Serum lipid and glucose profiles in HIV-positive Nigerian children

Growth and Metabolic Changes After Antiretroviral Initiation in South African Children

BACKGROUND

Poor growth and metabolic disturbances remain concerns for children living with HIV (CLHIV). We describe the impact of viral load (VL) on growth and lipid outcomes in South African CLHIV <12 years initiating World Health Organization recommended first-line antiretroviral therapy (ART) from 2012 to 2015.

METHODS

Z scores for length-for-age (LAZ), weight-for-age (WAZ) and body mass index-for-age were calculated. Lipids (total cholesterol, low-density lipoprotein and high-density lipoprotein) were measured. Hemoglobin A1C ≥5.8 was defined as at risk for type 2 diabetes. Mixed effects models were used to assess the association of VL at ART initiation with Z scores and lipids over time.

RESULTS

Of 241 CLHIV, 151 (63%) were <3 years initiating LPV/r-based ART and 90 (37%) were ≥3 years initiating EFV-based ART. Among CLHIV <3 years, higher VL at ART initiation was associated with lower mean LAZ (ß: -0.30, P=0.03), WAZ (ß: -0.32, P=0.01) and low-density lipoprotein (ß: -6.45, P=0.03) over time. Among CLHIV ≥3, a log 10 increase in pretreatment VL was associated with lower mean LAZ (ß: -0.29, P=0.07) trending towards significance and lower WAZ (ß: -0.32, P=0.05) as well as with more rapid increases in LAZ (ß: 0.14 per year, P=0.01) and WAZ (ß: 0.19 per year, P=0.04). Thirty percent of CLHIV were at risk for type 2 diabetes at ART initiation.

CONCLUSIONS

CLHIV initiating ART <3 years exhibited positive gains in growth and lipids, though high viremia at ART initiation was associated with persistently low growth and lipids, underscoring the need for early diagnosis and rapid treatment initiation. Future studies assessing the long-term cardiometabolic impact of these findings are warranted.

Correlates of fasting blood glucose among children living with hiv in a Nigerian tertiary hospital: a cross-sectional study

Background

There is growing concern as regards the emergence of metabolic disorders among children living with the Human Immunodeficiency Virus (HIV) worldwide. However, there is paucity of data on the correlates of metabolic indices among HIV-positive children in Africa.

Methods

This study examined 84 HIV-positive children on HAART recruited from the paediatric infectious diseases clinic of the University of Nigeria Teaching Hospital for blood glucose levels using finger-prick testing with an Accu-check glucose meter and test strips. Clinical information was obtained via clinical history and medical records. Data was analyzed to examine the relationship between FBG and the classes of HAART, duration of illness and treatment using analysis of variance (ANOVA).

Results

FBG was significantly associated with the classes of HAART (_x²=12.4, p = 0.017). In addition, there was a significant association between FBG and duration of illness [F(2, 81) = 6.0; P = 0.004], as well as FBG and duration on HAART [F(2, 81) = 7.9; P = 0.001]. However, duration on HAART and type of HAART were the significant predictors of FBG in this study accounting for 10.5% and 4.1% of the variance, respectively.

Conclusions

There is a greater risk of dysglycemia in paediatric patients with a longer cumulative exposure to HAART. Routine blood glucose checks among children on HAART, especially those who have received HAART for a longer duration of time may therefore be useful in their management.