1
|
Jao J, Bonner LB, Dobinda K, Powis KM, Sun S, Legbedze J, Mmasa KN, Makhema J, Mmalane M, Kgole S, Masasa G, Moyo S, Gerschenson M, Mohammed T, Abrams EJ, Kurland IJ, Geffner ME. Lower Insulin Sensitivity Through 36 Months of Life With in Utero HIV and Antiretroviral Exposure in Botswana: Results From the Tshilo Dikotla Study. Clin Infect Dis 2024:ciae088. [PMID: 38531012 DOI: 10.1093/cid/ciae088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND There are little data on changes in insulin sensitivity during the first few years of life following in utero human immunodeficiency virus (HIV) and antiretroviral (ARV) exposure. METHODS The Tshilo Dikotla study enrolled pregnant persons with HIV (PWH) (receiving tenofovir/emtricitabine or lamivudine plus dolutegravir or efavirenz) and pregnant individuals without HIV, as well as their liveborn children. Newborns were randomized to receive either zidovudine (AZT) or nevirapine (NVP) postnatal prophylaxis. Homeostasis Model Assessment for Insulin Resistance (HOMA-IR) was assessed at birth and 1, 18, 24, and 36 months of life. We fit linear mixed-effects models to evaluate the association between in utero HIV/ARV exposure and average HOMA-IR from birth through 36 months of life, adjusting for confounders. RESULTS A total of 419 children were included (287 with in utero HIV/ARV exposure and uninfected [CHEU] and 132 without in utero HIV/ARV exposure [CHUU]). CHEU were born to older women (29.6 vs 25.3 years of age) with higher gravidity (3 vs 1). HOMA-IR was persistently higher in CHEU versus CHUU in adjusted analyses (mean difference of 0.07 in log10 HOMA-IR, P = .02) from birth through 36 months of life. Among CHEU, no differences in HOMA-IR were observed from birth through 36 months by in utero ARV exposure status or between AZT and NVP infant prophylaxis arms. CONCLUSIONS In utero HIV/ARV exposure was associated with lower insulin sensitivity throughout the first 36 months of life, indicating persistent early life metabolic disturbances which may raise concern for poorer metabolic health later in life.
Collapse
Affiliation(s)
- Jennifer Jao
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Botswana-Harvard Health Partnership, Gaborone, Botswana
| | - Lauren B Bonner
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Katrina Dobinda
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kathleen M Powis
- Botswana-Harvard Health Partnership, Gaborone, Botswana
- Departments of Internal Medicine and Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Shan Sun
- Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Justine Legbedze
- Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Keolebogile N Mmasa
- County Durham and Darlington NHS Foundation Trust, Darlington Co Durham, United Kingdom
| | | | | | - Samuel Kgole
- Botswana-Harvard Health Partnership, Gaborone, Botswana
| | - Gosego Masasa
- Botswana-Harvard Health Partnership, Gaborone, Botswana
| | | | - Mariana Gerschenson
- Department of Cell and Molecular Biology, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii, USA
| | | | - Elaine J Abrams
- Mailman School of Public Health and Vagelos College of Physicians and Surgeons, ICAP at Columbia University, Columbia University, New York, New York, USA
| | - Irwin J Kurland
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Mitchell E Geffner
- Keck School of Medicine of USC, The Saban Research Institute of Children's Hospital Los Angeles, Los Angeles, California, USA
| |
Collapse
|
2
|
Ockene MW, Russo SC, Lee H, Monthé-Drèze C, Stanley TL, Ma IL, Toribio M, Shook LL, Grinspoon SK, Edlow AG, Fourman LT. Accelerated Longitudinal Weight Gain Among Infants With In Utero COVID-19 Exposure. J Clin Endocrinol Metab 2023; 108:2579-2588. [PMID: 36988326 PMCID: PMC10505544 DOI: 10.1210/clinem/dgad130] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Indexed: 03/30/2023]
Abstract
CONTEXT Since the initial outbreak of coronavirus disease 2019 (COVID-19), a novel population of children with in utero exposure to maternal infection has emerged whose health outcomes are largely unknown. OBJECTIVE To compare longitudinal growth trajectories among infants with vs without in utero COVID-19 exposure. METHODS We conducted a longitudinal cohort study leveraging a prospectively enrolled perinatal biorepository among 149 infants with in utero COVID-19 exposure and 127 unexposed controls. Weight, length, and body mass index (BMI) were abstracted from health records at 0, 2, 6, and 12 months and standardized using World Health Organization growth charts. Analyses were adjusted for maternal age, ethnicity, parity, insurance, and BMI as well as infant sex, birthdate, and breastfeeding. RESULTS Infants with in utero COVID-19 exposure vs controls exhibited differential trajectories of weight and BMI, but not length, z-score over the first year of life (study group × time interaction, P < .0001 for weight and BMI). Infants born to mothers with prenatal COVID-19 had lower BMI z-score at birth (effect size: -0.35, 95% CI -0.66 to -0.03) and greater gain in BMI z-score from birth to 12 months (effect size: 0.53, 95% CI 0.06 to 0.99). Birth weight z-score mediated a significant proportion of the relationship between COVID-19 exposure and postnatal growth (estimate ± SE, 32 ± 14%, P = .02). CONCLUSION Infants with in utero COVID-19 exposure exhibited lower birth weight and accelerated weight gain in the first year of life, which may be harbingers of downstream cardiometabolic pathology. Further studies are needed to delineate cardiometabolic sequelae among this emerging global population.
