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Pediatric Infectious Disease Journal:
doi: 10.1097/INF.0b013e3181d770c4
Original Studies

Longitudinal Changes in Carotid Intima-Media Thickness and Cardiovascular Risk Factors in Human Immunodeficiency Virus-Infected Children and Young Adults Compared With Healthy Controls

Ross, Allison C. MD*; Storer, Norma RN*; Ann O'Riordan, Mary MS†; Dogra, Vikram MD‡; McComsey, Grace A. MD*

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Objectives: HIV-infected patients are at increased risk of cardiovascular disease (CVD). This study assessed longitudinal changes in carotid intima-media thickness (cIMT) as a surrogate marker for CVD, and determined the relationship between cIMT and cardiovascular risk factors in HIV-infected children/young adults.

Methods: This was a longitudinal, observational study comparing cIMT, fasting metabolic profile, and C-reactive protein in HIV-infected subjects 2 to 21 years old to matched controls at baseline and 48 weeks.

Results: Thirty-five HIV+ subjects and 37 controls were included in the analysis. Among HIV+ subjects, the median age was 10 years, body mass index was 18.7 kg/m2, 37% were male, CD4 count was 32%, 77% had HIV-RNA <400 copies/mL, and 86% were on antiretrovirals. At baseline, HIV+ had higher lipids and C-reactive protein. HIV-infected had higher internal carotid artery (ICA) and common carotid artery (CCA) IMT (mm) (ICA: HIV+, 0.90; controls, 0.78 [P = 0.01]; CCA: HIV+, 1.00; controls, 0.95 [P = 0.05]). At 48 weeks, CD4% increased and low-density lipoprotein decreased in HIV-infected subjects. ICA and CCA median changes for HIV-infected subjects were −0.23 and −0.15 mm, respectively (both P < 0.01). In controls, only CCA changed (P = 0.04). Between-group changes were not significant, except when only 31 perinatally infected HIV+ subjects and the controls were compared (CCA P = 0.04). In multiple regression analyses of HIV+ subjects, antiretroviral therapy duration and CD4% were associated with cIMT changes.

Conclusions: Higher cIMT was found in HIV-infected subjects than in healthy controls, but at 48 weeks, cIMT was similar between groups. These data suggest that HIV-infected children/young adults are at high risk of CVD, but lipid control, immune restoration, and viral suppression with continuous antiretroviral therapy may prevent its worsening.

© 2010 Lippincott Williams & Wilkins, Inc.


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