Finding Ways to Help the Youngest With HIV

The Pediatric AIDS Clinic at University Hospitals Rainbow Babies & Children's Hospital is conducting what is believed to be the only study on HIV-positive children and cardiovascular disease. Dr. Grace McComsey, chief of Pediatric Infectious Diseases, Rheumatology, and Global Health at Rainbow and a professor at Case Western Reserve University School of Medicine, is heading the four-year study.

Eighty patients from across Ohio (the youngest is two; the oldest is 21; mean age is 9) are being followed. At the study's start, participants underwent blood tests to assess cholesterol levels and diabetes or prediabetes, and to look for markers of heart inflammation -- a condition more common among HIV patients.

"In adults atherosclerosis is checked with a CT scan. But that test involves too much radiation for it to be routinely used on children safely," explained McComsey. Instead, the team used noninvasive ultrasound to measure carotid IMT (intima media thickness) and to assess whether there was any plaque buildup. "Whatever happens in the neck artery is a reflection of what happens in the heart vessel," she said.

The initial study findings show that HIV-positive children have significantly higher IMT, cholesterol levels, and prediabetes compared with HIV-negative healthy kids. "All of these cardiovascular risk factors put them at higher risk even though they don't show signs of heart disease, such as chest pain," said McComsey.

After one year, during which researchers observed the participants but otherwise did not intervene, the HIV-positive group showed improvement in lipid levels compared to the HIV-negative control group. Participants' CD4 counts also improved after one year, linked with IMT improvements.

According to McComsey, the patients and their parents adopted improved diets and increased activity levels. These changes were not prompted by researchers, but instead by parents more aware of potential cardiovascular risks. "When you give a consent form to the parents, even without us trying to influence the results of the study, they changed the way [their children] were eating and exercising," she said.

The initial findings, "Heightened Inflammation Is Linked to Carotid Intima-Media Thickness and Endothelial Activation in HIV-Infected Children," were published in the journal Atherosclerosis (2010;211(2):492-498).

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