title: Metabolic disorders in vertically HIV-infected children: future adults at risk for cardiovascular disease.
abstract: BACKGROUND
  Despite metabolic disorders in HIV-infected children being widely described, there is still a lack of agreed criteria for diagnoses and management. Numerous studies are coming from other settings and results are heterogeneous when assessing several analytical and clinical parameters.
  
  
  OBJECTIVE
  To describe the prevalence of metabolic disorders and associated risk factors in the Spanish National cohort of HIV-infected pediatric patients (CoRISpe).
  
  
  METHODS
  This was a cross-sectional study following all vertically HIV-infected children and adolescents in three referral centers included in the CoRISpe. Metabolic data (fasting lipids, glucose and insulin levels and thyroid hormone levels) were collected. Fat distribution was clinically assessed by expert clinicians.
  
  
  RESULTS
  We included 157 patients [median age 13 years, interquartile range (IQR) 10-16]. Median duration of antiretroviral therapy was 10.2 years (IQR 5.0-13.0). Almost 20% of patients had insulin resistance and this was associated with hepatitis C co-infection, current use of stavudine (d4T) and hypertriglyceridemia. Hypercholesterolemia and hypertriglyceridemia were found in 23.9% and 24.8% of patients and were associated with current use of protease inhibitors (p = 0.042 and p = 0.022, respectively). Abnormal fat distribution was observed in 63 patients (40.5%): lipoatrophy in 32 (20.4%), lipohypertrophy in eight (5.1%) and a mixed pattern in 23 patients (14.6%), and it was significantly associated with previous exposure to stavudine (p < 0.001).
  
  
  CONCLUSIONS
  Metabolic disorders are a significant problem in our HIV-infected pediatric population. We need to encourage the development of global strategies and the creation of consensus guidelines that can decrease the cardiovascular risk in this population.
authors.affiliation: Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron -- Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Dapena
authors.forename: Beatriz
authors.initials: B
authors.lastname: Jiménez
authors.forename: Antoni
authors.initials: A
authors.lastname: Noguera-Julian
authors.forename: Pere
authors.initials: P
authors.lastname: Soler-Palacín
authors.forename: Clàudia
authors.initials: C
authors.lastname: Fortuny
authors.forename: Rebeca
authors.initials: R
authors.lastname: Lahoz
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Aracil
authors.forename: Concepción
authors.initials: C
authors.lastname: Figueras
authors.forename: María Isabel
authors.initials: MI
authors.lastname: de José
mesh_terms: D000293:Adolescent; D000328:Adult; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D002648:Child; D003430:Cross-Sectional Studies; D050171:Dyslipidemias / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000635:transmission*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000706:statistics & numerical data*; D007333:Insulin Resistance; D008297:Male; D008659:Metabolic Diseases / Q000453:epidemiology*; D015999:Multivariate Analysis; D012307:Risk Factors