Morphologic and metabolic abnormalities in vertically HIV-infected children and youth.
OBJECTIVE
To compare the distribution of lipid and glucose abnormalities and altered fat distribution among vertically HIV-infected patients and controls.


METHODS
Cross-sectional multicenter study on HIV-infected (HIV-positive) patients, 7-24 years of age, stratified by Tanner stage and protease inhibitor use (protease inhibitor, n = 161 and non- protease inhibitor, n = 79) and seronegative controls (HIV-negative, n = 146).


METHODS
Measurements included fasting lipids, glucose, insulin, 2-h oral glucose tolerance test, dual-energy X-ray absorptiometry, anthropometry, and antiretroviral therapy and medical histories. Multiple linear regression models were used to compare distributions between HIV-positive and HIV-negative groups.


RESULTS
Both HIV-positive groups had long exposures to antiretroviral therapy. Protease inhibitor and nonprotease inhibitor groups had similar current CD4 cell count and HIV-1 RNA, but the protease inhibitor group had lower nadir CD4 cell count, higher peak HIV-1 RNA, and more advanced Centers for Disease Control disease stage. In adjusted analyses, both HIV-positive groups had significantly lower mean Z scores for height, weight, BMI, and total and limb fat than the HIV-negative group. Mean triglycerides were significantly higher and high-density lipoprotein cholesterol lower in both HIV-positive groups relative to the HIV-negative group. The protease inhibitor group also had significantly higher mean total, low-density lipoprotein, and non-high density lipoprotein cholesterol. Mean fasting insulin was higher in both HIV-positive groups, and 2-h glucose and insulin were higher in the protease inhibitor group. Ritonavir was associated with increasing dyslipidemia and altered glucose metabolism.


CONCLUSIONS
In a large group of vertically HIV-infected children and youth with extensive antiretroviral therapy exposure, height, weight, and total and limb fat were lower than in controls. There was a high prevalence of lipid abnormalities among those on protease inhibitors and evidence of developing insulin resistance, factors that may accelerate lifetime risk for cardiovascular disease.
Aldrovandi
Grace M
GM
Saban Research Institute of Childrens Hospital Los Angeles, University of Southern California, Los Angeles, California, USA. galdrovandi@chla.usc.edu
Lindsey
Jane C
JC
Jacobson
Denise L
DL
Zadzilka
Amanda
A
Sheeran
Elizabeth
E
Moye
Jack
J
Borum
Peggy
P
Meyer
William A
WA
Hardin
Dana S
DS
Mulligan
Kathleen
K
D000293:Adolescent; D000886:Anthropometry / Q000379:methods; D019380:Anti-HIV Agents / Q000627:therapeutic use; D001786:Blood Glucose / Q000378:metabolism; D001823:Body Composition / Q000502:physiology; D018791:CD4 Lymphocyte Count; D002648:Child; D003430:Cross-Sectional Studies; D004334:Drug Administration Schedule; D005260:Female; D005951:Glucose Tolerance Test; D006128:Growth / Q000502:physiology; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy / Q000503:physiopathology* / Q000635:transmission; D017320:HIV Protease Inhibitors / Q000627:therapeutic use; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical; D007333:Insulin Resistance / Q000502:physiology; D008055:Lipids / Q000097:blood; D008297:Male; D011379:Prognosis; D019562:Viral Load; D055815:Young Adult
D019380:Anti-HIV Agents; D001786:Blood Glucose; D017320:HIV Protease Inhibitors; D008055:Lipids