Key result
Children with perinatally acquired HIV had thicker mean carotid intima-media thickness compared to HIV-negative children (1.05 vs 1.02 mm; P<0.05), which correlated with intestinal permeability.
Why the study?
The risk of cardiovascular disease and its underlying mechanisms in children living with perinatally acquired HIV in sub-Saharan Africa have been understudied.
Does perinatally acquired HIV infection increase subclinical vascular disease and is it associated with intestinal barrier dysfunction in children?
Cross-Sectional (n=197)
Does perinatally acquired HIV infection increase subclinical vascular disease and is it associated with intestinal barrier dysfunction in children?
Absolute Event Rate: 1.05% vs 1.02%
p-value: p=< .05
Children with perinatally acquired HIV on antiretroviral therapy exhibit increased carotid intima-media thickness, which is associated with intestinal barrier dysfunction.
May indicate heightened subclinical atherosclerosis risk in perinatally acquired HIV; hypothesis-generating for intestinal permeability link, needing longitudinal confirmation.
BACKGROUND: The risk of cardiovascular disease (CVD) and its mechanisms in children living with perinatally acquired HIV (PHIV) in sub-Saharan Africa has been understudied. METHODS: Mean common carotid artery intima-media thickness (IMT) and pulse-wave velocity (PWV) were evaluated in 101 PHIV and 96 HIV-negative (HIV-) children. PHIV were on ART, with HIV-1 RNA levels ≤400 copies/mL. We measured plasma and cellular markers of monocyte activation, T-cell activation, oxidized lipids, and gut integrity. RESULTS: Overall median (interquartile range, Q1-Q3) age was 13 (11-15) years and 52% were females. Groups were similar by age, sex, and BMI. Median ART duration was 10 (8-11) years. PHIV had higher waist-hip ratio, triglycerides, and insulin resistance (P ≤ .03). Median IMT was slightly thicker in PHIVs than HIV- children (1.05 vs 1.02 mm for mean IMT and 1.25 vs 1.21 mm for max IMT; P < .05), while PWV did not differ between groups (P = .06). In univariate analyses, lower BMI and oxidized LDL, and higher waist-hip ratio, hsCRP, and zonulin correlated with thicker IMT in PHIV (P ≤ .05). After adjustment for age, BMI, sex, CD4 cell count, triglycerides, and separately adding sCD163, sCD14, and hsCRP, higher levels of intestinal permeability as measured by zonulin remained associated with IMT (β = 0.03 and 0.02, respectively; P ≤ .03). CONCLUSIONS: Our study shows that African PHIV have evidence of CVD risk and structural vascular changes despite viral suppression. Intestinal intestinal barrier dysfunction may be involved in the pathogenesis of subclinical vascular disease in this population.
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Dirajlal‐Fargo et al. (2019) conducted a cross-sectional in Perinatally acquired HIV (n=197). Perinatally acquired HIV vs. HIV-negative children was evaluated on Mean common carotid artery intima-media thickness (IMT) (p=< .05). Children with perinatally acquired HIV had thicker mean carotid intima-media thickness compared to HIV-negative children (1.05 vs 1.02 mm; P<0.05), which correlated with intestinal permeability.
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