High Prevalence of Lipid Abnormalities and Insulin Resistance among Antiretroviral Naïve HIV-infected Children in India

C. Padmapriyadarsini, Anita Shet, R. Srinivasan, Geetha Ramachandran, G. N. Sanjeeva, Poornaganga Devi, K. Ramesh, Perumal K. Bhavani, Devaraj Reddy, E. Suresh, C. Chandrasekhar, Christine Wanke, Soumya Swaminathan

Research output: Contribution to journalArticle

Abstract

Background: As large numbers of children are accessing antiretroviral therapy (ART) in India, we evaluated the dietary intake, growth pattern and risk of metabolic complications like dyslipidemia and insulin resistance among ART-naïve HIV-infected children (CLHIV). Methods: CLHIV 2-12 years of age, at the time of initiating ART in Chennai and Bangalore, were assessed for their dietary intake, anthropometry, blood CD4 cell count, HIV-1 viral load, fasting serum lipids, glucose and insulin. Homeostatic model assessment-insulin resistance was derived. Results: Three hundred and ninety CLHIV (mean age [SD]: 8 [3] yrs; median viral load: 141,000 [25,876-436,000] copies/mL) were started on non-nucleoside reverse transcriptase inhibitor-based ART. Perinatal infection was documented among 97%. Sixty percent of children were in stage 3 or 4 of World Health Organization clinical staging of HIV/AIDS. Food insecurity was seen in 40% of households. A total of 204 children (52.4%) were stunted and 224 (57.6%) were underweight. Stunting seemed to be more prevalent with increasing age (0-4 years: 48%; >9 years: 60%). Mean intakes of calories, iron, folate and calcium were significantly less than recommended dietary allowances across all age groups. Dyslipidemia, in terms of any abnormal triglycerides or total cholesterol or low-density lipoprotein cholesterol (excluding high-density lipoprotein cholesterol), was seen in approximately 40% of children; insulin resistance in 17%; and C-reactive protein in risk range of metabolic syndrome in 24% of children. Conclusions: In the background of high food insecurity and malnutrition, cardiometabolic abnormalities were seen in 20%-35% of ART-naïve CLHIV in India emphasizing close monitoring of these children for long-Term cardiovascular morbidities after initiation of ART.

Original languageEnglish (US)
Pages (from-to)253-257
Number of pages5
JournalPediatric Infectious Disease Journal
Volume37
Issue number3
DOIs
StatePublished - Mar 1 2018

Keywords

  • HIV
  • anthropometrics
  • children
  • diet
  • dyslipidemia
  • insulin resistance

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Microbiology (medical)
  • Infectious Diseases

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  • Cite this

    Padmapriyadarsini, C., Shet, A., Srinivasan, R., Ramachandran, G., Sanjeeva, G. N., Devi, P., Ramesh, K., Bhavani, P. K., Reddy, D., Suresh, E., Chandrasekhar, C., Wanke, C., & Swaminathan, S. (2018). High Prevalence of Lipid Abnormalities and Insulin Resistance among Antiretroviral Naïve HIV-infected Children in India. Pediatric Infectious Disease Journal, 37(3), 253-257. https://doi.org/10.1097/INF.0000000000001829