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Children With HIV Have Increased Risk of Atherosclerosis

Risk is 2.5-fold greater in infected children (Dec. 5)

Children with human immunodeficiency virus (HIV) infection have a 2.5-fold increased risk of developing atherosclerosis, according to a study presented at the EUROECHO and Other Imaging Modalities 2012 meeting held in Athens, Greece. The researchers recommend antiretroviral treatment, lipid lowering drugs, and prevention with healthy lifestyles to prevent early death from cardiovascular disease in these patients.

Although antiretroviral drugs prolong the lives of HIV patients, the treatment is not a cure, the researchers say. In addition, many antiretroviral agents increase “bad” (LDL) cholesterol and lower “good” (HDL) cholesterol.

“Children with HIV will have high cholesterol for a long period, and on top of that, the virus causes chronic inflammation — both are bad for the arteries,” said Dr. Talia Sainz Costa.

Sainz Costa noted that patients with HIV infection die prematurely from diseases unrelated to acquired immune deficiency syndrome (AIDS), such as cancer and cardiovascular, hepatic, and renal diseases.

The new study, conducted in Spain, investigated whether HIV-infected children and adolescents have early atherosclerotic damage. The carotid intima–media thickness (IMT) — a marker of atherosclerosis — was measured using echocardiography in 150 children and adolescents with HIV and in 150 age- and sex-matched healthy controls.

After adjusting for age, sex, body mass index, and smoking status, HIV infection was independently associated with an increased carotid IMT (P = 0.005). Children and adolescents with HIV had a 2.5-fold increased risk of a greater IMT versus healthy controls.

“Our study shows that children and adolescents with HIV have arteries that are more rigid and less elastic, which means that the process of atherosclerosis has begun and they have an increased risk of an infarct in the future,” Sainz Costa said.

The researchers also found more activated T CD4+ cells in the HIV-infected children and young adults compared with healthy controls (P = 0.002). “This shows that the immune system is more active,” Sainz Costa remarked.

The investigators concluded that clinicians need to take cardiovascular prevention more seriously in children and adolescents with HIV while continuing to treat the infection. Sainz Costa said: “Cardiovascular disease has already put down roots in children and adolescents with HIV, and we need to take preventive measures at this early stage. We should be more aggressive in treating their high cholesterol with medication. This practice is common in adults but rare in children.”

She added: “We also need to be stricter about healthy lifestyle advice. Many children and adolescents with HIV come from families with low socioeconomic status and are more prone to smoking, poor diet, and inactivity. This age group also struggles with adherence to medication, which is another worry, but we should not let this decrease our efforts to prevent future complications.”

Source: European Society of Cardiology; December 5, 2012.

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