Collapse
Affiliation(s)
- Mollie W Ockene
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Samuel C Russo
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Hang Lee
- Biostatistics Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Carmen Monthé-Drèze
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Takara L Stanley
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Ingrid L Ma
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Mabel Toribio
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Lydia L Shook
- Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Obstetrics and Gynecology, Maternal-Fetal Medicine Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Steven K Grinspoon
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Andrea G Edlow
- Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Obstetrics and Gynecology, Maternal-Fetal Medicine Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Lindsay T Fourman
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| |
Collapse
|
3
|
Mataramvura H, Bunders MJ, Duri K. Human immunodeficiency virus and antiretroviral therapy-mediated immune cell metabolic dysregulation in children born to HIV-infected women: potential clinical implications. Front Immunol 2023; 14:1182217. [PMID: 37350953 PMCID: PMC10282157 DOI: 10.3389/fimmu.2023.1182217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/25/2023] [Indexed: 06/24/2023] Open
Abstract
Commencing lifelong antiretroviral therapy (ART) immediately following HIV diagnosis (Option B+) has dramatically improved the health of HIV-infected women and their children, with the majority being of HIV-exposed children born uninfected (HEU). This success has led to an increasing population of HIV-infected women receiving ART during pregnancy and children exposed to ART in utero. Nonetheless, a small proportion of children are still infected with HIV (HEI) each year. HEI children suffer from reduced immunocompetence and host-defence, due to CD4+ T lymphocyte depletion, but also dysregulation of other immune cells including CD8+ T lymphocytes, natural killer (NK) cells, macrophages including B lymphocytes. Furthermore, although HEU children are uninfected, altered immune responses are observed and associated with increased vulnerability to infections. The mechanisms underlying immune dysregulation in HEU children remain poorly described. Building on early studies, emerging data suggests that HIV/ART exposure early in life affects cell metabolic function of HEU children. Prenatal HIV/ART exposure has been associated with dysregulation of mitochondria, including impaired DNA polymerase activity. Furthermore, dysregulation of oxidative phosphorylation (OXPHOS) causes a decreased generation of adenosine triphosphate (ATP) and increased production of reactive oxygen species (ROS), resulting in oxidative stress. These altered metabolic processes can affect immune cell viability and immune responses. Recent studies have indicated that immune-metabolic dysregulation may contribute to HIV-associated pathogenesis and clinical observations associated with HIV and ART exposure in HEU/HEI children. Given the critical role metabolic processes in immune cell functioning, immune-metabolic dysregulation in HEU and HEI children may have implications in effective host-defence responses against pathogens, as well as efficacy of standard ART regimens and future novel HIV cure approaches in HEI children. At the same time, targeting metabolic pathways of immune cells may provide safer and novel approaches for HIV cure strategies. Here, we review the current literature investigating immune-metabolic dysregulation in paediatric HIV pathogenesis.
Collapse
Affiliation(s)
- Hope Mataramvura
- Immunology Unit, University of Zimbabwe Faculty of Medicine and Health Sciences (UZ-FMHS), Harare, Zimbabwe
| | - Madeleine J. Bunders
- III. Medical Department, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
- Department of Virus Immunology, Leibniz Institute of Virology, Hamburg, Germany
| | - Kerina Duri
- Immunology Unit, University of Zimbabwe Faculty of Medicine and Health Sciences (UZ-FMHS), Harare, Zimbabwe
| |
Collapse
|
4
|
In-utero HIV exposure and cardiometabolic health among children 5-8 years: findings from a prospective birth cohort in South Africa. AIDS 2023; 37:173-182. [PMID: 36476456 PMCID: PMC9751971 DOI: 10.1097/qad.0000000000003412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate if in-utero HIV exposure is associated with adverse cardiometabolic health outcomes at 5-8 years of age. DESIGN Prospective cohort study. METHODS We enrolled a random sample of HIV-exposed but uninfected (HEU) and HIV-unexposed children from the Drakenstein Child Health study, a longitudinal birth cohort study in Cape Town, South Africa, in a cardiometabolic health pilot study. Outcomes were assessed by trained study staff and included: anthropometry, body composition and size, blood pressure, fasting plasma glucose, HbA1c, lipids, and insulin resistance using HOMA-IR. We used multivariable linear and log-binomial regression to estimate associations between HIV-exposure and cardiometabolic outcomes, adjusted for child age, sex, height, body size, and maternal factors as appropriate. RESULTS We included 260 children (HEU n = 100, HIV-unexposed n = 160). HEU children had older mothers (median age 30 vs. 26 years), with minimal differences in gestational age and size at birth by HIV-exposure status. In multivariable analyses, HEU children had lower weight-for-age (mean difference -0.35, 95% confidence interval -0.66, -0.05), and height-for-age (mean difference -0.29, 95% confidence interval -0.56, -0.03; z-scores). There were no differences in adiposity, impaired glucose metabolism, or lipid levels by HIV-exposure status. Overall, 12% of children had blood pressure more than 90th percentile, with no differences by HIV-exposure status. CONCLUSION Overall, there were few differences in cardiometabolic outcomes between HEU and HIV-unexposed children in this South African cohort. Although these findings are reassuring, monitoring of cardiometabolic health is important as HEU and HIV-unexposed children enter adolescence and cardiometabolic risk trajectories become established.
Collapse
|
5
|
Shook LL, Fourman LT, Edlow AG. Immune Responses to SARS-CoV-2 in Pregnancy: Implications for the Health of the Next Generation. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2022; 209:1465-1473. [PMID: 36192115 PMCID: PMC9536183 DOI: 10.4049/jimmunol.2200414] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 08/08/2022] [Indexed: 11/06/2022]
Abstract
Widespread SARS-CoV-2 infection among pregnant individuals has led to a generation of fetuses exposed in utero, but the long-term impact of such exposure remains unknown. Although fetal infection is rare, children born to mothers with SARS-CoV-2 infection may be at increased risk for adverse neurodevelopmental and cardiometabolic outcomes. Fetal programming effects are likely to be mediated at least in part by maternal immune activation. In this review, we discuss recent evidence regarding the effects of prenatal SARS-CoV-2 infection on the maternal, placental, and fetal immune response, as well as the implications for the long-term health of offspring. Extrapolating from what is known about the impact of maternal immune activation in other contexts (e.g., obesity, HIV, influenza), we review the potential for neurodevelopmental and cardiometabolic morbidity in offspring. Based on available data suggesting potential increased neurodevelopmental risk, we highlight the importance of establishing large cohorts to monitor offspring born to SARS-CoV-2-positive mothers for neurodevelopmental and cardiometabolic sequelae.
