Carbohydrate, lipid, bone and inflammatory markers in HIV-positive adolescents on antiretroviral therapy and hormonal contraception.

BACKGROUND

Little is known about the cumulative effect of HIV antiretroviral therapy (ART) and hormonal contraception (HC) on metabolism and inflammation in HIV-positive women.

METHODS

We conducted a cross-sectional assessment of markers for carbohydrate, lipid, bone metabolism, inflammation and coagulation in HIV-positive adolescents on ART and HC (=37) versus on ART only (=51) in Thailand. The Wilcoxon rank-sum test was used to assess differences between groups.

RESULTS

The median age was 19.5 years. Most adolescents (95%) were perinatally infected. All were on ART for a median of 9 years. HC used was progestin only (=21); combined oral contraceptive (COC) tablets (=6) for the whole study period or alternating between progestin only and COC (=10). Prevalence of any metabolic abnormalities was 99%. Four biomarkers were significantly higher with HC no HC: insulin (10.3 6.2 μU/mL, =0.002), insulin resistance (1.89 1.19 mass units, =0.005), 25-OH vitamin D (33.2 20.2 ng/mL, <0.0001) and C-terminal telopeptide (690 530 ng/L, =0.011). Triglycerides and D-dimer were significantly lower with HC (103 139 mg/dL, =0.014 and 140 155 ng/mL, =0.003, respectively). There was no relationship between the type of HC or ART and the above differences.

CONCLUSION

Perinatally infected HIV-positive adolescents on ART in this pilot study had a high prevalence of metabolic abnormalities. Bone turnover markers and insulin resistance were significantly higher with HC. Research on the cumulative effect of HIV, ART and HC on metabolism and inflammation in adolescents with HIV is important in order to devise strategies for preventing and mitigating long-term comorbidities.