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A Comparison of Metabolic Outcomes Between Obese HIV-Exposed Uninfected Youth From the PHACS SMARTT Study and HIV-Unexposed Youth From the NHANES Study in the United States

Jao, Jennifer MD, MPHa; Jacobson, Denise L. PhD, MPHb; Yu, Wendy MPHb; Borkowsky, William MDc; Geffner, Mitchell E. MDd; McFarland, Elizabeth J. MDe; Patel, Kunjal DSc, MPHf; Williams, Paige L. PhDg; Miller, Tracie MDh for the Pediatric HIV/AIDS Cohort Study

JAIDS Journal of Acquired Immune Deficiency Syndromes: July 1, 2019 - Volume 81 - Issue 3 - p 319–327
doi: 10.1097/QAI.0000000000002018
Clinical Science

Background: Metabolic perturbations in HIV-exposed uninfected (HEU) obese youth may differ from those in the general obese pediatric population.

Methods: Metabolic parameters of obese (body mass index Z-score >95th percentile) HEU youth in the Pediatric HIV/AIDS Cohort Study (PHACS) Surveillance Monitoring of ART Toxicities (SMARTT) study were compared with a matched sample of obese youth from the US National Health and Nutrition Examination Survey (NHANES). We evaluated systolic and diastolic hypertension (blood pressure ≥90th percentile for age, sex, and height), total cholesterol >200 mg/dL, high-density lipoprotein cholesterol <35 mg/dL, low-density lipoprotein cholesterol >130 mg/dL, triglycerides (TGs) >150 mg/dL, and Homeostatic Model Assessment–Insulin Resistance >4.0. Modified Poisson regression models were fit to quantify the prevalence ratio (PR) of each outcome comparing the 2 cohorts, adjusting for confounders.

Results: The blood pressure outcome analytic subgroup included 1096 participants (n = 304 HEU), the total cholesterol and high-density lipoprotein cholesterol subgroup 1301 participants (n = 385 HEU), and the low-density lipoprotein cholesterol, TG, and Homeostatic Model Assessment–Insulin Resistance subgroup 271 (n = 83 HEU). After adjustment, obese HEU youth had a higher prevalence of systolic and diastolic hypertension [PR = 3.34, 95% confidence interval (CI): 2.48 to 4.50; PR = 2.04, 95% CI: 1.18 to 3.52, respectively], but lower prevalence of insulin resistance (PR = 0.67, 95% CI: 0.54 to 0.85) and hypercholesterolemia (PR = 0.67, 95% CI: 0.44 to 1.01) compared with obese NHANES youth.

Conclusions: In the United States, obese HEU youth seem to have an increased risk of hypertension, but lower risk of insulin resistance and hypercholesterolemia, compared with a general obese pediatric population. Monitoring for cardiovascular morbidity in adulthood may be warranted in HEU children.

aDivision of Pediatric Infectious Diseases, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL;

bCenter for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, MA;

cDivision of Infectious Diseases, Department of Pediatrics, New York University School of Medicine, New York, NY;

dThe Saban Research Institute of Children's Hospital Los Angeles, Keck School of Medicine of USC, Los Angeles, CA;

eDepartment of Pediatrics, University of Colorado School of Medicine, Aurora, CO;

Departments of fEpidemiology; and

gBiostatistics, Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, MA; and

hDepartment of Pediatrics, University of Miami, Miami, FL.

Correspondence to: Jennifer Jao, MD, MPH, Division of Pediatric Infectious Diseases, Department of Pediatrics, Northwestern University Feinberg School of Medicine, 225 E. Chicago Avenue, Box 20, Chicago, IL 60611 (e-mail:

The Pediatric HIV/AIDS Cohort Study was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development with cofunding from the National Institute on Drug Abuse, the National Institute of Allergy and Infectious Diseases, the Office of AIDS Research, the National Institute of Mental Health, the National Institute of Neurological Disorders and Stroke, the National Institute on Deafness and Other Communication Disorders, the National Institute of Dental and Craniofacial Research, and the National Institute on Alcohol Abuse and Alcoholism through cooperative agreements with the Harvard T.H. Chan School of Public Health (HD052102) (Principal Investigator: George Seage; Program Director: Julie Alperen) and the Tulane University School of Medicine (HD052104) (Principal Investigator: Russell Van Dyke; Co–Principal Investigator: Ellen Chadwick; Project Director: Patrick Davis). Data management services were provided by Frontier Science and Technology Research Foundation (PI: Suzanne Siminski), and regulatory services and logistical support were provided by Westat, Inc (PI: Julie Davidson).

J.J. was supported by NICHD K23HD070760 during the part of the preparation of this manuscript. M.E.G. serves as a consultant for AbbVie, BioBridge, Daiichi Sankyo, Diurnal, Endo, Nutritional Growth Solutions, Novo Nordisk, Pfizer, and Sandoz; is a member of data safety monitoring boards for Ascendis and Tolmar; and receives royalties from McGraw-Hill and UpToDate. E.J.M. receives institutional support for conducting clinical trials investigating pediatric antiretrovirals sponsored by Gilead, Inc. The remaining authors have no conflicts of interest to disclose.

The conclusions and opinions expressed in this article are those of the authors and do not necessarily reflect those of the National Institutes of Health or U.S. Department of Health and Human Services.

T.M. and D.L.J. conceptualized the manuscript. J.J. wrote the first draft of the manuscript and had primary responsibility for the final content and approval of the manuscript. D.L.J. and W.Y. analyzed the data. D.L.J., W.Y., and P.L.W. made significant edits to the Methods section. J.J., T.M., D.L.J., W.Y., W.B., M.E.G., E.J.M., K.P., and P.L.W. edited and revised the entire manuscript.

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Received December 03, 2018

Accepted February 18, 2019

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