Collapse
Affiliation(s)
- Lydia L Shook
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
- Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston, MA; and
| | - Lindsay T Fourman
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Andrea G Edlow
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, MA;
- Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston, MA; and
| |
Collapse
|
6
|
Duri K, Gumbo FZ, Munjoma PT, Chandiwana P, Mhandire K, Ziruma A, Macpherson A, Rusakaniko S, Gomo E, Misselwitz B, Mazengera LR. The University of Zimbabwe College of Health Sciences (UZ-CHS) BIRTH COHORT study: rationale, design and methods. BMC Infect Dis 2020; 20:725. [PMID: 33008316 PMCID: PMC7532096 DOI: 10.1186/s12879-020-05432-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 09/21/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Commencing lifelong antiretroviral therapy (ART) immediately following HIV diagnosis (Option B+), has greatly improved maternal-infant health. Thus, large and increasing numbers of HIV-infected women are on ART during pregnancy, a situation concurrently increasing numbers of HIV-exposed-uninfected (HEU) infants. Compared to their HIV-unexposed-uninfected (HUU) counterparts, HEU infants show higher rates of adverse birth outcomes, mortality, infectious/non-communicable diseases including impaired growth and neurocognitive development. There is an urgent need to understand the impact of HIV and early life ART exposures, immune-metabolic dysregulation, comorbidities and environmental confounders on adverse paediatric outcomes. METHODS Six hundred (600) HIV-infected and 600 HIV-uninfected pregnant women ≥20 weeks of gestation will be enrolled from four primary health centres in high density residential areas of Harare. Participants will be followed up as mother-infant-pairs at delivery, week(s) 1, 6, 10, 14, 24, 36, 48, 72 and 96 after birth. Clinical, socio-economic, nutritional and environmental data will be assessed for adverse birth outcomes, impaired growth, immune/neurodevelopment, vertical transmission of HIV, hepatitis-B/C viruses, cytomegalovirus and syphilis. Maternal urine, stool, plasma, cord blood, amniotic fluid, placenta and milk including infant plasma, dried blood spot and stool will be collected at enrolment and follow-up visits. The composite primary endpoint is stillbirth and infant mortality within the first two years of life in HEU versus HUU infants. Maternal mortality in HIV-infected versus -uninfected women is another primary outcome. Secondary endpoints include a range of maternal and infant outcomes. Sub-studies will address maternal stress and malnutrition, maternal-infant latent tuberculosis, Helicobacter pylori infections, immune-metabolomic dysregulation including gut, breast milk and amniotic fluid dysbiosis. DISCUSSION The University of Zimbabwe-College of Health-Sciences-Birth-Cohort study will provide a comprehensive assessment of risk factors and biomarkers for HEU infants' adverse outcomes. This will ultimately help developing strategies to mitigate effects of maternal HIV, early-life ART exposures and comorbidities on infants' mortality and morbidity. TRIAL REGISTRATION ClinicalTrial.gov Identifier: NCT04087239 . Registered 12 September 2019.
Collapse
Affiliation(s)
- Kerina Duri
- Department of Immunology, University of Zimbabwe College of Health Sciences (UZ-CHS), P.O. Box A178 Avondale, Harare, Zimbabwe.
| | - Felicity Z Gumbo
- Department of Paediatrics and Child Health, UZ-CHS, Harare, Zimbabwe
| | - Privilege T Munjoma
- Department of Immunology, University of Zimbabwe College of Health Sciences (UZ-CHS), P.O. Box A178 Avondale, Harare, Zimbabwe
| | | | | | - Asaph Ziruma
- Department of Obstetrics and Gynaecology, UZ-CHS, Harare, Zimbabwe
| | - Andrew Macpherson
- Clinic for Visceral Surgery and Medicine, Inselspital Bern and Bern University, Bern, Switzerland
| | | | - Exnevia Gomo
- UZ-CHS Research Support Centre, UZ-CHS, Harare, Zimbabwe
- Department of Medical Laboratory Sciences, UZ-CHS, Harare, Zimbabwe
| | - Benjamin Misselwitz
- Clinic for Visceral Surgery and Medicine, Inselspital Bern and Bern University, Bern, Switzerland
| | - Lovemore Ronald Mazengera
- Department of Immunology, University of Zimbabwe College of Health Sciences (UZ-CHS), P.O. Box A178 Avondale, Harare, Zimbabwe
| |
Collapse
|
7
|
Abstract
BACKGROUND 25-hydroxylase (CH25H) is an interferon-stimulated gene (ISG), which catalyzes the synthesis of 25-hydroxycholesterol (25HC). 25HC intervenes in metabolic and infectious processes and controls cholesterol homeostasis and influences viral entry into host cells. We verified whether natural resistance to HIV-1 infection in HIV-1-exposed seronegative (HESN) individuals is at least partially mediated by particularities in sterol biosynthesis. METHODS Peripheral blood mononuclear cells (PBMCs) and monocyte-derived macrophages (MDMs) isolated from 15 sexually exposed HESN and 15 healthy controls were in vitro HIV-1-infected and analyzed for: percentage of IFNα-producing plasmacytoid dendritic cells (pDCs); cholesterol signaling and inflammatory response RNA expression; resistance to HIV-1 infection. MDMs from five healthy controls were in vitro HIV-1-infected in the absence/presence of exogenously added 25HC. RESULTS IFNα-producing pDCs were augmented in HESN compared with healthy controls both in unstimulated and in in vitro HIV-1-infected PBMCs (P < 0.001). An increased expression of CH25H and of a number of genes involved in cholesterol metabolism (ABCA1, ABCG1, CYP7B1, LXRα, OSBP, PPARγ, SCARB1) was observed as well; this, was associated with a reduced susceptibility to in-vitro HIV-1-infection of PBMCs and MDMs (P < 0.01). Notably, addition of 25HC to MDMs resulted in increased cholesterol efflux and augmented resistance to in-vitro HIV-1-infection. CONCLUSION Results herein show that in HESN sterol metabolism might be particularly efficient. This could be related to the activation of the IFNα pathway and results into a reduced susceptibility to in-vitro HIV-1 infection. These results suggest a possible basis for therapeutic interventions to modulate HIV-1 infection.
Collapse
|
8
|
A Comparison of Metabolic Outcomes Between Obese HIV-Exposed Uninfected Youth From the PHACS SMARTT Study and HIV-Unexposed Youth From the NHANES Study in the United States. J Acquir Immune Defic Syndr 2020; 81:319-327. [PMID: 30844997 DOI: 10.1097/qai.0000000000002018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Metabolic perturbations in HIV-exposed uninfected (HEU) obese youth may differ from those in the general obese pediatric population. METHODS Metabolic parameters of obese (body mass index Z-score >95th percentile) HEU youth in the Pediatric HIV/AIDS Cohort Study (PHACS) Surveillance Monitoring of ART Toxicities (SMARTT) study were compared with a matched sample of obese youth from the US National Health and Nutrition Examination Survey (NHANES). We evaluated systolic and diastolic hypertension (blood pressure ≥90th percentile for age, sex, and height), total cholesterol >200 mg/dL, high-density lipoprotein cholesterol <35 mg/dL, low-density lipoprotein cholesterol >130 mg/dL, triglycerides (TGs) >150 mg/dL, and Homeostatic Model Assessment-Insulin Resistance >4.0. Modified Poisson regression models were fit to quantify the prevalence ratio (PR) of each outcome comparing the 2 cohorts, adjusting for confounders. RESULTS The blood pressure outcome analytic subgroup included 1096 participants (n = 304 HEU), the total cholesterol and high-density lipoprotein cholesterol subgroup 1301 participants (n = 385 HEU), and the low-density lipoprotein cholesterol, TG, and Homeostatic Model Assessment-Insulin Resistance subgroup 271 (n = 83 HEU). After adjustment, obese HEU youth had a higher prevalence of systolic and diastolic hypertension [PR = 3.34, 95% confidence interval (CI): 2.48 to 4.50; PR = 2.04, 95% CI: 1.18 to 3.52, respectively], but lower prevalence of insulin resistance (PR = 0.67, 95% CI: 0.54 to 0.85) and hypercholesterolemia (PR = 0.67, 95% CI: 0.44 to 1.01) compared with obese NHANES youth. CONCLUSIONS In the United States, obese HEU youth seem to have an increased risk of hypertension, but lower risk of insulin resistance and hypercholesterolemia, compared with a general obese pediatric population. Monitoring for cardiovascular morbidity in adulthood may be warranted in HEU children.
