20th International AIDS Conference - Melbourne, Australia


TUAB0203 - Oral Abstract

High prevalence of PLIN gene and metabolic risk factors among children initiating antiretroviral therapy in south India

Presented by Padmapriyadarsini Chandrasekaran (India).

P. Chandrasekaran1, A. Shet2, K. Ramesh1, P.K. Bhavani1, R. Srinivasan1, G. Sanjeeva3, P. Gangadevi1, E. Suresh4, C. Chandrasekar5, C. Wanke6, S. Swaminathan1

1National Institute for Research in Tuberculosis (ICMR), Chennai, India, 2St. John's Medical College Hospital, Bangalore, India, 3Indira Gandhi Institute of Child Health, Bangalore, India, 4Institute of Child Health and Government Hospital for Children, Chennai, India, 5Government Hospital of Thoracic Medicine, Chennai, India, 6Tufts University School of Medicine, Boston, United States

Background: Dyslipidemia and insulin resistance leading to cardiovascular morbidity are long-term complications of antiretroviral therapy (ART). We examined the risk factors of metabolic syndrome, namely blood lipids, insulin resistance, waist:hip ratio and Perilipin (PLIN) gene, among HIV infected ART-naïve children in south India.
Methods: Prospective study to determine the incidence of dyslipidemia among children, initiating ART is recruiting participants at the National Institute for Research in Tuberculosis, Chennai and St. John''s hospital, Bangalore since 2010. At enrollment, anthropometry and dietary details, fasting blood for serum lipids, glucose, insulin, high-sensitivity C-reactive protein (hs-CRP), CD4 cell count, HIV-1 viral load and gene polymorphisms are collected. Homeostatic model assessment-Insulin resistance (HOMA-IR) estimated using the formula [fasting glucose (mg/dL) X insulin (uU/mL)]/405. The PLIN polymorphisms were genotyped by real-time PCR.
Results: Two hundred and twenty three HIV infected children {mean age: 8 + 3 yrs; body weight, 17 + 6 kgs; mean CD4% 16 + 8% and median viral load: 146,187 copies/ml} were started on NNRTI-based ART. 97% were infected perinatally; 16% (32) were co-infected with tuberculosis. 40% of households were food insecure.
In this cohort, 58% of children were stunted and 60% were underweight. Mean (SD) of serum cholesterol was 130 (35) mg/dl; LDL-c 77 (29) mg/dl; serum triglyceride was 141(81) mg/dl and waist: hip ratio was 0.96. Mean blood glucose was 84(15) mg/dl; insulin 8 (9) mg/dl and hs-CRP was 2.2mg/dl. Pre-ART initiation serum triglycerides was > 150mg/dl in 34%, HOMA-IR was >3.5 in 8% and hs-CRP was 3-10mg/dl in 22% of children, indicating that at least a quarter of the children were at high risk for cardiovascular morbidity. Minor allele A at PLIN4 11482G-A, that is associated with increased risk of metabolic syndrome was seen in 57% (66/115) of the children.
Conclusions: Despite high background of food insecurity and malnutrition, cardio-metabolic abnormalities were seen in 20-30% of HIV-infected ART-naive children in South India. Due to relatively high number of carriers of genetic risk variants, children with advanced disease, need to be closely monitored for the development of dyslipidemia and long-term cardiovascular morbidities which may occur secondary to disease or ART.

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