Meeting News

'Biologic link' may connect in utero HIV exposure, adolescent obesity

NEW ORLEANS — Children who were exposed to HIV but uninfected in utero show a predisposition for developing obesity and reactive airway disease in adolescence, according to findings presented at the Endocrine Society Annual Meeting.

Lindsay Fourman

“To us this indicates that there is a strong biologic link between the in utero HIV exposure and the long-term metabolic health of the offspring,” Lindsay Fourman, MD, of Massachusetts General Hospital in Boston, said during a press conference.

Fourman and colleagues compared the long-term health outcomes of 50 adolescents and young adults born after 1990 who were HIV-exposed but uninfected while in utero (mean age, 18 years; 46% females) with those of 141 age-, sex-, race- and ZIP code-matched adolescents who were not exposed to the virus (mean age, 19 years; 45% females). Manual chart reviews of medical records taken from a patient database registry of both the adolescents and their mothers were performed.

More adolescents and young adults in the HIV-exposed group had obesity in adolescence than those in the matched group (42% vs. 24%; P = .04). There was also a higher rate of reactive airway disease among HIV-exposed group compared with the control group (40% vs. 24%; P = .04).

Maternal CD4 levels appear to play a role in these findings, according to Fourman, as lower counts in the third trimester of the mothers of HIV-exposed group had an association with higher adolescent BMI (P = .01) as well as higher birth and placental weights (P = .006). According to Fourman, there was an eightfold increase in the odds of obesity for HIV-exposed but uninfected adolescents and young adults whose mothers had CD4 counts of less than 250 cells/mL (OR = 8.2; 95% CI, 1.5-54.9).

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More adolescents and young adults in the HIV-exposed group had obesity in adolescence than those in the matched group.
Adobe Stock

“We found this to be remarkable because these two parameters, the CD4 count and BMI in the adolescent, are something that was collected over 12 years apart in time. The fact that they are so strongly correlated was striking,” Fourman said, noting that the association remained even after adjustments for paternal age, BMI, antiretroviral therapy regimen, HIV duration and median income.

Fourman said next steps include establishing phenotypes via prospective studies to confirm other possibly connected issues such as blood glucose and fatty liver. As for specific interventions to lower the prevalence of obesity in this population, Fourman suggested that steps could be taken during pregnancy to improve the in utero environment if that proves to be the predominant source of this association. In addition, more can be done to ensure proper steps are taken during childhood as well.

“Right now, these kids are followed for the first 2 years of life to rule out that they don’t have HIV, and then they basically return to their regular pediatrician and are not necessarily flagged as having had in utero exposure anymore,” Fourman told Endocrine Today. “It’s not really prominent in their medical record, and so the clinician loses sight of that, and they might be at high risk.” – by Phil Neuffer

Reference:

Fourman L, et al. SAT-256. Obesity and reactive airway disease are increased among HIV-exposed uninfected adolescents. Presented at: The Endocrine Society Annual Meeting; March 23-26, 2019; New Orleans.

Disclosure: Fourman reports no relevant financial disclosures.

NEW ORLEANS — Children who were exposed to HIV but uninfected in utero show a predisposition for developing obesity and reactive airway disease in adolescence, according to findings presented at the Endocrine Society Annual Meeting.

Lindsay Fourman

“To us this indicates that there is a strong biologic link between the in utero HIV exposure and the long-term metabolic health of the offspring,” Lindsay Fourman, MD, of Massachusetts General Hospital in Boston, said during a press conference.

Fourman and colleagues compared the long-term health outcomes of 50 adolescents and young adults born after 1990 who were HIV-exposed but uninfected while in utero (mean age, 18 years; 46% females) with those of 141 age-, sex-, race- and ZIP code-matched adolescents who were not exposed to the virus (mean age, 19 years; 45% females). Manual chart reviews of medical records taken from a patient database registry of both the adolescents and their mothers were performed.

More adolescents and young adults in the HIV-exposed group had obesity in adolescence than those in the matched group (42% vs. 24%; P = .04). There was also a higher rate of reactive airway disease among HIV-exposed group compared with the control group (40% vs. 24%; P = .04).

Maternal CD4 levels appear to play a role in these findings, according to Fourman, as lower counts in the third trimester of the mothers of HIV-exposed group had an association with higher adolescent BMI (P = .01) as well as higher birth and placental weights (P = .006). According to Fourman, there was an eightfold increase in the odds of obesity for HIV-exposed but uninfected adolescents and young adults whose mothers had CD4 counts of less than 250 cells/mL (OR = 8.2; 95% CI, 1.5-54.9).

#
More adolescents and young adults in the HIV-exposed group had obesity in adolescence than those in the matched group.
Adobe Stock

“We found this to be remarkable because these two parameters, the CD4 count and BMI in the adolescent, are something that was collected over 12 years apart in time. The fact that they are so strongly correlated was striking,” Fourman said, noting that the association remained even after adjustments for paternal age, BMI, antiretroviral therapy regimen, HIV duration and median income.

Fourman said next steps include establishing phenotypes via prospective studies to confirm other possibly connected issues such as blood glucose and fatty liver. As for specific interventions to lower the prevalence of obesity in this population, Fourman suggested that steps could be taken during pregnancy to improve the in utero environment if that proves to be the predominant source of this association. In addition, more can be done to ensure proper steps are taken during childhood as well.

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“Right now, these kids are followed for the first 2 years of life to rule out that they don’t have HIV, and then they basically return to their regular pediatrician and are not necessarily flagged as having had in utero exposure anymore,” Fourman told Endocrine Today. “It’s not really prominent in their medical record, and so the clinician loses sight of that, and they might be at high risk.” – by Phil Neuffer

Reference:

Fourman L, et al. SAT-256. Obesity and reactive airway disease are increased among HIV-exposed uninfected adolescents. Presented at: The Endocrine Society Annual Meeting; March 23-26, 2019; New Orleans.

Disclosure: Fourman reports no relevant financial disclosures.

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