Collapse
|
9
|
le Roux SM, Abrams EJ, Donald KA, Brittain K, Phillips TK, Nguyen KK, Zerbe A, Kroon M, Myer L. Growth trajectories of breastfed HIV-exposed uninfected and HIV-unexposed children under conditions of universal maternal antiretroviral therapy: a prospective study. THE LANCET CHILD & ADOLESCENT HEALTH 2019; 3:234-244. [PMID: 30773459 DOI: 10.1016/s2352-4642(19)30007-0] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 12/18/2018] [Accepted: 12/19/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Over 1 million HIV-exposed uninfected (HEU) children are born in sub-Saharan Africa annually. Little data exist on the risk of impaired growth in this population under current policies of universal maternal antiretroviral therapy (ART) with breastfeeding. We aimed to study the growth of breastfed HEU children born to women who initiated ART during pregnancy and compare their growth with that of breastfed HIV-unexposed (HU) children drawn from the same community. METHODS A prospective cohort of HIV-uninfected and HIV-infected pregnant women, who were initiating ART, were enrolled at their first antenatal care visit in a primary care centre in Gugulethu, Cape Town, South Africa. HIV infected women were participants of the Maternal Child Health Antiretroviral Therapy (MCH-ART) study, and HIV-uninfected pregnant women were participants in the HIV-Unexposed-Uninfected (HU2) study. All women were followed up during pregnancy, through delivery, to the early postnatal visit, which was scheduled for the first week after birth. At this visit, eligible breastfeeding mother-child pairs were recruited for continuation of postnatal follow-up until approximately age 12 months. Child anthropometry was measured at around 6 weeks, and every 3 months from month 3 to month 12. Weight-for-age (WAZ), length-for-age (LAZ), weight-for-length (WLZ), head circumference-for-age, and body-mass index-for-age Z scores were compared between HEU and HU children longitudinally using mixed effects linear regression. At 12 months, proportions of HEU and HU children with moderate or severe malnutrition were compared cross-sectionally using logistic regression. MCH-ART is registered with ClinicalTrials.gov, number NCT01933477. FINDINGS Between June, 2013, and April, 2016, 884 breastfeeding mothers and their newborn babies (HEU, n=471; HU, n=413) were enrolled into postnatal follow-up. Excluding 12 children who tested HIV positive during follow-up, 461 HEU and 411 HU children attended 4511 study visits in total, with a median of 6 visits (IQR 5-6) per child. Birth characteristics were similar (overall, 94 [11%] of 872 preterm [<37 weeks] and 90 [10%] small-for-gestational age [birthweight <10th percentile]). Median duration of breastfeeding was shorter among HEU than HU children (3·9 months [IQR 1·4-12·0] vs 9·0 months [IQR 3·0-12·0]). Although WAZ scores increased over time in both groups, HEU children had consistently lower mean WAZ scores than HU children (overall β -0·34, 95% CI -0·47 to -0·21). LAZ scores decreased in both groups after 9 months. At 12 months, HEU children had lower mean LAZ scores than HU children (β -0·43, -0·61 to -0·25), with a higher proportion of children stunted (LAZ score <-2: 35 [10%] of 342 HEU vs 14 [4%] of 342 HU children; odds ratio [OR] 2·67, 95% CI 1·41 to 5·06). Simultaneously, overweight (WLZ score >2) was common in both groups of children at 12 months (54 [16%] of 342 HEU vs 60 [18%] of 340 HU children; OR 0·87, 95% CI 0·58 to 1·31). INTERPRETATION Compared with HU children, HEU children have small deficits in early growth trajectories under policies of universal maternal ART and breastfeeding. Large proportions of both HEU and HU children were overweight by 12 months, indicating substantial risks for early onset obesity among South African children. Although the longer-term metabolic effects of ART exposure in the context of childhood obesity warrants further investigation, addressing childhood obesity should be an urgent public health priority in this setting. FUNDING Eunice Kennedy Shriver National Institute of Child Health and Human Development, Elizabeth Glaser Pediatric AIDS Foundation, South African Medical Research Council, and the Fogarty Foundation.
Collapse
Affiliation(s)
- Stanzi M le Roux
- Division of Epidemiology and Biostatistics, University of Cape Town, Cape Town, South Africa.
| | - Elaine J Abrams
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, NY, USA; Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Kirsten A Donald
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa; Neuroscience Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Division of Developmental Paediatrics, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Kirsty Brittain
- Division of Epidemiology and Biostatistics, University of Cape Town, Cape Town, South Africa; Centre for Infectious Disease Epidemiology and Research (CIDER), School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Tamsin K Phillips
- Division of Epidemiology and Biostatistics, University of Cape Town, Cape Town, South Africa; Centre for Infectious Disease Epidemiology and Research (CIDER), School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Kelly K Nguyen
- Division of Epidemiology and Biostatistics, University of Cape Town, Cape Town, South Africa
| | - Allison Zerbe
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Max Kroon
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa; Neonatal Medicine, University of Cape Town and Mowbray Maternity Hospital, Cape Town, South Africa
| | - Landon Myer
- Division of Epidemiology and Biostatistics, University of Cape Town, Cape Town, South Africa; Centre for Infectious Disease Epidemiology and Research (CIDER), School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
10
|
Cockcroft K, Milligan R. Working Memory Structure in Atypical Development: HIV-infected and HIV-exposed, Uninfected School Beginners. Dev Neuropsychol 2019; 44:248-272. [PMID: 30623681 DOI: 10.1080/87565641.2018.1564309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Not much is known about the structure of working memory in atypical development. We undertook a detailed comparison of the functional organization of working memory in HIV-infected (n = 95; Mage = 7.42 years), and HIV-exposed (n = 86; Mage = 7.36 years) children, together with an uninfected, unexposed typically developing comparison group (n = 92; Mage = 7.05 years). Participants were in their first year of formal education. Within-group comparisons of five models showed that a four-factor model with separate verbal and visuospatial storage and processing accounted for the typically developing group, while working memory was structurally undifferentiated in the HIV-affected groups.
