977
Metabolic Abnormalities in Behaviorally Infected Young Women: Preliminary Results of Adolescent Medicine Trials Network for HIV/AIDS Interventions, ATN 021
Kathleen Mulligan*1, D Monte2, R Harris2, S Stoszek2, P Emmanuel3, D Hardin4, B Kapogiannis5, C Worrell6, C Wilson7, G Aldrovandi8, and ATN 021 Protocol Team
1Univ of California, San Francisco, US; 2Westat, Rockville, MD, US; 3Univ of South Florida, Tampa, US; 4Ohio State Univ, Columbus, US; 5National Institute of Child Health and Human Development, NIH, Bethesda, MD; 6Natl Inst of Child Hlth and Human Devt, NIH, Bethesda, MD, US; 7Univ of Alabama at Birmingham, US; and 8Children`s Hosp Los Angeles, CA, US
Background: Rates of HIV infection, as well as
obesity and metabolic disorders, are increasing in young women of color. We
evaluated the nature and scope of metabolic abnormalities and their association
with ART and lifestyle factors among young women (aged 14 to 24 years) infected
with HIV through risk behaviors.
Methods: HIV+ women (n = 173) and HIV–
controls (n = 61) were recruited at 15 Adolescent Medicine Trial Network (ATN)
sites. HIV+ women were categorized as ART-naïve (n = 85), NNRTI (n =
34), PI (n = 36), NNRTI/PI (n = 18). Measurements included fasting lipids,
insulin, and glucose, oral glucose tolerance, high sensitivity c-reactive
protein (hsCRP), fat distribution by dual energy x-ray absorptiometry, and ART
and medical histories by interview and questionnaire. Results were compared
across groups and within HIV+ groups by ANOVA. Means (±SE) are
race-adjusted.
Results: The median age of HIV+ women was
20 years; 77% were African American, 35% smoked cigarettes, and only 32%
reported exercising regularly. More than half of ART recipients were overweight
or obese (body mass index >25 kg/m2). The PI group had a longer
duration of HIV infection (median 4 years), lower nadir CD4 count, and higher
peak viral load. Lopinavir/r and nelfinavir were the most commonly used PI;
<20% were on atazanavir. Triglycerides in all HIV+ groups were
higher than HIV–. Total cholesterol was higher in groups on NNRTI or
PI than ART-naïve. Despite a relatively short duration of HIV (<1 year),
ART-naïve had higher triglycerides and lower high-density lipoprotein
cholesterol (HDL-C) than HIV–, consistent with untreated HIV
infection. hsCRP levels tended to be higher in all ART groups. Fasting and 2-hour
glucose and insulin levels did not differ significantly among groups, nor did
total or regional fat distribution.
|
|
HIV–
|
ART
|
p-value
|
|
Naive
|
NNRTI
|
PI
|
Non-NNRTI/PI
|
All
|
HIV+ only
|
|
Triglycerides (mg/dL)
|
65±7
|
84±6*
|
129±9*†
|
107±9*
|
96±12*
|
<0.0001
|
0.004
|
|
Total cholesterol (mg/dL)
|
154±4
|
152±3
|
167±5†
|
173±5*†
|
149±7
|
0.003
|
0.003
|
|
HDL-C (mg/dL)
|
48±2
|
40±1*
|
43±2*
|
46±2†
|
39±3*
|
0.001
|
0.12
|
|
Non HDL-C (mg/dL)
|
106±4
|
112±4
|
124±5*
|
127±5*†
|
110±8
|
0.009
|
0.06
|
|
hsCRP (mg/L)
|
2.2±0.8
|
2.9±0.7
|
5.6±1.1*
|
3.8±1.1
|
7.9±1.5*†
|
0.005
|
0.03
|
* p <0.05 vs HIV–; †
p <0.05 vs ART-naïve
Conclusions: Dyslipidemia was relatively prominent
in this group of young HIV+ women. Coupled with high rates of
obesity, lifestyle factors (smoking, inactivity) and elevated hsCRP, these
factors may accelerate lifetime risk of cardiovascular disease. These results
underscore the need for a multifaceted approach to addressing cardiovascular
risk in this population.
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