Background:  Information regarding metabolic cardiovascular risk among HIV⁺ children is limited. We compared biomarkers of vascular dysfunction among perinatally infected HIV⁺ children with and without hyperlipidemia (HL) and HIV^– children.

Methods:  HIV⁺ children enrolled in the PHACS Adolescent Master Protocol (AMP) study have fasting lipid profiles and clinical outcomes (CD4%, HIV viral load, antiretroviral therapies, and anthropometrics) evaluated annually. Based on lipid profiles, HL was defined as ≥1 of the following: total cholesterol >200 mg/dL; LDL cholesterol >130 mg/dL; triglycerides >110 mg/dL in children <10 years or >150 mg/dL for 10 to 19 years; or HDL cholesterol <35 mg/dL. The first 50 HIV⁺ with HL (Group A) and without HL (Group B) were compared to 55 HIV^– controls (Group C). Biomarkers of vascular dysfunction (C-reactive protein [CRP], interleukin-6 [IL-6], macrophage chemotactic protein-1 [MCP-1], plasminogen activator inhibitor-1 [PAI-1], fibrinogen, P-selectin, I-CAM-1, V-CAM-1, E-selectin, and adiponectin) were measured in all groups. The groups were compared using Kruskal-Wallis test for continuous variables and exact test for nominal variables. A p value <0.01 was considered statistically significant because the groups were compared on many outcomes.

Results:  Overall prevalence of HL (measured in mg/dL) in the HIV⁺ AMP cohort was 45% (117 of 262). Groups were similar on age (12 y), sex (50% male), race (62 to 76% black, non-Hispanic), and body mass index (61% with Z-score between –1.0 and 1.0). Group A (vs Group B) had significantly higher cholesterol (mean 205 [IQR 176 to 220] vs 158 [IQR 141 to 179]), LDL cholesterol (mean 128 [IQR 92 to 147] vs 87 [IQR 74 to 107]), and triglyceride (mean 151 [IQR 96 to 185] vs 84 [IQR 53 to 118]). There were no differences in CD4 percentage, viral load, or HDL cholesterol. A greater number of children with HL were on PI compared to those without (90% vs 70%, p = 0.02). Biomarkers of vascular dysfunction were compared across groups (Table). HIV groups (A and B) differed from controls on several biomarkers yet these measures were similar among HIV-infected children with and without HL.

Comparison of Biomarkers (median) by Group

*3-group comparison

^{1, 2} paired comparisons significantly different from each other (p <0.05)

Conclusions:  HIV⁺ children with and without HL show greater levels of biomarkers than controls. These changes may reflect vascular dysfunction and may be associated with elevated cardiovascular risk over the long-term. Differences are pronounced in coagulant and endothelial dysfunction.