Collapse
Affiliation(s)
- Kate Cockcroft
- a Department of Psychology, School of Human and Community Development , University of the Witwatersrand , Johannesburg , South Africa
| | - Robyn Milligan
- a Department of Psychology, School of Human and Community Development , University of the Witwatersrand , Johannesburg , South Africa
| |
Collapse
|
11
|
Tort O, Escribà T, Egaña-Gorroño L, de Lazzari E, Cofan M, Fernandez E, Gatell JM, Martinez E, Garcia F, Arnedo M. Cholesterol efflux responds to viral load and CD4 counts in HIV+ patients and is dampened in HIV exposed. J Lipid Res 2018; 59:2108-2115. [PMID: 30213800 PMCID: PMC6210904 DOI: 10.1194/jlr.m088153] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 08/29/2018] [Indexed: 01/30/2023] Open
Abstract
Cholesterol efflux (CE) capacity has been inversely associated with atherosclerosis and may provide an insight on inflammation occurring in human immunodeficiency virus (HIV) individuals. We address this by studying CE in HIV patients at different stages of HIV disease progression. In this cross-sectional study, CE from ApoB-depleted plasma, lipids levels, viral load (VL), CD4+/CD8+ T-cells, high-sensitive C-reactive protein (hsCRP), and lipoprotein (a) were evaluated in untreated HIV-infected patients (UHIVs; n = 43), elite controllers (ECs; n = 8), HIV-exposed seronegative individuals (HESNs; n = 32), and healthy controls (HCs; n = 14). Among UHIVs, those with CD4+ <500 cells/mm3 presented the lowest significant CE, HDL cholesterol (HDL-C), and ApoAI levels. ECs showed similar HDL-C, ApoAI, and CE compared with HCs. Among UHIVs, CE positively correlated with CD4+ T-cell counts (Beta: 1.05; 95% CI: 1.02; 1.07), and for VL higher than 3.8 log, CE was inversely associated with VL (Beta: 0.70; 95% CI: 0.51; 0.95). Remarkably, HESNs presented higher CE (0.78 ± 0.14) than UHIVs (0.65 ± 0.17; P = 0.0005), but lower than HCs (0.90 ± 0.13; P = 0.009). hsCRP levels were highest in the UHIV group (0.45 ± 0.49). CE was sensitive to HIV disease progression. Low CE in HIV patients was associated with lower CD4+ T-cells and higher VL and hsCRP. CE was also lower in HESNs compared with HCs. Our results suggest that immune status secondary to HIV progression and exposure influence plasma HDL-CE capacity.
Collapse
Affiliation(s)
- Olivia Tort
- Group of Genomics and Pharmacogenomics, Acquired Immune Deficiency Syndrome Research Group, Catalan Project for the Development of a Human Immunodeficiency Virus Vaccine (HIVACAT), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic de Barcelona, Barcelona, Spain
| | - Tuixent Escribà
- Group of Genomics and Pharmacogenomics, Acquired Immune Deficiency Syndrome Research Group, Catalan Project for the Development of a Human Immunodeficiency Virus Vaccine (HIVACAT), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic de Barcelona, Barcelona, Spain
| | - Lander Egaña-Gorroño
- Group of Genomics and Pharmacogenomics, Acquired Immune Deficiency Syndrome Research Group, Catalan Project for the Development of a Human Immunodeficiency Virus Vaccine (HIVACAT), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic de Barcelona, Barcelona, Spain
| | - Elisa de Lazzari
- Infectious Diseases Service, Hospital Clínic-IDIBAPS, Laboratory of Retrovirology and Viral Immunopathogenesis, University of Barcelona, Barcelona, Spain
| | - Montserrat Cofan
- Lipid Clinic, Department of Endocrinology and Nutrition, Hospital Clínic de Barcelona, IDIBAPS, Barcelona, Spain and CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Emma Fernandez
- Infectious Diseases Service, Hospital Clínic-IDIBAPS, Laboratory of Retrovirology and Viral Immunopathogenesis, University of Barcelona, Barcelona, Spain
| | - José Maria Gatell
- Hospital Clinic/IDIBAPS, University of Barcelona, ViiV Healthcare, Barcelona, Spain
| | - Esteban Martinez
- Infectious Diseases Service, Hospital Clínic-IDIBAPS, Laboratory of Retrovirology and Viral Immunopathogenesis, University of Barcelona, Barcelona, Spain
| | - Felipe Garcia
- Infectious Diseases Service, Hospital Clínic-IDIBAPS, Laboratory of Retrovirology and Viral Immunopathogenesis, University of Barcelona, Barcelona, Spain
| | - Mireia Arnedo
- Group of Genomics and Pharmacogenomics, Acquired Immune Deficiency Syndrome Research Group, Catalan Project for the Development of a Human Immunodeficiency Virus Vaccine (HIVACAT), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic de Barcelona, Barcelona, Spain
| |
Collapse
|
12
|
Milligan R, Cockcroft K. Working Memory Profiles in HIV-Exposed, Uninfected and HIV-Infected Children: A Comparison with Neurotypical Controls. Front Hum Neurosci 2017; 11:348. [PMID: 28729828 PMCID: PMC5498467 DOI: 10.3389/fnhum.2017.00348] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 06/19/2017] [Indexed: 11/13/2022] Open
Abstract
This study compared the working memory profiles of three groups of children, namely HIV-infected (HIV-I; n = 95), HIV-exposed, uninfected (HIV-EU; n = 86) and an HIV-unexposed, uninfected, (HIV-UU; n = 92) neurotypical control group. Working memory, an executive function, plays an important role in frontal lobe-controlled behaviors, such as motivation, planning, decision making, and social interaction, and is a strong predictor of academic success in school children. Memory impairments have been identified in HIV-I children, particularly in visuospatial processing. Verbal working memory has not been commonly investigated in this population, while it is unknown how the working memory profiles of HIV-EU children compare to their HIV-I and HIV-UU peers. Of interest was whether the working memory profiles of the HIV-EU children would be more similar to the HIV-I group or to the uninfected control group. The results revealed no significant differences in working memory performance between the HIV-I and HIV-EU groups. However, this does not mean that the etiology of the working memory deficits is the same in the two groups, as these groups showed important differences when compared to the control group. In comparison to the controls, the HIV-I group experienced difficulties with processing tasks irrespective of whether they drew on a verbal or visuospatial modality. This appears to stem from a generalized executive function deficit that also interferes with working memory. In the HIV-EU group, difficulties occurred with verbally based tasks, irrespective of whether they required storage or processing. For this group, the dual demands of complex processing and using a second language seem to result in demand exceeding capacity on verbal tasks. Both groups experienced the greatest difficulties with verbal processing tasks for these different reasons. Thus, disruption of different cognitive abilities could result in similar working memory profiles, as evidenced in this study. This has implications for the underlying developmental neurobiology of HIV-I and HIV-EU children, as well the choice of appropriate measures to assist affected children.
