean total, LDL, and non-HDL cholesterol. Mean fasting insulin was higher in both HIVpos groups, and 2-h glucose and insulin were higher in the PI group. Ritonavir was associated with increasing dyslipidemia and altered glucose metabolism. Author Contributions: GMA and KM designed the study and the analyses, with input from the other authors. JL and DJ had primary responsibility for data analysis. AZ, BH and WM contributed to the collection/analysis of clinical and laboratory data. GMA wrote the first draft of the paper but all authors contributed to writing the paper and approved the final version of the paper.Preliminary results of this study were presented at the 9 th International Workshop on Lipodystrophy and Adverse Drug Reactions in Sydney, Australia, July 2007. Conclusions-In a large group of vertically-infected children/youth with extensive ART exposure, height, weight, and total and limb fat were lower than in controls. There was a high prevalence of lipid abnormalities among those on PI and evidence of developing insulin resistance, factors that may accelerate lifetime risk for cardiovascular disease. NIH Public Access

Satisfação corporal e características de lipodistrofia em crianças e adolescentes com HIV/AIDS em uso de terapia antirretroviral de alta potência

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