Young adults with perinatally acquired HIV had lower adjusted odds of prehypertension and elevated blood glucose but higher adjusted odds of low high-density lipoprotein cholesterol than participants without HIV or perinatal HIV exposure in a cross-sectional study of 660 young adults in Nigeria.
"People on HIV antiretroviral therapy are living longer but face shorter comorbidity-free lives, due to the early onset of non-communicable diseases associated with aging," wrote lead author Ahmad T. Aliyu of the Institute of Human Virology at the University of Maryland School of Medicine in Baltimore and the International Research Center of Excellence at the Institute of Human Virology Nigeria, and colleagues.
Investigators evaluated cardiometabolic disorders among 660 participants aged 18 to 24 years at two tertiary hospitals in Abuja. Using purposive homogeneous sampling, they enrolled 154 participants with perinatally acquired HIV, 155 with nonperinatally acquired HIV, 154 who were exposed to HIV perinatally but did not acquire HIV and 197 without HIV or perinatal HIV exposure. Participants who declined consent, were pregnant or had mental illness were excluded, according to the research published in the journal AIDS.
The median age was 20 years, and 53% of participants were female. Among participants with HIV, median duration of antiretroviral therapy was 11.7 years. Approximately 91% were receiving a dolutegravir-based regimen, and approximately 55% had HIV-1 RNA below 20 copies/mL. That threshold was reached by approximately 62% of participants with perinatally acquired HIV and approximately 47% of those with nonperinatally acquired HIV.
Investigators determined blood pressure from the average of three seated left-arm measurements and classified values using Seventh Joint National Committee criteria. Diabetes was defined by random blood glucose of at least 11.1 mmol/L, hemoglobin A1c of at least 6.5% or a history of diabetes treatment. Metabolic syndrome was defined using Joint Interim Statement criteria as meeting at least three criteria for elevated hemoglobin A1c or random blood glucose, elevated blood pressure or treatment for hypertension, hypertriglyceridemia, low high-density lipoprotein cholesterol, and abdominal obesity.
Researchers calculated prevalence estimates and used logistic regression to examine associations between participant characteristics and metabolic outcomes. Age and sex were included a priori in multivariable models, while additional covariates were selected using theoretical and data-driven criteria at the bivariate level. Participants without HIV or perinatal HIV exposure served as the reference group.
Across the cohort, 5% had hypertension, 28% had prehypertension, 12% had diabetes, 22% had prediabetes and 10% had metabolic syndrome. Low high-density lipoprotein cholesterol was present in 65%, elevated blood glucose in 24%, abdominal obesity in 16% and elevated blood pressure in 14%. Differences among the four groups were statistically significant only for elevated blood glucose, low high-density lipoprotein cholesterol, and abdominal obesity.
After adjustment for age and sex, participants with perinatally acquired HIV had lower odds of prehypertension and elevated blood glucose and higher odds of low high-density lipoprotein cholesterol than participants without HIV or perinatal HIV exposure. In multivariable analyses, participants with nonperinatally acquired HIV also had higher odds of low high-density lipoprotein cholesterol and lower odds of elevated blood pressure. Participants exposed to HIV perinatally who did not acquire HIV had lower odds of metabolic syndrome, elevated blood glucose, abdominal obesity and elevated blood pressure than the reference group.
Across all participants, male participants had higher odds of prehypertension and hypertension, while participants who were overweight had higher odds of prehypertension.
The authors cited potential bias related to use of hemoglobin A1c for diagnosing diabetes among people with HIV and potential channeling bias because participants without HIV may have sought care at the study sites for cardiometabolic conditions.
The study was supported by the National Institutes of Health Fogarty International Center through a supplement to a D43 award. The authors reported that the funders had no role in the study design, data collection and analysis, publication decision or manuscript preparation. They reported no conflicts of interest.