Collapse
Affiliation(s)
| | - Kate Cockcroft
- Department of Psychology, School of Human and Community Development, University of the WitwatersrandJohannesburg, South Africa
| |
Collapse
|
13
|
Jao J, Kirmse B, Yu C, Qiu Y, Powis K, Nshom E, Epie F, Tih PM, Sperling RS, Abrams EJ, Geffner ME, LeRoith D, Kurland IJ. Lower Preprandial Insulin and Altered Fuel Use in HIV/Antiretroviral-Exposed Infants in Cameroon. J Clin Endocrinol Metab 2015; 100:3260-9. [PMID: 26133363 PMCID: PMC4570172 DOI: 10.1210/jc.2015-2198] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Intrauterine HIV/antiretroviral (ARV) and postnatal ARVs are known to perturb energy metabolism and could have permanent effects on future metabolic health. Such maladaptive effects could be mediated by changes in mitochondrial function and intermediary metabolism due to fetal and early-life ARV exposure in HIV/ARV-exposed uninfected (HEU) infants. OBJECTIVE The objective of the study was to understand the relationship(s) between mitochondrial fuel use (assessed via acylcarnitines and branched chain amino acids) and preprandial insulin in infants exposed to in utero HIV/ARV plus postnatal zidovudine or nevirapine compared with HIV/ARV-unexposed uninfected (HUU) infants. DESIGN This was a prospective cohort study with the following three groups: 1) intrauterine HIV/ARV/postnatal zidovudine-exposed (HEU-A), 2) intrauterine HIV/ARV/postnatal nevirapine-exposed (HEU-N), and 3) HUU infants. Principal component analysis and linear regression modeling were performed to assess the association between in utero HIV/ARV exposure and infant insulin. SETTING The study was conducted at Cameroonian urban antenatal centers. PARTICIPANTS HIV-infected and -uninfected pregnant woman/infant dyads participated in the study. MAIN OUTCOME Preprandial insulin was the main outcome measured. RESULTS Of 366 infants, 38 were HEU-A, 118 HEU-N. Forty intermediary metabolites were consolidated into seven principal components. In a multivariate analysis, both HEU-A (β = -.116, P= .012) and HEU-N (β = -.070, P= .022) demonstrated lower insulin compared with HUU infants. However, at high levels of plasma metabolites, HEU-A (β = .027, P= .050) exhibited higher insulin levels than HEU-N or HUU infants. A unique array of short-chain acylcarnitines (β = .044, P= .001) and branched-chain amino acids (β = .033, P= .012) was associated with insulin. CONCLUSION HEU-A and HEU-N infants have lower preprandial insulin levels at 6 weeks of age and appear to use metabolic fuel substrates differently than HUU infants. Future studies are warranted to determine whether observed differences have lasting metabolic implications, such as later insulin resistance.
Collapse
Affiliation(s)
- Jennifer Jao
- Departments of Medicine (J.J.), Obstetrics, Gynecology, and Reproductive Science (J.J.), Genetics and Genomic Sciences (C.Y.), and Obstetrics, Gynecology, and Reproductive Science (R.S.S.), and Department of Medicine (D.L.), Division of Endocrinology, Icahn School of Medicine, Mt Sinai, New York, New York 10029; Department of Pediatrics (B.K.), Division of Genetics and Metabolism, Children's National Medical Center/George Washington University School of Medicine, Washington, DC 20037; Department of Medicine (Y.Q., I.J.K.), Division of Endocrinology, Albert Einstein College of Medicine, Bronx, New York 10461; Departments of Pediatrics and Internal Medicine (K.P.), Massachusetts General Hospital, Boston, Massachusetts 02114; Cameroon Baptist Convention Health Services (E.N., F.E., P.M.T.), Bamenda, Cameroon; ICAP (E.J.A.), Mailman School of Public Health and College of Physicians and Surgeons, Columbia University, New York, New York 10032; and The Saban Research Institute of Children's Hospital Los Angeles (M.E.G.), Keck School of Medicine of University of Southern California, Los Angeles, California 90033
| | - Brian Kirmse
- Departments of Medicine (J.J.), Obstetrics, Gynecology, and Reproductive Science (J.J.), Genetics and Genomic Sciences (C.Y.), and Obstetrics, Gynecology, and Reproductive Science (R.S.S.), and Department of Medicine (D.L.), Division of Endocrinology, Icahn School of Medicine, Mt Sinai, New York, New York 10029; Department of Pediatrics (B.K.), Division of Genetics and Metabolism, Children's National Medical Center/George Washington University School of Medicine, Washington, DC 20037; Department of Medicine (Y.Q., I.J.K.), Division of Endocrinology, Albert Einstein College of Medicine, Bronx, New York 10461; Departments of Pediatrics and Internal Medicine (K.P.), Massachusetts General Hospital, Boston, Massachusetts 02114; Cameroon Baptist Convention Health Services (E.N., F.E., P.M.T.), Bamenda, Cameroon; ICAP (E.J.A.), Mailman School of Public Health and College of Physicians and Surgeons, Columbia University, New York, New York 10032; and The Saban Research Institute of Children's Hospital Los Angeles (M.E.G.), Keck School of Medicine of University of Southern California, Los Angeles, California 90033
| | - Chunli Yu
- Departments of Medicine (J.J.), Obstetrics, Gynecology, and Reproductive Science (J.J.), Genetics and Genomic Sciences (C.Y.), and Obstetrics, Gynecology, and Reproductive Science (R.S.S.), and Department of Medicine (D.L.), Division of Endocrinology, Icahn School of Medicine, Mt Sinai, New York, New York 10029; Department of Pediatrics (B.K.), Division of Genetics and Metabolism, Children's National Medical Center/George Washington University School of Medicine, Washington, DC 20037; Department of Medicine (Y.Q., I.J.K.), Division of Endocrinology, Albert Einstein College of Medicine, Bronx, New York 10461; Departments of Pediatrics and Internal Medicine (K.P.), Massachusetts General Hospital, Boston, Massachusetts 02114; Cameroon Baptist Convention Health Services (E.N., F.E., P.M.T.), Bamenda, Cameroon; ICAP (E.J.A.), Mailman School of Public Health and College of Physicians and Surgeons, Columbia University, New York, New York 10032; and The Saban Research Institute of Children's Hospital Los Angeles (M.E.G.), Keck School of Medicine of University of Southern California, Los Angeles, California 90033
