HIV Positive Children and Adolescents Have Elevated Risk of Cardiovascular Disease

By Liz Highleyman

It is well known that many HIV positive adults taking antiretroviral therapy have an elevated risk of cardiovascular disease, as indicated by abnormal blood lipids and other factors. The same appears to be true for children and adolescents with HIV, according to a study published in the June 6, 2008 online edition of the Journal of Pediatrics.

HIV positive children. CDC Website.

Tracie Miller from the University of Miami School of Medicine and colleagues conducted a study to compare risk factors for cardiovascular disease in HIV-infected children and uninfected control subjects.

The prospective, longitudinal analysis included data collected from 1998 through 2003 for 42 HIV positive children and adolescents infected via mother-to-child transmission, as well as matched nationally representative control subjects from the 2003-2004 National Health and Nutrition Examination Survey (NHANES). The average age of the HIV positive patients was 10 years (range 2.7 to 19.9 years), 68% had CDC stage B or C disease, and 76% were on HAART.

Results

• Compared with age- and sex-matched control subjects, the HIV positive children and adolescents had:

• Lower body weight;
• Lower body mass index;
• Higher triglyceride level (136 vs 90 mg/dL; P < 0.001);
• Higher total and low-density lipoprotein (LDL or "bad") cholesterol;
• Lower high-density lipoprotein (HDL or "good") cholesterol (47 vs 54 mg/dL; P < 0.001).

• Protease inhibitor use was independently associated with:

• Higher triglyceride level (P = 0.02);
• Higher LDL cholesterol (P = 0.04);
• Lower HDL cholesterol (P = 0.02).

• In contrast, non-nucleoside reverse-transcriptase inhibitor (NNRTI) use was associated with:

• Less visceral fat (P = 0.01);
• Higher HDL cholesterol (P = 0.005).

Based on these findings, the study authors concluded, "Children infected with HIV have adverse cardiac risk profiles compared with NHANES controls. Antiretroviral therapy has a significant influence on these factors."

In an interview with the Miami Herald, Dr. Miller pointed out that it will take decades to determine whether these risk factors will translate into a higher rate of heart attacks and other clinical cardiovascular events in children and adolescents with HIV as they age. However, some studies suggest that HIV positive adults have a 7-10 times higher risk of having a heart attack compared with their HIV negative counterparts.

Dr. Miller added that it is not too soon for HIV positive children and adolescents to adopt a healthy lifestyle. She has designed a program offering education about diet, exercise, and avoidance of alcohol and tobacco smoking, and is starting a study to assess whether lifestyle changes will be beneficial in minimizing cardiovascular disease in this population.

University of Miami, Miami, FL; Tufts University, Boston, MA; Harvard University, Boston, MA; University of Rochester, Rochester, NY.

7/08/08

Reference

TL Miller, EJ Orav, SE Lipshultz, and others. Risk Factors for Cardiovascular Disease in Children Infected with Human Immunodeficiency Virus-1. Journal of Pediatrics. June 6, 2008 [Epub ahead of print].

Other sources

F Tasker. Young with HIV have more heart risk. Miami Herald. June 23, 2008.