title: Aggregate risk of cardiovascular disease among adolescents perinatally infected with the human immunodeficiency virus.
abstract: BACKGROUND
  Perinatally HIV-infected adolescents may be susceptible to aggregate atherosclerotic cardiovascular disease risk, as measured by the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) coronary arteries and abdominal aorta risk scores, as a result of prolonged exposure to HIV and antiretroviral therapy.
  
  
  RESULTS
  Coronary arteries and abdominal aorta PDAY scores were calculated for 165 perinatally HIV-infected adolescents, using a weighted combination of modifiable risk factors: dyslipidemia, cigarette smoking, hypertension, obesity, and hyperglycemia. Demographic and HIV-specific predictors of scores ≥1 were identified, and trends in scores over time were assessed. Forty-eight percent and 24% of the perinatally HIV-infected adolescents had coronary arteries and abdominal aorta scores ≥1, representing increased cardiovascular disease risk factor burden. Significant predictors of coronary arteries scores ≥1 included male sex, history of an AIDS-defining condition, longer duration of use of a ritonavir-boosted protease inhibitor, and no prior use of tenofovir. Significant predictors of abdominal aorta scores ≥1 included suppressed viral load, history of an AIDS-defining condition, and longer duration of boosted protease inhibitor use. No significant changes in coronary arteries and abdominal aorta risk scores were observed over the 4-year study period.
  
  
  CONCLUSIONS
  A substantial proportion of perinatally HIV-infected youth have high PDAY scores, reflecting increased aggregate atherosclerotic cardiovascular disease risk factor burden. High scores were predicted by HIV disease severity and boosted protease inhibitor use. PDAY scores may be useful in identifying high-risk youth who may benefit from early lifestyle or clinical interventions.
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, MA (K.P., G.R.S.); Center for Biostatistics in AIDS Research, Boston, MA (K.P., J.W., D.L.J., G.R.S., P.L.W.); Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit (S.E.L.); Division of Pediatric Clinical Research and Division of Pediatric Infectious Disease and Immunology, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL (D.C.L., G.B.S., J.D.W., T.L.M.); Saban Research Institute of Children's Hospital Los Angeles, Keck School of Medicine of USC, Los Angeles, CA (M.E.G.); Section of Pediatric Endocrinology and Diabetology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis (L.A.D.M.); Department of Pediatrics, Tulane University Health Sciences Center, New Orleans, LA (R.B.V.D.); Maternal and Pediatric Infectious Disease Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (G.K.S.); Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston (W.T.S.); Department of Pediatrics, Northwestern University Feinberg School of Medicine, Children's Memorial Hospital, Chicago, IL (L.Y.); Division of Cardiology, University of Maryland School of Medicine, Baltimore (S.D.F.); and Department of Pediatrics, Division of Pediatric Cardiology, Presbyterian Hospital/Columbia University, College of Physicians and Surgeons, New York City, NY (T.J.S.).
authors.forename: Kunjal
authors.initials: K
authors.lastname: Patel
authors.forename: Jiajia
authors.initials: J
authors.lastname: Wang
authors.forename: Denise L
authors.initials: DL
authors.lastname: Jacobson
authors.forename: Steven E
authors.initials: SE
authors.lastname: Lipshultz
authors.forename: David C
authors.initials: DC
authors.lastname: Landy
authors.forename: Mitchell E
authors.initials: ME
authors.lastname: Geffner
authors.forename: Linda A
authors.initials: LA
authors.lastname: Dimeglio
authors.forename: George R
authors.initials: GR
authors.lastname: Seage
authors.forename: Paige L
authors.initials: PL
authors.lastname: Williams
authors.forename: Russell B
authors.initials: RB
authors.lastname: Van Dyke
authors.forename: George K
authors.initials: GK
authors.lastname: Siberry
authors.forename: William T
authors.initials: WT
authors.lastname: Shearer
authors.forename: Luciana
authors.initials: L
authors.lastname: Young
authors.forename: Gwendolyn B
authors.initials: GB
authors.lastname: Scott
authors.forename: James D
authors.initials: JD
authors.lastname: Wilkinson
authors.forename: Stacy D
authors.initials: SD
authors.lastname: Fisher
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Starc
authors.forename: Tracie L
authors.initials: TL
authors.lastname: Miller
mesh_terms: D000293:Adolescent; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000453:epidemiology*; D002648:Child; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D008297:Male; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000175:diagnosis* / Q000453:epidemiology*; D012307:Risk Factors
keywords: HIV; adolescence; atherosclerosis; risk factors