In the Journals

Adolescents born with HIV at increased risk for CVD

Adolescents who contracted HIV perinatally have a significantly heightened aggregate risk for atherosclerotic CVD, according to findings from the Adolescent Master Protocol of the Pediatric HIV/AIDS Cohort Study.
This increased risk may be related to the severity of HIV and long-term exposure to antiretroviral therapy, the researchers wrote.

The study evaluated 451 perinatally HIV-infected adolescents aged 15 to 19 years with a history of antiretroviral use, along with 227 uninfected adolescents. Aggregate risk levels were formulated for these patients during annual visits during the 4-year study, according to the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) coronary arteries and abdominal aorta risk scores. These scores included assessment of modifiable risk factors such as dyslipidemia, smoking status, hypertension, obesity and hyperglycemia, and they were calculated for at least one time point in 165 of the infected participants.

Fasting blood work was taken at each annual visit to assess glucose and total and HDL cholesterol levels. HIV-related clinical evaluation, including measurements of disease severity such as T-cell count, HIV viral load and CDC clinical classification of HIV disease, also was performed.

The researchers found that 48% of the perinatally infected HIV patients had coronary artery scores ≥1 and 24% had abdominal aorta risk scores ≥1, suggesting increased CVD risk among these adolescents. Characteristics found to be significantly predictive of coronary artery scores ≥1 on multivariate analysis included male sex, a history of AIDS-associated clinical conditions, longer duration of ritonavir (Norvir, AbbVie)-boosted protease inhibitor use and no previous use of tenofovir (Viread, Gilead Sciences; P<.05 for all; C-statistic=0.74 for final model). HIV virologic suppression (≤400 copies/mL), history of an AIDS-defining clinical event and a longer duration of treatment with a boosted protease inhibitor were significantly predictive of abdominal aorta risk scores ≥1 (P<.05 for all; C-statistic=0.84 for final model).

There were no significant changes over time to coronary artery (P=.19) or abdominal aorta risk scores (P=.34). The researchers wrote that additional studies will be needed to ascertain whether these observations indicate consistency over time, or whether the duration of follow-up had been too short.

“Continued follow-up of adolescents in our study as they age into adulthood will be necessary to better evaluate longitudinal trends in CVD risk and identify associated factors,” the researchers wrote. “… Our study contributes to growing literature showing increased global risk for premature CVD morbidity and mortality in the perinatally HIV-infected population, including risk of cardiomyopathy and cardiometabolic disease. A comprehensive assessment and treatment plan based on validated screening and interventions may be useful for those at highest risk in the perinatally HIV-infected population.”

Disclosure: The researchers report no relevant financial disclosures.

Adolescents who contracted HIV perinatally have a significantly heightened aggregate risk for atherosclerotic CVD, according to findings from the Adolescent Master Protocol of the Pediatric HIV/AIDS Cohort Study.
This increased risk may be related to the severity of HIV and long-term exposure to antiretroviral therapy, the researchers wrote.

The study evaluated 451 perinatally HIV-infected adolescents aged 15 to 19 years with a history of antiretroviral use, along with 227 uninfected adolescents. Aggregate risk levels were formulated for these patients during annual visits during the 4-year study, according to the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) coronary arteries and abdominal aorta risk scores. These scores included assessment of modifiable risk factors such as dyslipidemia, smoking status, hypertension, obesity and hyperglycemia, and they were calculated for at least one time point in 165 of the infected participants.

Fasting blood work was taken at each annual visit to assess glucose and total and HDL cholesterol levels. HIV-related clinical evaluation, including measurements of disease severity such as T-cell count, HIV viral load and CDC clinical classification of HIV disease, also was performed.

The researchers found that 48% of the perinatally infected HIV patients had coronary artery scores ≥1 and 24% had abdominal aorta risk scores ≥1, suggesting increased CVD risk among these adolescents. Characteristics found to be significantly predictive of coronary artery scores ≥1 on multivariate analysis included male sex, a history of AIDS-associated clinical conditions, longer duration of ritonavir (Norvir, AbbVie)-boosted protease inhibitor use and no previous use of tenofovir (Viread, Gilead Sciences; P<.05 for all; C-statistic=0.74 for final model). HIV virologic suppression (≤400 copies/mL), history of an AIDS-defining clinical event and a longer duration of treatment with a boosted protease inhibitor were significantly predictive of abdominal aorta risk scores ≥1 (P<.05 for all; C-statistic=0.84 for final model).

There were no significant changes over time to coronary artery (P=.19) or abdominal aorta risk scores (P=.34). The researchers wrote that additional studies will be needed to ascertain whether these observations indicate consistency over time, or whether the duration of follow-up had been too short.

“Continued follow-up of adolescents in our study as they age into adulthood will be necessary to better evaluate longitudinal trends in CVD risk and identify associated factors,” the researchers wrote. “… Our study contributes to growing literature showing increased global risk for premature CVD morbidity and mortality in the perinatally HIV-infected population, including risk of cardiomyopathy and cardiometabolic disease. A comprehensive assessment and treatment plan based on validated screening and interventions may be useful for those at highest risk in the perinatally HIV-infected population.”

Disclosure: The researchers report no relevant financial disclosures.