Aggregate Risk of Cardiovascular Disease among Adolescents Perinatally Infected with the Human Immunodeficiency Virus
Background—Perinatally HIV-infected adolescents may be susceptible to aggregate atherosclerotic cardiovascular disease (CVD) risk, as measured by the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) coronary arteries (CA) and abdominal aorta (AA) risk scores, due to prolonged exposure to HIV and antiretroviral therapy.
Methods and Results—CA and AA PDAY scores were calculated for 165 perinatally HIV-infected adolescents, using a weighted combination of modifiable risk factors: dyslipidemia, cigarette smoking, hypertension, obesity, and hyperglycemia. Demographic and HIV-specific predictors of scores ≥1 were identified and trends in scores over time were assessed. 48% and 24% of the perinatally HIV-infected adolescents had CA and AA scores ≥1, representing increased CVD risk factor burden. Significant predictors of CA scores ≥1 included male sex, history of an AIDS-defining condition, longer duration of use of a ritonavir-boosted protease inhibitor, and no prior use of tenofovir. Significant predictors of AA scores ≥1 included suppressed viral load, history of an AIDS-defining condition, and longer duration of boosted protease inhibitor use. No significant changes in CA and AA risk scores were observed over the 4-year study period.
Conclusions—A substantial proportion of perinatally HIV-infected youth have high PDAY scores reflecting increased aggregate atherosclerotic CVD risk factor burden. High scores were predicted by HIV disease severity and boosted protease inhibitor use. PDAY scores may be useful in identifying high-risk youth who may benefit from early lifestyle or clinical interventions.
- Received February 22, 2013.
- Revision received October 25, 2013.
- Accepted December 9, 2013.