There are increased risks for
cardiovascular disease (CVD) and insulin resistance among young individuals
with HIV, according to research results presented at the virtual Conference on Retroviruses and Opportunistic
Infections, held from March 8 to 11, 2020.
Using electronic health records from the
Adolescent Medicine Trials Network, investigators examined whether detectable
viral load and low CD4 count were associated with CVD in youth, aged 14 to 26
years, living with HIV.1
The study cohort was predominately black
and male with a mean age of 21 years. Detectable viral load was demonstrated in
47.8% of patients and and 8.6% had a
baseline CD4 ≤ 200, indicating immune dysfunction Bivariate and multivariate
linear regression model analyses indicated that viral load was associated with
significantly increased risk for CVD. According to the investigators, “these
findings contribute to our understanding of the broad spectrum of the [viral
load] CVD risk relationship.”
Adding to the understanding of this relationship, a separate study presented at the meeting showed insulin resistance as a factor for increased long-term CVD risk among youth with HIV.
Investigators examined the insulin
resistance trajectory in a longitudinal cohort study including 90 children who
were perinatally infected with HIV and received antiretroviral therapy (ART) at
age <12 weeks.2. 2 Of note, these children
demonstrated consistently normal ranges of CD4 cell counts. Cases were matched
with 156 HIV-exposed uninfected children and 161 HIV-unexposed uninfected
children.
The main study outcome was the Homeostatic Model Assessment (HOMA)
insulin resistance index (HOMA-IR), modelled using log HOMA-IR given skewness.
After adjusting for demographic and physical factors as well as random effect,
the perinatally infected group had a geometric mean HOMA-IR of 1.2-times (95%
CI, 1.1-1.3) greater than that of unexposed and uninfected children. The
elevated HOMA-IR was not likely to be the result of environmental differences
between households, as no significant differences were found between the 2 uninfected
control groups.
Investigators concluded that despite
being closely monitored and receiving ART soon after birth, these youth exhibited
elevated insulin resistance that persisted into adolescence, which has
long-term implications for cardiovascular risk.
References
- Gurung S, Simpson KN, Grov C, et al. Cardiovascular risk profile: A clinic-basded sample of youth living with HIV in the US. Poster presented at: CROI 2020; March 8-11, 2020. http://www.croiconference.org/sites/default/files/uploads/croi2020-boston-abstract-ebook.pdf. Accessed March 19, 2020.
- Davies C, Innes S, Cotton M, Browne SH, Ayele B. CHER trial cohort shows greater insulin resistance into adolescence. Poster presented at: CROI 2020; March 8–11, 2020; http://www.croiconference.org/sites/default/files/uploads/croi2020-boston-abstract-ebook.pdf. Accessed March 19, 2020.
