Longitudinal changes in carotid intima-media thickness and cardiovascular risk factors in human immunodeficiency virus-infected children and young adults compared with healthy controls.
OBJECTIVE
HIV-infected patients are at increased risk of cardiovascular disease (CVD). This study assessed longitudinal changes in carotid intima-media thickness (cIMT) as a surrogate marker for CVD, and determined the relationship between cIMT and cardiovascular risk factors in HIV infected children/young adults.


METHODS
This was a longitudinal, observational study comparing cIMT,fasting metabolic profile, and C-reactive protein in HIV-infected subjects 2 to 21 years old to matched controls at baseline and 48 weeks.


RESULTS
Thirty-five HIV + subjects and 37 controls were included in the analysis. Among HIV + subjects, the median age was 10 years, body mass index was 18.7 kg/m2, 37% were male, CD4 count was 32%, 77% had HIV-RNA 400 copies/mL, and 86% were on antiretrovirals. At baseline,HIV + had higher lipids and C-reactive protein. HIV-infected had higher internal carotid artery (ICA) and common carotid artery (CCA) IMT (mm)(ICA: HIV + , 0.90; controls, 0.78 [P = 0.01]; CCA: HIV + , 1.00; controls,0.95 [P = 0.05]). At 48 weeks, CD4% increased and low-density lipoprotein decreased in HIV-infected subjects. ICA and CCA median changes for HIV-infected subjects were -0.23 and -0.15 mm, respectively (both P 0.01). In controls, only CCA changed (P = 0.04). Between-group changes were not significant, except when only 31 perinatally infected HIV - subjects and the controls were compared (CCA P = 0.04). In multiple regression analyses of HIV + subjects, antiretroviral therapy duration and CD4% were associated with cIMT changes.


CONCLUSIONS
Higher cIMT was found in HIV-infected subjects than in healthy controls, but at 48 weeks, cIMT was similar between groups. These data suggest that HIV-infected children/young adults are at high risk of CVD, but lipid control, immune restoration, and viral suppression with continuous antiretroviral therapy may prevent its worsening.
Ross
Allison C
AC
Pediatric Infectious Diseases, Emory University School of Medicine, Atlanta, GA 30322, USA. across3@emory.edu
Storer
Norma
N
O'Riordan
Mary Ann
MA
Dogra
Vikram
V
McComsey
Grace A
GA
D000293:Adolescent; D002097:C-Reactive Protein / Q000032:analysis; D018791:CD4 Lymphocyte Count; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000473:pathology; D002340:Carotid Artery Diseases / Q000453:epidemiology* / Q000473:pathology; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D055442:Metabolome; D012307:Risk Factors; D017539:Tunica Intima / Q000473:pathology*; D017540:Tunica Media / Q000473:pathology*; D019562:Viral Load; D055815:Young Adult
D002097:C-Reactive Protein