The same mechanisms that cause those with long-term HIV infection to suffer higher rates of heart attacks or strokes put children born with disease at early risk of cardiovascular disease, according to a new study.
A new study finds that children born with HIV may be at higher risk for cardiovascular (CV) disease by adolescence, due to the accumulated effects of chronic inflammation and other risk factors.
The study, published this week in the journal PLoS ONE, highlights the importance of recognizing the long-term effects of both HIV and antiretroviral therapy (ART), which include hyperlipidemia, diabetes, and higher rates of cardiovascular morbidity. ART has been specifically linked to hyperlipidemia; protease inhibitors, in particular, suppress the process of lipid homeostatis in the liver, which causes an increase in circulating lipids and insulin resistance.
Thus, physicians who treat patients with long-term HIV infection report seeing high levels of coronary plaque, and heart attacks and strokes are among the biggest health concerns for these patients over the past decade. This has led to the REPRIEVE trial, which is studying the use of statins in this population.
The REPRIEVE trial involves adults starting at age 40. The study in PLoS ONE finds something else: the CV effects of living with HIV from birth appear to show up by the time children reach their teens, based on measurements taken among a group of 65 HIV-infected Brazilian children and adolescents who were compared with a control group. Participants were between 8 and 15 years of age.
Measurements taken included information about the level of ART, viral loads for the HIV group, CD4 T-cell counts, body mass, height, body fat, blood pressure, total cholesterol, triglycerides, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, blood glucose, insulin, glycated hemogloblin (A1C), and information about cytokines interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-α).
Researchers found the participants with HIV had similar body size to the control group—measurements were similar for body fat, trunk body fat, fat mass index, blood pressure, and insulin, and total cholesterol. But those with HIV had worse lipid profiles: higher levels of triglycerides, LDL cholesterol, and blood glucose; IL-6 and TNF-α were also higher for the HIV group. Those in the HIV group also had higher mean and maximum measures for carotid intima-media thickness, a measure of the inner 2 layers of the carotid artery that can serve as an early warning of heart disease before patients experience symptoms.
In discussing the findings, the authors said the clinical implications of this last finding was “uncertain,” although it “could preclude early development of morbidity and mortality due to cardiovascular diseases, especially in young people with severe abnormalities of individual risk factors.”
“It is necessary to keep the focus that chronic inflammation imposed by HIV is the central mechanism that may cause an increase in the risk of cardiac disease,” the authors wrote. “We conclude that HIV-infected children and adolescents may be at risk for premature atherosclerosis due to inflammation, elevated [carotid intima-media thickness], higher atherogenic lipid levels, and higher blood glucose levels.”
De Lima LRA, Petroski EL, Moreno YMF, et al. Dyslipidemia, chronic inflammation, and subclinical atherosclerosis in children and adolescents with HIV: the PositHIVe Health Study [published online January 10, 2018]. PLoS ONE. 2018; http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0190785.