| | - Yunping Qiu
- Departments of Medicine (J.J.), Obstetrics, Gynecology, and Reproductive Science (J.J.), Genetics and Genomic Sciences (C.Y.), and Obstetrics, Gynecology, and Reproductive Science (R.S.S.), and Department of Medicine (D.L.), Division of Endocrinology, Icahn School of Medicine, Mt Sinai, New York, New York 10029; Department of Pediatrics (B.K.), Division of Genetics and Metabolism, Children's National Medical Center/George Washington University School of Medicine, Washington, DC 20037; Department of Medicine (Y.Q., I.J.K.), Division of Endocrinology, Albert Einstein College of Medicine, Bronx, New York 10461; Departments of Pediatrics and Internal Medicine (K.P.), Massachusetts General Hospital, Boston, Massachusetts 02114; Cameroon Baptist Convention Health Services (E.N., F.E., P.M.T.), Bamenda, Cameroon; ICAP (E.J.A.), Mailman School of Public Health and College of Physicians and Surgeons, Columbia University, New York, New York 10032; and The Saban Research Institute of Children's Hospital Los Angeles (M.E.G.), Keck School of Medicine of University of Southern California, Los Angeles, California 90033
| | - Kathleen Powis
- Departments of Medicine (J.J.), Obstetrics, Gynecology, and Reproductive Science (J.J.), Genetics and Genomic Sciences (C.Y.), and Obstetrics, Gynecology, and Reproductive Science (R.S.S.), and Department of Medicine (D.L.), Division of Endocrinology, Icahn School of Medicine, Mt Sinai, New York, New York 10029; Department of Pediatrics (B.K.), Division of Genetics and Metabolism, Children's National Medical Center/George Washington University School of Medicine, Washington, DC 20037; Department of Medicine (Y.Q., I.J.K.), Division of Endocrinology, Albert Einstein College of Medicine, Bronx, New York 10461; Departments of Pediatrics and Internal Medicine (K.P.), Massachusetts General Hospital, Boston, Massachusetts 02114; Cameroon Baptist Convention Health Services (E.N., F.E., P.M.T.), Bamenda, Cameroon; ICAP (E.J.A.), Mailman School of Public Health and College of Physicians and Surgeons, Columbia University, New York, New York 10032; and The Saban Research Institute of Children's Hospital Los Angeles (M.E.G.), Keck School of Medicine of University of Southern California, Los Angeles, California 90033
| | - Emmanuel Nshom
- Departments of Medicine (J.J.), Obstetrics, Gynecology, and Reproductive Science (J.J.), Genetics and Genomic Sciences (C.Y.), and Obstetrics, Gynecology, and Reproductive Science (R.S.S.), and Department of Medicine (D.L.), Division of Endocrinology, Icahn School of Medicine, Mt Sinai, New York, New York 10029; Department of Pediatrics (B.K.), Division of Genetics and Metabolism, Children's National Medical Center/George Washington University School of Medicine, Washington, DC 20037; Department of Medicine (Y.Q., I.J.K.), Division of Endocrinology, Albert Einstein College of Medicine, Bronx, New York 10461; Departments of Pediatrics and Internal Medicine (K.P.), Massachusetts General Hospital, Boston, Massachusetts 02114; Cameroon Baptist Convention Health Services (E.N., F.E., P.M.T.), Bamenda, Cameroon; ICAP (E.J.A.), Mailman School of Public Health and College of Physicians and Surgeons, Columbia University, New York, New York 10032; and The Saban Research Institute of Children's Hospital Los Angeles (M.E.G.), Keck School of Medicine of University of Southern California, Los Angeles, California 90033
| | - Fanny Epie
- Departments of Medicine (J.J.), Obstetrics, Gynecology, and Reproductive Science (J.J.), Genetics and Genomic Sciences (C.Y.), and Obstetrics, Gynecology, and Reproductive Science (R.S.S.), and Department of Medicine (D.L.), Division of Endocrinology, Icahn School of Medicine, Mt Sinai, New York, New York 10029; Department of Pediatrics (B.K.), Division of Genetics and Metabolism, Children's National Medical Center/George Washington University School of Medicine, Washington, DC 20037; Department of Medicine (Y.Q., I.J.K.), Division of Endocrinology, Albert Einstein College of Medicine, Bronx, New York 10461; Departments of Pediatrics and Internal Medicine (K.P.), Massachusetts General Hospital, Boston, Massachusetts 02114; Cameroon Baptist Convention Health Services (E.N., F.E., P.M.T.), Bamenda, Cameroon; ICAP (E.J.A.), Mailman School of Public Health and College of Physicians and Surgeons, Columbia University, New York, New York 10032; and The Saban Research Institute of Children's Hospital Los Angeles (M.E.G.), Keck School of Medicine of University of Southern California, Los Angeles, California 90033
| | - Pius Muffih Tih
- Departments of Medicine (J.J.), Obstetrics, Gynecology, and Reproductive Science (J.J.), Genetics and Genomic Sciences (C.Y.), and Obstetrics, Gynecology, and Reproductive Science (R.S.S.), and Department of Medicine (D.L.), Division of Endocrinology, Icahn School of Medicine, Mt Sinai, New York, New York 10029; Department of Pediatrics (B.K.), Division of Genetics and Metabolism, Children's National Medical Center/George Washington University School of Medicine, Washington, DC 20037; Department of Medicine (Y.Q., I.J.K.), Division of Endocrinology, Albert Einstein College of Medicine, Bronx, New York 10461; Departments of Pediatrics and Internal Medicine (K.P.), Massachusetts General Hospital, Boston, Massachusetts 02114; Cameroon Baptist Convention Health Services (E.N., F.E., P.M.T.), Bamenda, Cameroon; ICAP (E.J.A.), Mailman School of Public Health and College of Physicians and Surgeons, Columbia University, New York, New York 10032; and The Saban Research Institute of Children's Hospital Los Angeles (M.E.G.), Keck School of Medicine of University of Southern California, Los Angeles, California 90033
