Adiposity Increases May Result in Dyslipidemia in Perinatally-Acquired HIV

Younger patients with perinatally-acquired HIV infection demonstrated increased adiposity with a corresponding decrease in insulin sensitivity and dyslipidemia, according to study results presented at IDWeek 2022, held from October 19 to 23, in Washington, DC.

Researchers sought to understand the effects of obesity on long-term metabolic complications in younger patients with perinatally-acquired HIV infection. Data were obtained between 2007 and 2009 from a study conducted at 15 sites in the United States, including Puerto Rico. A total of 232 patients aged 7 to 19 years underwent 2 whole-body dual energy x-ray absorptiometry (DXA) scans to assess body composition, with the first scan performed at baseline and the second scan 2 years later. The researchers evaluated metabolic outcomes, including homeostatic assessment of insulin resistance and non-high-density lipoprotein cholesterol (non-HDL-C).

Generalized linear regression models were used to assess the association between the 2-year percent change in body and trunk fat with metabolic outcomes at years 2 and 3. Adjustments were made for potential confounders, including race (Black vs nonBlack), Tanner stage, sex, family history of diabetes or cardiovascular disease, CD4 count (≤350 vs >350 cells/mm³), HIV viral load (≥400 vs <400 copies/mL), and antiretroviral therapy (ART) exposure.

During the first DXA scan, the majority of patients (70%) were Black, the median age was 12 years, the median CD4 count was 714 cells/mm³, and 70% had an HIV viral load of more than 400 copies/mL. Of these patients, 72%, 25%, and 3% used protease inhibitor-, non-nucleoside reverse transcriptase inhibitor-, and integrase strand transfer inhibitor-based ART, respectively.

Between baseline and the second DXA scan at 2 years, patients’ median body and trunk fat increased by 5.41% and 4.47%, respectively. In the unadjusted analysis, non-HDL-C levels among the patients increased by 0.19 (95% CI, 0.03-0.35) and 0.65 (95% CI, 0.12-1.19) mg/dL for every 1% increase in total body fat and trunk fat, respectively, within a 2-year period. These findings were similar in the adjusted analysis, though mild attenuation was noted.

For patients in both unadjusted and adjusted analyses, there was a corresponding 0.5% increase in insulin resistance at 3 years (0.002 [log₁₀]; 95% CI, -0.0 to 0.005) for every 1% increase in body and trunk fat between baseline and 2 years.

“Increases in adiposity over time may lead to downstream decreased insulin sensitivity and dyslipidemia in YPHIV [youth with perinatally-acquired HIV],” the researchers concluded.

Disclosures: Some authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.