P.013 Longitudinal Study of Vascular Markers of Premature Atherosclerosis and Metabolic Correlates in HIV-Infected Children

Abstract

Purpose

To determine the presence of vascular markers of premature atherosclerosis and metabolic correlates in a prospectively followed cohort of antiretroviral treated HIV-infected children.

Methods

Vascular assessment included: carotid intima-media thickness and brachial artery reactivity using vascular ultrasound; peripheral pulse wave velocity (PWV) using photoplethysmography; central PWV, arterial stiffness and impedance indices using an Echo-Doppler method; and only at follow-up, augmentation index and PWV by applanation tonometry. Disease markers, oral glucose tolerance, fasting lipid profiles and abdominal fat (single slice CT scan) were also determined.

Results

Twenty children were assessed at baseline (median age 12.6 [range 8.5–18.5] years; 50% female) and follow-up 21–25 months later. All were on combination antiretroviral therapy at baseline, but 5 were off therapy at follow-up with fewer receiving protease inhibitors. Resting systolic blood pressure and pulse pressure increased significantly over the study period (both p < 0.0001), as did elastic modulus, stiffness index and input impedance (p =0.0018, p = 0.0004, p = 0.0082, respectively). PWV measures by the different methods were not shown to correlate significantly. Dyslipidemia and abnormal glucose metabolism were present in 14 and 2 at baseline, and in 7 and 0 at follow-up, respectively. Visceral, subcutaneous and total abdominal fat content increased over time, but not significantly so.

Conclusions

An increase in measures of large arterial wall stiffness was observed over time. The reduction in dyslipidemia at follow-up may be related to fewer children receiving protease inhibitors. The potential risk of premature atherosclerosis in HIV-infected children on anti-retroviral therapy warrants long-term monitoring of metabolic profiles and vascular function.