Earlier antiretroviral initiation is independently associated with better arterial stiffness in children living with perinatally acquired HIV with sustained viral suppression in Mozambique.

Igor S Dobe,Steve Innes,Ana O Mocumbi,Birhanu Ayele,Sara H Browne,Noorjean Majid

doi:10.4102/sajhivmed.v22i1.1282

Abstract

BackgroundCardiovascular disease is a major driver of morbidity and mortality in adults living with HIV. The drivers of cardiovascular disease in children living with perinatally acquired HIV (PHIV) with sustained HIV viral suppression are unclear.ObjectivesWe explored the contribution of HIV-specific risk factors to arterial stiffness independently of traditional risk factors (metabolic syndrome [MetS]) in prepubertal children with PHIV with sustained viral suppression in a low-income country in Africa.MethodFor this cross-sectional analysis, arterial stiffness was assessed by pulse wave velocity z-score (PWVz), measured using a Vicorder device. Metabolic syndrome components were measured. We retrospectively collected the antiretroviral therapy (ART) exposures, HIV stage, CD4 count and HIV viral load. A multivariate linear regression model was constructed for MetS components, retaining age and gender as obligatory variables. We then added HIV-related metrics to assess whether these had an independent or additive effect.ResultsWe studied 77 virally suppressed children with PHIV without evidence of cardiovascular disease (from medical history and physical examination). In the initial model, the PWVz was independently associated with each MetS component. The PWVz was higher in participants with proportionally greater visceral fat (waist/height ratio), elevated lipids (triglyceride/high-density lipoprotein ratio) and insulin resistance (log homeostatic model assessment [HOMA]). The addition of age at ART initiation increased the model R2 value from 0.36 to 0.43. In the resulting model, younger age at ART initiation was independently associated with a better PWVz (P < 0.001).ConclusionEarlier ART initiation was independently associated with lower large artery stiffness. This effect was independent of the effect of elevated lipids, visceral fat and insulin resistance.

Highlights

Effective antiretroviral therapy (ART) for HIV infection has increased life expectancy, with survival extending into decades.[1]
The initial model for metabolic syndrome (MetS) components (Model 1, Table 2) revealed that the PWV z-score (PWVz) was independently associated with each component of the MetS, as expected: the PWVz was higher in participants with proportionally greater visceral fat, elevated lipids and resistance
The resulting model (Model 2, Table 3) revealed that the PWVz was independently associated with younger age at ART initiation

Summary

Introduction

Effective antiretroviral therapy (ART) for HIV infection has increased life expectancy, with survival extending into decades.[1] Cardiovascular disease is a leading co-morbidity and cause of mortality among adults living with HIV and is predicted to have a major impact on the quality and length of life in children and adolescents living with perinatally acquired HIV (PHIV).[2]. Cardiovascular disease is a major driver of morbidity and mortality in adults living with HIV. The drivers of cardiovascular disease in children living with perinatally acquired HIV (PHIV) with sustained HIV viral suppression are unclear

Objectives

Results

Conclusion