December 6, 2012
Research presented at EUROECHO and Other Imaging Modalities 2012 (the annual meeting of the European Association of Cardiovascular Imaging in Athens, Greece, December 5-8) indicated that children with HIV have a 2.5-fold increased risk of atherosclerosis. According to Dr. Talia Sainz Costa, a pediatrician and principal investigator of the study, many antiretroviral drugs increase bad (LDL) cholesterol and lower good (HDL) cholesterol, so that children with HIV have high cholesterol for a long period of time. Also, the virus causes chronic inflammation. Both of these conditions are bad for the arteries.
The study investigated whether children and adolescents have early atherosclerosis damage. Researchers used echocardiography to measure carotid intima-media thickness (IMT) -- a marker of atherosclerosis -- in 150 children and adolescents with HIV and 150 age- and sex-matched health controls. During testing, researchers found that 17 percent of the participants with HIV were smokers, compared to 11 percent of the control group. After adjustment for age, sex, basic metabolic index, and smoking status, HIV was independently associated with thicker IMT (P=0.005). Thus, children and adolescents had a 2.5-fold increased risk of higher IMT due to HIV. Dr. Sainz Costa commented that the study showed that in children and adolescents with HIV, the arteries are more rigid and less elastic. This is an indication that the process of atherosclerosis has begun and that these individuals face increased risk of an infarction in the future. The researchers also found that frequencies of activated T CD4+ cells were higher in HIV-infected subjects, showing that the immune system is more active.
The researchers concluded that clinicians need to take cardiovascular prevention more seriously in children and adolescents with HIV, while continuing to treat the HIV infection. Dr. Sainz Costa added that physicians also need to be stricter about healthy lifestyle advice. She noted that HIV research is investigating ways to control the inflammation and immune activation and advised clinicians to focus on ensuring that patients take the antiretroviral treatment, take lipid lowering drugs when necessary, and adopt healthier lifestyles.
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