Background:  Metabolic complications of ART may pose a significant challenge for health maintenance among the emerging population of young adults who acquired HIV in infancy or childhood. The purpose of this study was to characterize the extent of metabolic abnormalities in a cohort of HIV-infected patients who acquired HIV in infancy or childhood.

Methods:  This is a cross-sectional study conducted between 2004 and 2007 in which 40 patients (54% male, mean age 17 years, range 11 to 27 years; 38% black, 48% white, 8% mixed race, and 3% Hispanic) completed oral glucose tolerance testing, fasting insulin, and lipid studies. Additionally, anthropometric assessments including whole body dual-energy X-ray absorptiometry (DEXA) scan were performed.

Results:  All subjects were ART experienced with a mean duration of 13.5 (2.6 [SD]) years; all had current or past protease inhibitor (PI) and stavudine (d4T) exposure. One subject was not on ART; 88% were currently on a PI. Half of the subjects had <50 HIV RNA (by polymerase chain reaction) copies/mL, and the mean CD4 T cell count was 665 (416). Impaired glucose tolerance was present in 20% of subjects; no subject had type-2 diabetes. Mean fasting insulin was 18.0 (13.7) IU/mL, glucose 86 (9) mg/dL, and the mean homeostatic model for assessment of insulin resistance (HOMA) was 3.9(3.2). A HOMA value >4.0 is considered insulin resistant in adolescents; 38% of subjects had a HOMA >4.0. Dyslipidemia was common; 50% had triglycerides ≥150 mg/dL, 53% had HDL cholesterol <50/40 mg/dL for females and males, respectively, and 24% had total cholesterol ≥200 mg/dL. The mean body mass index was 21.9 (3.6) kg/m²; 15% were overweight with a body mass index >25 kg/m², only 1 patient had a body mass index >30 kg/m². The mean waist-to-hip ratio was 0.92 (0.07); 16% had a waist-to-hip ratio >1.00, and the mean percentage of body fat by DEXA was 19.9 (8.7). There was a significant positive correlation between waist-to-hip ratio and HOMA (r = 0.39, p = 0.015).

Conclusions:  Abnormal glucose homeostasis characterized by impaired glucose tolerance and HOMA >4.0 was common among heavily treated adolescents and young adults with HIV infection. Insulin resistance was related to waist-to-hip ratio in this non-obese patient group. Dyslipidemia was also common and similar to results from adult HIV⁺ cohorts. These data demonstrate that long-term exposure to ART may convey substantial metabolic risk including increased risk for subsequent type-2 diabetes and cardiovascular disease. These findings warrant careful monitoring in this population as well as further research.