Longitudinal assessment of metabolic abnormalities in adolescents and young adults with HIV-infection acquired perinatally or in early childhood.
Metabolic complications of HIV pose challenges for health maintenance among young adults who acquired HIV in early childhood. Between July 2004 and July 2009, we evaluated 47 HIV-infected subjects who acquired HIV in early life. Participants completed glucose tolerance testing; insulin, lipid, urine albumin, and creatinine determinations; and dual-energy x-ray absorptiometry scans. Longitudinal data were available for 39 subjects; duration of follow-up was 26.4 ± 16.8 months. At baseline, participants were 17.1 ± 3.9 years old; and duration of antiretroviral therapy was 12.7 ± 3.4 years. CD4 count was 658 ± 374 cells per cubic millimeter, and 55% had undetectable viral load. Impaired glucose tolerance was present in 15%; 33% had insulin resistance (homeostasis model assessment of insulin resistance >4.0). Furthermore, 52% had triglycerides of at least 150 mg/dL, 36% had high-density lipoprotein cholesterol less than 40 mg/dL, 18% had low-density lipoprotein cholesterol of at least 130 mg/dL, and 25% had total cholesterol of at least 200 mg/dL. Microalbuminuria was present in 15% of participants and was inversely correlated with CD4% (P = .001). During follow-up, more than one third remained insulin resistant; lipid parameters tended to improve. There were significant increases in body mass index (P = .0002), percentage leg fat (P = .008), and percentage trunk fat (P = .002). Impaired glucose tolerance, insulin resistance, dyslipidemia, and microalbuminuria are common among young adults with HIV. Long-term exposure to therapy may translate into substantial persistent metabolic risk.
Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA.
David
D
Dimock
Vijaya
V
Thomas
Anna
A
Cushing
Julia B
JB
Purdy
Carol
C
Worrell
Jeffrey B
JB
Kopp
Rohan
R
Hazra
Colleen
C
Hadigan
D015502:Absorptiometry, Photon; D000293:Adolescent; D000419:Albuminuria / Q000209:etiology; D000886:Anthropometry; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D001823:Body Composition / Q000502:physiology; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000517:prevention & control; D002340:Carotid Artery Diseases / Q000139:chemically induced / Q000473:pathology; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D005951:Glucose Tolerance Test; D015658:HIV Infections / Q000150:complications* / Q000209:etiology / Q000378:metabolism; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance / Q000502:physiology; D052439:Lipid Metabolism Disorders / Q000139:chemically induced / Q000378:metabolism; D008060:Lipodystrophy / Q000139:chemically induced / Q000209:etiology; D008137:Longitudinal Studies; D008297:Male; D008659:Metabolic Diseases / Q000139:chemically induced / Q000209:etiology* / Q000378:metabolism; D011627:Puberty; D040242:Risk Reduction Behavior; D055815:Young Adult
D007328:Insulin