10th International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV 6-8 November 2008, London, UK

CAROTID INTIMA-MEDIA THICKNESS (cIMT) IMPROVES OVER TIME IN HIV-INFECTED CHILDREN

Antiviral Therapy 2008; 13(Suppl. 4):A6 (abstract no. O-07)

AC Ross^1,2, N Storer^1,2, MA O’Riordan^1,2, V Dogra³, D El-Bejjani², S Bhatt³ and GA McComsey^1,2
1Rainbow Babies & Children’s Hospital, Cleveland, OH, USA; ²Case Western Reserve University, Cleveland, OH, USA; ³University of Rochester, Rochester, NY, USA

BACKGROUND: cIMT is an established surrogate marker for subclinical atherosclerosis and cardiovascular disease (CVD) risk. HIV+ subjects have increased cIMT and HIV+ adults have more rapid IMT progression than HIV-controls. This is the first study reporting IMT progression in HIV+ children.

METHODS: cIMT was measured in 39 HIV+ children and 39 healthy controls at baseline and yearly for 3 years, and reported as internal carotid artery (ICA) and common carotid artery (CCA) thicknesses. Fasting metabolic profile was measured concurrently. Diabetes and family history of premature CVD were exclusionary. Here, we present the 48-week results. Within-and between-group comparisons of cIMT changes from baseline to 48 weeks were made using two-sample tests appropriate to the distribution. Spearman correlation coefficients were used to assess correlations with changes in IMT. Regression analyses were performed first to determine baseline prognostic factors for change at 48 weeks in cIMT and secondly to determine which factors change relative to the changes in cIMT over 48 weeks.

RESULTS: HIV was acquired by 89% of HIV+ children by vertical transmission; 63% were female, 74% AA, median age 10 years, and body mass index (BMI) 18.7 kg/m²; median baseline CD4 was 840 (32%); and 69% had HIV RNA <50 copies/ml. A total of 89% were on antiretroviral therapy (ART) with 46% on non-nucleoside reverse transcriptase inhibitors (NNRTI), 34% on protease inhibitors (PI) and 9% on NNRTI+PI. The median duration of ART and PI was 70 and 25 months, respectively. Mean CCA IMT was nominally higher in HIV+ than HIV-(P=0.07), whereas ICA thicknesses (mm) was significantly higher in HIV+ (mean [±sd] 1.05 [±0.16] versus 0.95 [±0.15]; P=0.006). There were no differences in age, BMI, waist circumference (WC), HOMA-IR, or high-sensitivity C-reactive protein (hsCRP) between groups, but fasting lipids and waist-to-hip ratio (WHR) were higher in the HIV+ group. Four HIV+ patients and two controls were lost to follow-up. At 48 weeks, there was no change from baseline in HIV RNA, but CD4% increased (P=0.02), LDL decreased (P=0.009) and WC increased (P<0.001) in the HIV+ group; in controls, BMI (P=0.007) and WC (P<0.001) increased over time. At 48 weeks, mean (±sd) change in cIMT for HIV+ subjects was -0.13 (0.18) and -0.16 (0.23) mm for CCA and ICA, respectively (both P<0.001). In the HIV- group, cIMT did not change significantly, and cIMT changes were not significantly different between groups. CCA and ICA changes were correlated with antriretroviral duration (R=-0.44, P=0.009) and PI duration (R=-0.46, P=0.006), and ICA changes were correlated with baseline CD4 and CD4% (both R=-0.37, P=0.04). In multiple regression analyses, antriretroviral duration was predictive of CCA change, and baseline CD4, age, sex, total- and LDL-cholesterol were predictive of ICA change. Change in CCA was also significantly associated with CD4 change and change in ICA was associated with change in LDL-cholesterol.

CONCLUSIONS: At 48 weeks, cIMT improved in HIV-infected children. This might be due to the concurrent decrease in LDL-cholesterol and increase in CD4 counts.

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2008-11-06
O-07

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