| | - Rhoda S Sperling
- Departments of Medicine (J.J.), Obstetrics, Gynecology, and Reproductive Science (J.J.), Genetics and Genomic Sciences (C.Y.), and Obstetrics, Gynecology, and Reproductive Science (R.S.S.), and Department of Medicine (D.L.), Division of Endocrinology, Icahn School of Medicine, Mt Sinai, New York, New York 10029; Department of Pediatrics (B.K.), Division of Genetics and Metabolism, Children's National Medical Center/George Washington University School of Medicine, Washington, DC 20037; Department of Medicine (Y.Q., I.J.K.), Division of Endocrinology, Albert Einstein College of Medicine, Bronx, New York 10461; Departments of Pediatrics and Internal Medicine (K.P.), Massachusetts General Hospital, Boston, Massachusetts 02114; Cameroon Baptist Convention Health Services (E.N., F.E., P.M.T.), Bamenda, Cameroon; ICAP (E.J.A.), Mailman School of Public Health and College of Physicians and Surgeons, Columbia University, New York, New York 10032; and The Saban Research Institute of Children's Hospital Los Angeles (M.E.G.), Keck School of Medicine of University of Southern California, Los Angeles, California 90033
| | - Elaine J Abrams
- Departments of Medicine (J.J.), Obstetrics, Gynecology, and Reproductive Science (J.J.), Genetics and Genomic Sciences (C.Y.), and Obstetrics, Gynecology, and Reproductive Science (R.S.S.), and Department of Medicine (D.L.), Division of Endocrinology, Icahn School of Medicine, Mt Sinai, New York, New York 10029; Department of Pediatrics (B.K.), Division of Genetics and Metabolism, Children's National Medical Center/George Washington University School of Medicine, Washington, DC 20037; Department of Medicine (Y.Q., I.J.K.), Division of Endocrinology, Albert Einstein College of Medicine, Bronx, New York 10461; Departments of Pediatrics and Internal Medicine (K.P.), Massachusetts General Hospital, Boston, Massachusetts 02114; Cameroon Baptist Convention Health Services (E.N., F.E., P.M.T.), Bamenda, Cameroon; ICAP (E.J.A.), Mailman School of Public Health and College of Physicians and Surgeons, Columbia University, New York, New York 10032; and The Saban Research Institute of Children's Hospital Los Angeles (M.E.G.), Keck School of Medicine of University of Southern California, Los Angeles, California 90033
| | - Mitchell E Geffner
- Departments of Medicine (J.J.), Obstetrics, Gynecology, and Reproductive Science (J.J.), Genetics and Genomic Sciences (C.Y.), and Obstetrics, Gynecology, and Reproductive Science (R.S.S.), and Department of Medicine (D.L.), Division of Endocrinology, Icahn School of Medicine, Mt Sinai, New York, New York 10029; Department of Pediatrics (B.K.), Division of Genetics and Metabolism, Children's National Medical Center/George Washington University School of Medicine, Washington, DC 20037; Department of Medicine (Y.Q., I.J.K.), Division of Endocrinology, Albert Einstein College of Medicine, Bronx, New York 10461; Departments of Pediatrics and Internal Medicine (K.P.), Massachusetts General Hospital, Boston, Massachusetts 02114; Cameroon Baptist Convention Health Services (E.N., F.E., P.M.T.), Bamenda, Cameroon; ICAP (E.J.A.), Mailman School of Public Health and College of Physicians and Surgeons, Columbia University, New York, New York 10032; and The Saban Research Institute of Children's Hospital Los Angeles (M.E.G.), Keck School of Medicine of University of Southern California, Los Angeles, California 90033
| | - Derek LeRoith
- Departments of Medicine (J.J.), Obstetrics, Gynecology, and Reproductive Science (J.J.), Genetics and Genomic Sciences (C.Y.), and Obstetrics, Gynecology, and Reproductive Science (R.S.S.), and Department of Medicine (D.L.), Division of Endocrinology, Icahn School of Medicine, Mt Sinai, New York, New York 10029; Department of Pediatrics (B.K.), Division of Genetics and Metabolism, Children's National Medical Center/George Washington University School of Medicine, Washington, DC 20037; Department of Medicine (Y.Q., I.J.K.), Division of Endocrinology, Albert Einstein College of Medicine, Bronx, New York 10461; Departments of Pediatrics and Internal Medicine (K.P.), Massachusetts General Hospital, Boston, Massachusetts 02114; Cameroon Baptist Convention Health Services (E.N., F.E., P.M.T.), Bamenda, Cameroon; ICAP (E.J.A.), Mailman School of Public Health and College of Physicians and Surgeons, Columbia University, New York, New York 10032; and The Saban Research Institute of Children's Hospital Los Angeles (M.E.G.), Keck School of Medicine of University of Southern California, Los Angeles, California 90033
| | - Irwin J Kurland
- Departments of Medicine (J.J.), Obstetrics, Gynecology, and Reproductive Science (J.J.), Genetics and Genomic Sciences (C.Y.), and Obstetrics, Gynecology, and Reproductive Science (R.S.S.), and Department of Medicine (D.L.), Division of Endocrinology, Icahn School of Medicine, Mt Sinai, New York, New York 10029; Department of Pediatrics (B.K.), Division of Genetics and Metabolism, Children's National Medical Center/George Washington University School of Medicine, Washington, DC 20037; Department of Medicine (Y.Q., I.J.K.), Division of Endocrinology, Albert Einstein College of Medicine, Bronx, New York 10461; Departments of Pediatrics and Internal Medicine (K.P.), Massachusetts General Hospital, Boston, Massachusetts 02114; Cameroon Baptist Convention Health Services (E.N., F.E., P.M.T.), Bamenda, Cameroon; ICAP (E.J.A.), Mailman School of Public Health and College of Physicians and Surgeons, Columbia University, New York, New York 10032; and The Saban Research Institute of Children's Hospital Los Angeles (M.E.G.), Keck School of Medicine of University of Southern California, Los Angeles, California 90033
| |
Collapse
|