Abstract
HIV-infected children and adolescents may be at risk for cardiovascular disease due to chronic inflammation and exacerbation of risk factors. The aim of this study was as follows: 1) compare cardiovascular risk factors, chronic inflammation, and carotid intima-media thickness (IMTc) between the HIV and control groups; 2) determine the association of HIV and antiretroviral (ART) regimens with cardiovascular risk factors, chronic inflammation, and IMTc; and 3) identify variables associated with elevated IMTc. Cross-sectional analysis of 130 children and adolescents, 8–15 years of age, divided into HIV-infected (n = 65) and healthy control (n = 65) participants. Body fat, blood pressure, glycemia, insulin, and glycated hemoglobin, total cholesterol and fractions (LDL-C and HDL-C), triglycerides, C-reactive protein (CRP), interleukin (IL)-6, tumor necrosis factor-alpha (TNF-α), and the IMTc were measured. The results showed HIV-infected children and adolescents had higher levels of glycemia (87.9 vs. 75.9 mg.dL−1, p< 0.001), LDL-c (94.7 vs. 79.5 mg.dL−1, p = 0.010), triglycerides (101.2 vs. 61.6 mg.dL−1, p< 0.001), CRP (1.6 vs. 1.0 mg.L−1, p = 0.007), IL-6 (1.42 vs. 0.01 pg.mL−1, p< 0.001), TNF-α (0.49 vs. 0.01 pg.mL−1, p< 0.001), mean IMTc (0.526 vs. 0.499 mm, p = 0.009), and lower HDL-c (53.7 vs. 69.4 mg.dL−1, p< 0.001) compared to controls. Systolic blood pressure (β = 0.006, p = 0.004) and TNF-α (β = −0.033, p = 0.029) accounted for 16% of IMTc variability in HIV-infected children and adolescents. In patients using protease inhibitors-based ART, male gender (β = −0.186, p = 0.008), trunk body fat (β = −0.011, p = 0.006), glucose (β = 0.005, p = 0.046), and IL-6 (β = 0.017, p = 0.039) accounted for 28% of IMTc variability. HIV-infected children and adolescents may be at risk for premature atherosclerosis due to chronic inflammation and dyslipidemia. Interventions with the potential to improve lipid profile, mitigate inflammation, and reduce cardiovascular risk are needed.
Highlights
Children and adolescents infected with human immunodeficiency virus (HIV) by mother-to-child transmission are exposed to the adverse effects of HIV, related complications, and adverse reactions of treatment since conception
The main finding of the present study was HIV-infected children and adolescents had profiles potentially associated with premature atherosclerosis due to inflammation, elevated intima-media thickening of the carotid artery (IMTc), higher atherogenic lipid levels, and higher blood glucose levels
Results of our study indicated HIV infection was associated with elevated levels of IL-6 and reduced high-density lipoprotein of cholesterol (HDL-C) regardless of antiretroviral use or type (Non protease inhibitors (PI)-antiretroviral therapy (ART) or PI-ART), Both parameters may contribute to premature atherosclerosis and mortality through chronic inflammation, thrombotic activity, and damage to the endothelial structure [10, 38, 40]
Summary
Children and adolescents infected with HIV by mother-to-child transmission are exposed to the adverse effects of HIV, related complications, and adverse reactions of treatment since conception. The abnormalities in carbohydrate metabolism are evident [2,3,4,5], but less common complications [6], other studies have not demonstrated any impairment [7, 8]. The occurrence of these cardiovascular risk factors in childhood and adolescence has been associated with intima-media thickening of the carotid artery (IMTc) [9]. There is a need for studies to test the association between HIV and inflammation biomarkers, with a control group as a reference, verifying the contribution of cardiovascular risk factors and inflammation to IMTc
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