Teens who are born with human immunodeficiency virus (HIV) may fare well through their early years, as the disease progresses slowly for 80 percent of them. But sooner or later, the disease will begin to take hold. Now they may also have to look out for signs of heart disease, as a study from the National Institutes of Health has found that their risk of developing it runs higher.
“Our results show that a large proportion of teens who have had HIV their whole lives appear to be at significant risk of cardiovascular disease later in life,” said co-author of the study Dr. George Siberry, from the National Institute of Child Health and Human Development (NICHD), in a statement. Therefore, along with maintaining their HIV treatment, health care providers should also monitor them “carefully” for signs of heart disease, which include heart attack and stroke.
Mothers rarely pass HIV onto their children these days. Before HIV pregnancy treatments, 25 percent of HIV-positive mothers who didn’t breastfeed their children or receive anti-HIV treatment passed the virus to their children. But with treatment, that rate has gone down to less than two percent, according to the Department of Health and Human Services (HHS). Those who contract the virus, however, are placed under daily drug regimens, which include protease inhibitors and reverse transcriptase inhibitors — drugs that prevent the viruses inside the T-cells from replicating. Side effects of these drugs, specifically protease inhibitors, have been shown to increase fat (lipid) levels inside the body, increasing the risk of heart disease. In adults, that risk increases by as much as 70 to 80 percent.
For the current study, which is part of the Pediatric HIV/AIDS Cohort Study and was the first to investigate heart disease risk in adolescents, researchers looked at 165 teens, 15 and older, who were born to HIV-positive mothers and had been getting anti-HIV medications — including protease inhibitors — since they were born. Their risk of heart disease was measured with a scoring system known as the Pathobiological Determinants of Atherosclerosis in Youth (PDAY), which looked at their cholesterol levels, blood sugar levels, weight, and other risk factors of heart disease.
If these factors amounted to a score of one or more, the researchers considered the teen to have an 18 percent higher chance of plaque build-up in their coronary arteries and a 24 percent higher chance of build-up in their abdominal aorta — that’s compared to a score of zero, which is found in people with no risk factors. Forty-eight percent of the teens scored a one or more when it came to the coronary artery measure, while 24 percent scored one or above with the abdominal aorta measure. These scores were mostly attributed to high cholesterol levels, the researcher said, and risk factors like smoking and high blood pressure weren’t common among the teens.
Based on the studies involving adults, the American Heart Association notes on its website that although HIV medications can have side effects, it's best to stick to them, not only because they treat HIV, but also because dropping them could cause a greater risk of heart disease. “It’s too soon to recommend changing treatment regimens on the basis of our findings,” said the study’s first author Dr. Kunjal Patel, of the Harvard School of Public Health, in the statement. “Until we can learn more, we can best serve adolescents who have HIV by monitoring their risk factors for heart disease carefully and urging them to adopt other measures that have been found to reduce the risk of heart disease in the general population.” These include exercise, a healthy diet, and abstaining from smoking, he added.
Source: Patel K, Siberry G, Wang J, et al. Aggregate Risk of Cardiovascular Disease among Adolescents Perinatally Infected with the Human Immunodeficiency Virus. Circulation. 2014.