Department of Pediatrics, Division of Pediatric Clinical Research, Miller School of Medicine at the University of Miami, Miami, FL, USA.
HIV Med. 2012 May;13(5):264-75. doi: 10.1111/j.1468-1293.2011.00970.x. Epub 2011 Dec 4.
HIV-infected children may be at risk for premature cardiovascular disease. We compared levels of biomarkers of vascular dysfunction in HIV-infected children (with and without hyperlipidaemia) with those in HIV-exposed, uninfected (HEU) children enrolled in the Pediatric HIV/AIDS Cohort Study (PHACS), and determined factors associated with these biomarkers.
A prospective cohort study was carried out. Biomarkers of inflammation [C-reactive protein (CRP), interleukin-6 (IL-6) and monocyte chemoattractant protein-1 (MCP1)], coagulant dysfunction (fibrinogen and P-selectin), endothelial dysfunction [soluble intracellular cell adhesion molecule-1 (sICAM), soluble vascular cell adhesion molecule-1 (sVCAM) and E-selectin], and metabolic dysfunction (adiponectin) were measured in 226 HIV-infected and 140 HEU children. Anthropometry, body composition, lipids, glucose, insulin, HIV disease severity, and antiretroviral therapy were recorded.
The median ages of the children were 12.3 years in the HIV-infected group and 10.1 years in the HEU group. Body mass index (BMI) z-scores, waist and hip circumferences, and percentage body fat were lower in the HIV-infected children. Total and non-high-density lipoprotein (HDL) cholesterol and triglycerides were higher in HIV-infected children. HIV-infected children also had higher MCP-1, fibrinogen, sICAM and sVCAM levels. In multivariable analyses in the HIV-infected children alone, BMI z-score was associated with higher CRP and fibrinogen, but lower MCP-1 and sVCAM. Unfavourable lipid profiles were positively associated with IL-6, MCP-1, fibrinogen, and P- and E-selectin, whereas increased HIV viral load was associated with markers of inflammation (MCP-1 and CRP) and endothelial dysfunction (sICAM and sVCAM).
HIV-infected children have higher levels of biomarkers of vascular dysfunction than do HEU children. Risk factors associated with higher biomarkers include unfavourable lipid levels and active HIV replication.
HIV 感染儿童可能存在心血管疾病早发的风险。我们比较了伴有和不伴有高脂血症的 HIV 感染儿童（HIVI）与儿科 HIV/AIDS 队列研究（PHACS）中 HIV 暴露但未感染的儿童（HEU）的血管功能障碍生物标志物水平，并确定了与这些生物标志物相关的因素。
进行了一项前瞻性队列研究。测定了炎症标志物[C 反应蛋白（CRP）、白细胞介素-6（IL-6）和单核细胞趋化蛋白-1（MCP1）]、凝血功能障碍标志物（纤维蛋白原和 P-选择素）、内皮功能障碍标志物[可溶性细胞间黏附分子-1（sICAM）、可溶性血管细胞黏附分子-1（sVCAM）和 E-选择素]和代谢功能障碍标志物（脂联素）在 226 名 HIVI 儿童和 140 名 HEU 儿童中的水平。记录了人体测量学、身体成分、血脂、血糖、胰岛素、HIV 疾病严重程度和抗逆转录病毒治疗情况。
HIVI 组儿童的中位年龄为 12.3 岁，HEU 组为 10.1 岁。HIVI 儿童的体重指数（BMI）z 评分、腰围和臀围以及体脂百分比较低。总胆固醇和非高密度脂蛋白（HDL）胆固醇及甘油三酯水平在 HIVI 儿童中较高。HIVI 儿童的 MCP-1、纤维蛋白原、sICAM 和 sVCAM 水平也较高。在仅 HIVI 儿童的多变量分析中，BMI z 评分与 CRP 和纤维蛋白原升高相关，但与 MCP-1 和 sVCAM 降低相关。不良的血脂谱与 IL-6、MCP-1、纤维蛋白原和 P-选择素及 E-选择素呈正相关，而 HIV 病毒载量升高与炎症标志物（MCP-1 和 CRP）和内皮功能障碍标志物（sICAM 和 sVCAM）相关。
与 HEU 儿童相比，HIV 感染儿童的血管功能障碍生物标志物水平更高。与更高生物标志物相关的危险因素包括不良的血脂水平和活跃的 HIV 复制。
