All anti-retroviral therapy is not heart healthy

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As highly active anti-retroviral therapy (HAART) controls HIV proliferation and indefinitely extends the lives of infected individuals, attendant morbidities of therapies, disease, and aging loom large. Morbidities obviously have major importance for perinatally-infected children who will receive therapies from infancy and throughout their lives. In this issue of The Journal, Miller et al present important findings of established risk factors for cardiovascular disease in children infection with HIV (most of whom were receiving HAART) compared with NHANES controls and contemporaries. Children infected with HIV had higher triglyceride and lower HDL-cholesterol levels than controls (P <.001). Class-specific therapies had independent effects: protease inhibitor therapy with higher triglyceride (P = .02), higher LDL-cholesterol (P = .04) and lower HDL-cholesterol (P = .02) levels; and non-nucleoside reverse-transcriptase inhibitor therapy with lower visceral fat (P = .01) and higher HDL-cholesterol level (P = .005). Because body mass index was not highly predictive of these cardiovascular risk factor findings, repeated evaluations in individuals, more studies in patient cohorts and more emphasis on heart-healthy lifestyles and therapies are all important steps to optimize long term health of children, adolescents, and adults infected with HIV.

In an accompanying editorial, Siberry reminds us of the short (2 decade) but rapidly advancing story of the lives of perinatally-infected children and that these pioneers are writing medical history as they march into adulthood.