Miami Herald - June 24, 2008
Fred Tasker, ftasker@MiamiHerald.com

Young people who have HIV are faced with yet another hurdle: higher rates of cardiovascular risk, a new study says.

Children and adolescents living with HIV have sharply higher cardiac risk factors than their uninfected peers, according to a study (J Pediatr. 2008 Jun 6. [Epub ahead of print]) done in part at the University of Miami School of Medicine. Many of the drugs used to control HIV make those risks even higher.

Dr. Tracie Miller calls it "a double whammy." She's a professor of pediatrics at the medical school who took part in the multi-hospital study.

"We know that adults with HIV have a seven-to-10-times higher risk of having a heart attack than other adults," she said. The fear is that the same factors are at work in children from birth to 20.

This is one of the first studies to look at the consequences of HIV on children.

It will take decades to know whether the higher risk factors will translate into more heart attacks and higher death rates, Miller says. But they are the same risk factors that cause those problems in adults.

Many HIV-positive youth are able to lead nearly normal lives because of anti-retroviral drugs such as protease inhibitors. But the drugs have a strong effect on cholesterol and other lipid levels.

The study, published this month in the Journal of Pediatrics, took place from 1998 to 2003 and involved 42 children infected at birth by HIV-positive mothers.

KEY RISK FACTORS

It found that compared to noninfected children the HIV-positive youths had triglyceride levels 50 percent higher, total cholesterol 6 percent higher, LDL "bad" cholesterol 10 percent higher and HDL "good" cholesterol 13 percent lower. All four are key risk factors for heart disease.

Infection of children by HIV-positive mothers in the United States peaked at 800 in 1992 and has fallen sharply to about 20 in 2006 with the advent of the drug zidovudine, given to infected pregnant women. Zidovudine is one of the protease inhibitors found to increase children's cardiac risks.

Other anti-retroviral drugs, such as non-nucleoside reverse transcriptase inhibitors (NNRTIS), have been associated with lower lipid levels, Miller said. But patients typically need multi-drug "cocktails," not single drugs, to keep HIV at bay.

Miller has designed a program that includes education, monitoring, diet, lifestyle and exercise. It's important that infected children avoid high-fat and sugar-rich foods, as well as alcohol and tobacco, she says.

Yuri Velasquez, 23, is a counselor in a UM project that helps teach HIV-positive youth 13 to 24 about the risks revealed in the study.

'THEY LISTEN'

"These are teenagers, in high school. Their lunch tends to be a Big Mac or a Burger King. We try to point them in the right direction. We have a dietitian who explains the risk factors and talks about nutrition and cardiac risks. They listen. Over time they change a little bit."

Miller is starting a study to see if such lifestyle changes help. One problem is that children on successful anti-HIV regimes can feel as well as uninfected kids, and be tempted to adopt the same poor-diet, sedentary lifestyles. As the children get older, Miller says they also might be treated by statins and other cholesterol-lowering drugs, as well as anti-inflammatories. But not all such drugs have been studied for interaction with anti-retroviral drugs. And there are concerns about keeping patients on such drugs for a lifetime, starting so young.

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