There are increased risks for cardiovascular disease (CVD) and insulin resistance among young individuals with HIV, according to research results presented at the virtual Conference on Retroviruses and Opportunistic Infections, held from March 8 to 11, 2020.
Using electronic health records from the Adolescent Medicine Trials Network, investigators examined whether detectable viral load and low CD4 count were associated with CVD in youth, aged 14 to 26 years, living with HIV.1
The study cohort was predominately black and male with a mean age of 21 years. Detectable viral load was demonstrated in 47.8% of patients and and 8.6% had a baseline CD4 ≤ 200, indicating immune dysfunction Bivariate and multivariate linear regression model analyses indicated that viral load was associated with significantly increased risk for CVD. According to the investigators, “these findings contribute to our understanding of the broad spectrum of the [viral load] CVD risk relationship.”
Adding to the understanding of this relationship, a separate study presented at the meeting showed insulin resistance as a factor for increased long-term CVD risk among youth with HIV.
Investigators examined the insulin resistance trajectory in a longitudinal cohort study including 90 children who were perinatally infected with HIV and received antiretroviral therapy (ART) at age <12 weeks.2. 2 Of note, these children demonstrated consistently normal ranges of CD4 cell counts. Cases were matched with 156 HIV-exposed uninfected children and 161 HIV-unexposed uninfected children.
The main study outcome was the Homeostatic Model Assessment (HOMA) insulin resistance index (HOMA-IR), modelled using log HOMA-IR given skewness. After adjusting for demographic and physical factors as well as random effect, the perinatally infected group had a geometric mean HOMA-IR of 1.2-times (95% CI, 1.1-1.3) greater than that of unexposed and uninfected children. The elevated HOMA-IR was not likely to be the result of environmental differences between households, as no significant differences were found between the 2 uninfected control groups.
Investigators concluded that despite being closely monitored and receiving ART soon after birth, these youth exhibited elevated insulin resistance that persisted into adolescence, which has long-term implications for cardiovascular risk.
- Gurung S, Simpson KN, Grov C, et al. Cardiovascular risk profile: A clinic-basded sample of youth living with HIV in the US. Poster presented at: CROI 2020; March 8-11, 2020. http://www.croiconference.org/sites/default/files/uploads/croi2020-boston-abstract-ebook.pdf. Accessed March 19, 2020.
- Davies C, Innes S, Cotton M, Browne SH, Ayele B. CHER trial cohort shows greater insulin resistance into adolescence. Poster presented at: CROI 2020; March 8–11, 2020; http://www.croiconference.org/sites/default/files/uploads/croi2020-boston-abstract-ebook.pdf. Accessed March 19, 2020.