Children and young adults who were infected with HIV at birth with a history of antiretroviral therapy have lower levels of limb fat than their HIV-negative peers, American investigators report in the March 27th edition of AIDS. The study also showed a higher prevalence of lipid abnormalities amongst the HIV-positive children and young people.
Individuals infected with HIV at birth face a lifetime of antiretroviral therapy and this could increase the risk of cardiovascular disease. The investigators believe their findings “underscore the need for promoting lifestyle changes (diet, exercise, reduced television watching, smoking cessation) that reduce cardiovascular risk”.
Antiretroviral therapy reduces rates of illness and death amongst people with HIV, and there is increasing optimism that such treatment will enable many people with HIV to live a near-normal lifespan.
However, HIV treatment has side-effects. Some anti-HIV drugs, particularly d4T (stavudine, Zerit) and AZT (zidovudine, Retrovir), have been linked to body-shape changes. Furthermore, metabolic changes have been observed in people taking HIV treatment, including increases in cholesterol and glucose abnormalities.
Investigators wished to identify the prevalence of body-shape and metabolic disorders in a sample of HIV-positive children and young adults aged between seven and 24 years. These individuals were all infected with HIV at birth and were selected from 37 Pediatric AIDS Clinical Trials Group (PACTG) sites across the US.
These young people were compared to individuals of a comparable stage of physical development, age and sex.
The study population included 161 people whose antiretroviral therapy included a protease inhibitor and 79 who took HIV treatment which did not include this class of drug. These individuals were aged between seven and 24 years (median, twelve years). The control population included 146 HIV-negative people.
Both groups of HIV-positive individuals had a long history of antiretroviral therapy. The median duration of HIV treatment was a little under ten years for the individuals in the protease inhibitor group and nine years for those in the non-protease inhibitor group.
HIV-positive individuals, regardless of which treatment they took, had lower mean scores for height (p
Furthermore, total limb fat (assessed by DEXA scan) was lower in both groups of HIV-positive individuals when compared to the HIV-negative controls (p
Use of d4T and AZT was widespread. Over half (54%) the individuals treated with a protease inhibitor had taken d4T, the median duration of such treatment being almost six years. Over a third of individuals taking a non-protease inhibitor regimen also had experience of d4T, the median duration of treatment being six years. Furthermore, 26% of protease inhibitor-treated individuals had taken AZT (median duration six years), as had 46% of those taking a non-protease inhibitor regimen (for a median duration of seven years).
Next the investigators looked at lipid levels. Their analysis showed that the protease inhibitor group had a higher prevalence of abnormal lipid values than the HIV-negative controls. This included total cholesterol above 200mg/dl (29% vs 10%), high LDL cholesterol (above 130mg/dl, 19% vs 6%), low HDL cholesterol (below 35mg/dl, 10% vs 4%) and high triglycerides (above 130mg/dl, 52% vs 13%).
Fasting insulin was higher in HIV-positive individuals - regardless of their treatment - than HIV-negative controls (p
“We observed a high prevalence of dyslipidemia in those with HIV infection, particularly those on protease inhibitor-containing regimens,” comment the investigators, adding “dyslipidemia, particularly LDL cholesterol of more than 130md/dl, has been associated with an elevated risk of cardiovascular disease in adults.”
The investigators also express concern that “low levels of extremity fat among HIV-infected children and youth may become an important factor in adherence to antiretrovirals and may warrant interventions.”
Lifestyle modifications that reduce the risk of cardiovascular disease should be promoted to HIV-positive children and young adults, suggest the investigators.
Aldrovandi GM et al. Morphologic and metabolic abnormalities in vertically HIV-infected children and youth. AIDS 23: 661-672, 2009.