title: Lipid and glucose alterations in perinatally-acquired HIV-infected adolescents and young adults.
abstract: BACKGROUND
  Successful antiretroviral therapy (ART) has dramatically reduced mortality among HIV-infected children. However, there is growing concern about long-term effects associated to ART. The aim of this study was to determine the prevalence of metabolic abnormalities in a cohort of perinatally HIV-infected adolescents and young adults and to identify associated factors.
  
  
  METHODS
  We present results from a cross-sectional analysis including individuals 12 to 20 years of age, from a prospective, longitudinal cohort of perinatally-acquired HIV-infected children, adolescents and young adults in Madrid. Clinical and immunological data were recorded and complete lipid and glycemic profiles were determined.
  
  
  RESULTS
  Ninety-nine adolescents were included, with a median age of 15.3 years [13.6-16.7]. Patients with abnormal levels of lipids were as follows: 27.2% total cholesterol ≥200 mg/dl, 25.9% LDL cholesterol (LDL-c) ≥ 130 mg/dl, 14.1% HDL-C < 35 mg/dl and 39.8% triglycerides ≥ 150 mg/dl. Current use of protease inhibitors (PI) was associated with higher triglyceride values (p = 0.022). Four (4.6%) patients showed fasting glucose ≥ 100 mg/dl and 30.6% presented with insulin resistance (IR) (HOMA-IR over the 90th centile). In the multivariate logistic regression analysis adjusted for sex, age, weight, Tanner stage, protease inhibitors (PI) and nucleoside reverse transcriptase inhibitors (NRTI) treatment length and CD4 nadir, IR was associated with higher waist circumference Z score; OR: 3.92(CI95%: 1.15-13.4) (p = 0.03).
  
  
  CONCLUSIONS
  There was a high prevalence of insulin resistance and lipid abnormalities in this cohort of perinatally-acquired HIV-infected adolescents. A simple clinical measurement like waist circumference Z score might be a reliable marker and predictor of insulin resistance in these patients.
authors.affiliation: Pediatric Infectious Diseases Unit, 12 de Octubre University Hospital Complutense University, Instituto de Investigación Hospital 12 de Octubre, C/Avenida de Córdoba, S/N 28048, Madrid, Spain. danielblazquezgamero@gmail.com.
authors.forename: Daniel
authors.initials: D
authors.lastname: Blázquez
authors.affiliation: Department of Pediatrics, Clínico San Carlos Hospital, Madrid, Spain. josetomas.ramos@salud.madrid.org.
authors.forename: José Tomás
authors.initials: JT
authors.lastname: Ramos-Amador
authors.affiliation: Unidad de Pediatría Hospitalaria E. Infecciosas y Tropicales Pediátricas, La Paz University Hospital, Madrid, Spain. tsainzcosta@gmail.com.
authors.forename: Talía
authors.initials: T
authors.lastname: Saínz
authors.affiliation: Unidad de Pediatría Hospitalaria E. Infecciosas y Tropicales Pediátricas, La Paz University Hospital, Madrid, Spain. mariajose.mellado@salud.madrid.org.
authors.forename: María José
authors.initials: MJ
authors.lastname: Mellado
authors.affiliation: Department of Pediatrics, Puerta de Hierro University Hospital, Madrid, Spain. martataida@yahoo.es.
authors.forename: Marta
authors.initials: M
authors.lastname: García-Ascaso
authors.affiliation: Unidad de Pediatría Hospitalaria E. Infecciosas y Tropicales Pediátricas, La Paz University Hospital, Madrid, Spain. maribeldejose@hotmail.com.
authors.forename: María Isabel
authors.initials: MI
authors.lastname: De José
authors.affiliation: Pediatric Infectious Diseases Unit, 12 de Octubre University Hospital Complutense University, Instituto de Investigación Hospital 12 de Octubre, C/Avenida de Córdoba, S/N 28048, Madrid, Spain. pablorojoconejo@netscape.net.
authors.forename: Pablo
authors.initials: P
authors.lastname: Rojo
authors.affiliation: Pediatric Infectious Diseases Unit, Gregorio Marañón University Hospital, Madrid, Spain. marialuisa.navarro@salud.madrid.org.
authors.forename: María Luisa
authors.initials: ML
authors.lastname: Navarro
authors.affiliation: Laboratorio de Inmunobiología Molecular, Instituto de Investigación Sanitaria Hospital Gregorio Marañón (IISHGM), Madrid, Spain. mmunoz.hgugm@gmail.com.
authors.forename: María Ángeles
authors.initials: MÁ
authors.lastname: Muñoz-Fernández
authors.affiliation: Pediatric Infectious Diseases Unit, Gregorio Marañón University Hospital, Madrid, Spain. jesaave@yahoo.es.
authors.forename: Jesús
authors.initials: J
authors.lastname: Saavedra
authors.affiliation: Department of Pediatrics, Móstoles University Hospital, Móstoles, Spain. miguelangel.roa@gmail.com.
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Roa
authors.affiliation: Laboratorio de Inmunobiología Molecular, Instituto de Investigación Sanitaria Hospital Gregorio Marañón (IISHGM), Madrid, Spain. santiago.jimenezde@salud.madrid.org.
authors.forename: Santiago
authors.initials: S
authors.lastname: Jiménez
authors.affiliation: Department of Pediatrics, Principe de Asturias University Hospital, Alcalá de Henares, Spain. jbeceiro.hupa@salud.madrid.org.
authors.forename: José
authors.initials: J
authors.lastname: Beceiro
authors.affiliation: Department of Pediatrics, Getafe University Hospital, Getafe, Spain. prieto_tatoluis_manuel@hotmail.com.
authors.forename: Luis
authors.initials: L
authors.lastname: Prieto
authors.affiliation: Department of Pediatrics, Clínico San Carlos Hospital, Madrid, Spain. mgarcial.hciii@salud.madrid.org.
authors.forename: Milagros García
authors.initials: MG
authors.lastname: Hortelano
authors.affiliation: Pediatric Infectious Diseases Unit, 12 de Octubre University Hospital Complutense University, Instituto de Investigación Hospital 12 de Octubre, C/Avenida de Córdoba, S/N 28048, Madrid, Spain. maribelgt@hotmail.com.
authors.forename: María Isabel
authors.initials: MI
authors.lastname: González-Tomé
mesh_terms: D000293:Adolescent; D023241:Antiretroviral Therapy, Highly Active; D001786:Blood Glucose / Q000378:metabolism*; D002648:Child; D008076:Cholesterol, HDL / Q000378:metabolism*; D008078:Cholesterol, LDL / Q000378:metabolism*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D050171:Dyslipidemias / Q000453:epidemiology / Q000378:metabolism*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000378:metabolism*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical; D007333:Insulin Resistance; D050356:Lipid Metabolism; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D011480:Protease Inhibitors / Q000627:therapeutic use; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use; D014280:Triglycerides / Q000378:metabolism*; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D011480:Protease Inhibitors; D018894:Reverse Transcriptase Inhibitors; D014280:Triglycerides