Risk Factors for Cardiovascular Disease in Children Infected with Human Immunodeficiency Virus-1

Objective

To determine risk factors for cardiovascular disease (CVD) in children infected with human immunodeficiency virus (HIV) compared with nationally representative controls from 2003-2004 National Health and Nutrition Examination Survey (NHANES) data.

Study design

A prospective, longitudinal analysis of CVD risk factors in 42 HIV-infected children compared with NHANES controls, with multivariable modeling of demographic, disease-specific, and treatment-related factors contributing to cardiac risk in the HIV cohort.

Results

The 42 children infected with HIV were initially an average of 10.1 years old; 68% were Centers for Disease Control and Prevention pediatric HIV disease stage B or C, and 76% were receiving highly active antiretroviral therapy (HAART). Compared with age- and sex-adjusted NHANES controls, the children infected with HIV had lower weight (−0.46 standard deviation [SD] vs +0.54 SD; P < .001), height (−0.62 SD vs +0.26 SD; P < .001), and body mass index (−0.09 SD vs +0.51 SD; P < .001), a higher level of triglycerides (136 mg/dL vs 90 mg/dL; P < .001), and a lower level of high-density lipoprotein (HDL) cholesterol (47 mg/dL vs 54 mg/dL; P < .001). Protease inhibitor therapy was independently associated with higher triglyceride (P = .02) and low-density lipoprotein cholesterol levels (P = .04) and lower HDL cholesterol level (P = .02); nonnucleoside reverse-transcriptase inhibitor therapy was associated with lower visceral fat (P = .01) and higher HDL cholesterol level (P = .005).

Conclusions

Children infected with HIV have adverse cardiac risk profiles compared with NHANES controls. Antiretroviral therapy has a significant influence on these factors.

Abbreviations: AMC, Arm muscle circumference, ART, Antiretroviral therapy, BMI, Body mass index, CDC, Centers for Disease Control and Prevention, CT, Computed tomography, CVD, Cardiovascular disease, HAART, Highly active antiretroviral therapy, HDL, High-density lipoprotein, HIV, Human immunodeficiency virus, IQR, Interquartile range, LDL, Low-density lipoprotein, MAC, Mid-arm circumference, NHANES, National Health and Nutrition Examination Survey, NRTI, Nucleoside reverse-transcriptase inhibitor, NNRTI, Nonnucleoside reverse-transcriptase inhibitor, PI, Protease inhibitor, SAT, Subcutaneous adipose tissue, SD, Standard deviation, TSF, Triceps skinfold, VAT, Visceral adipose tissue