Marietta Charakida, Agnieszka B Dzwonek, Vas Novelli and Nigel J Klein
Background: Antiretroviral therapy (ART) has greatly improved clinical outcomes in human immunodeciency virus (HIV) infection in adults and children. However, emerging data link ART to clinical lipodystrophy and premature atherosclerosis. We examined the impact of body fat changes on blood pressure and endothelial function in HIV infected children with and without ART. Methods: Central and peripheral body fat distribution was assessed in 68 HIV infected children. In all children blood pressure was measured and high resolution ultrasound was used to determine endothelium dependent dilatation (flow mediated dilatation-FMD) in the brachial artery. Results: From the 68 HIV infected children, 46 were on ART. There was no evidence of clinical lipodystrophy with ART in this cohort. Total cholesterol was increased in children on ART (p<0.001). FMD was significantly lower in those on ART compared to antiretroviral naive children (p<0.01). Increased BMI and waist as well as peripheral body circumference measurements in the arm and thigh were associated with higher systolic blood pressure (p<0.05 and p<0.01 respectively). An inverse association was noted between peripheral body composition measurements (zcalf and zthigh) and FMD (p<0.05 for both). Conclusion: HIV-infected children on ART have deranged lipids and evidence of early arterial abnormalities. Increased body fat accumulation is associated with reduced endothelial function and elevated blood pressure in HIVinfected children. These findings suggest that healthy dietary intake and weight control would be advisable in HIV infected children for optimal vascular disease prevention.
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