Charakida Marietta, Loukogeorgakis Stavros P, Okorie Michael I, Masi Stefano, Halcox Julian P, Deanfield John E, Klein Nigel J
Institute of Child Health, University College London, London, UK.
Antivir Ther. 2009;14(8):1075-9. doi: 10.3851/IMP1437.
Recent evidence suggests that both the HIV virus and antiretroviral therapy (ART) are associated with premature atherosclerosis in adults. Increased arterial stiffness as assessed by pulse wave velocity (PWV) has been associated with adverse cardiovascular outcome in adults. The relationship between HIV infection and treatment and arterial stiffness has not been evaluated in children.
We studied 83 HIV-infected children with a mean +/-sd age of 11.0 +/-3.1 years and 59 controls aged 12.2 +/-2.8 years. Among the HIV-infected children, 48 were receiving ART (23 including a protease inhibitor). Arterial stiffness was assessed non-invasively by carotid-radial PWV. Disease severity was defined according to the CDC classification.
PWV was significantly increased in HIV-infected children compared with controls (P<0.05). A significant association between age and PWV was noted in HIV-infected children but not in controls. HIV-infected children receiving ART had significantly increased total cholesterol levels and PWV compared with non-treated children (P<0.001 and P<0.05, respectively). CDC stage was greater in ART-treated compared with non-treated HIV-infected children (P<0.001). No differences in other cardiovascular risk factors were noted in the two groups. After multivariable analysis, ART, systolic blood pressure, disease severity and total cholesterol remained independent predictors of PWV.
HIV-infected children have increased arterial stiffness compared with healthy children. These changes were more pronounced with increasing age in HIV-infected children particularly in those who were receiving ART.
近期证据表明，HIV病毒和抗逆转录病毒疗法（ART）均与成人过早发生动脉粥样硬化有关。通过脉搏波速度（PWV）评估的动脉僵硬度增加与成人不良心血管结局相关。HIV感染及治疗与动脉僵硬度之间的关系尚未在儿童中进行评估。
我们研究了83名感染HIV的儿童，其平均年龄为11.0±3.1岁，标准差为±sd，以及59名年龄为12.2±2.8岁的对照儿童。在感染HIV的儿童中，48名正在接受ART治疗（其中23名包括蛋白酶抑制剂）。通过颈-桡动脉PWV对动脉僵硬度进行无创评估。根据美国疾病控制与预防中心（CDC）的分类定义疾病严重程度。
与对照组相比，感染HIV的儿童PWV显著升高（P<0.05）。在感染HIV的儿童中观察到年龄与PWV之间存在显著关联，但在对照组中未观察到。与未接受治疗的儿童相比，接受ART治疗的感染HIV儿童的总胆固醇水平和PWV显著升高（分别为P<0.001和P<0.05）。接受ART治疗的感染HIV儿童的CDC分期高于未接受治疗的儿童（P<0.001）。两组在其他心血管危险因素方面未观察到差异。经过多变量分析，ART、收缩压、疾病严重程度和总胆固醇仍然是PWV的独立预测因素。
与健康儿童相比，感染HIV的儿童动脉僵硬度增加。这些变化在感染HIV的儿童中随着年龄增长更为明显，尤其是在接受ART治疗的儿童中。
