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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*

Pediatric Infectious Disease Journal: July 2010 - Volume 29 - Issue 7 - pp 634-638
doi: 10.1097/INF.0b013e3181d770c4
Original Studies

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.

From the *Department of Pediatrics, Division of Infectious Diseases, Rheumatology and Global Health, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH; †Department of Pediatrics, Division of Critical Care and Pharmacology, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH; and ‡Department of Imaging Sciences, Division of Ultrasound, University of Rochester, Rochester, NY.

Accepted for publication January 14, 2010.

The study was funded by an independent research grant from GlaxoSmithKline Collaborative Study Group. The funding agency had absolutely no role in study design, data collection, or analysis.

G.A.M. serves as a consultant and has received research funding from Bristol-Myers Squibb, GlaxoSmithKline, Gilead, and Abbott. A.C.R. has received research funding from Bristol-Myers Squibb and Cubist Pharmaceuticals. All other authors have no conflicts.

Preliminary baseline data were previously published (McComsey GA, O'Riordan M, Hazen SL, et al. Increased carotid intima media thickness and cardiac biomarkers in HIV infected children. AIDS. 2007;21:921–927).

Address for correspondence: Allison C. Ross, MD, Pediatric Infectious Diseases, Emory University School of Medicine, 2015 Uppergate Dr., NE, Atlanta, GA 30322. E-mail: across3@emory.edu.

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© 2010 Lippincott Williams & Wilkins, Inc.