High prevalence of low high-density lipoprotein cholesterol and insulin resistance among children and adolescents living with HIV in Uganda: Harbinger for metabolic syndrome?

Abstract

AbstractBackgroundAntiretroviral Therapy-associated adverse effects and comorbidities are still pervasive in people living with HIV, especially metabolic syndrome (MetS), which is on the rise and occurring at early age. However, there is paucity of data on MetS in children and adolescents living with HIV (CALWH), particularly in sub-Saharan Africa. We investigated the age-dependent prevalence of components of MetS in this population.MethodsA cross-sectional pilot study of CALWH treated at the Baylor Uganda Clinical Centre of Excellence in Kampala, Uganda. Using stratified by age group and sex random sampling, participants were recruited from May to August 2021. At enrollment, we collected data on participant demographics, anthropometric measurements, HIV disease characteristics, and past medical history and obtained blood for fasting levels of glucose, insulin, triglycerides, total cholesterol, and high-density lipoprotein (HDL) cholesterol. The primary outcome of MetS was defined by both the International Diabetes Federation (IDF) and Adult Treatment Panel (ATPIII) criteria. We estimated the prevalence of MetS and its components for all participants and by the stratification factors.ResultsWe enrolled 90 children and adolescents: <10 y/o (N=30), 10 to <16 y/o (N=30), and ≥16 (N=30) y/o. Fifty-one percent were females. The prevalence of MetS was 1.11% (1 of 90) using either IDF or ATPIII criteria for all participants, and 3.33% for ≥16-year group. Over 55% of participants had ≥1 IDF component, with 47% having low HDL cholesterol; 14% of participants had early insulin resistance using the HOMA index. The proportion of early insulin resistance was 6.67%, 23.33%, and 13.33% for the three age groups, respectively. Two participants (6.67%) in the 10 to <16 years group had significant insulin resistance. For every 1-year increase in age, HOMA index increased by 0.04 (95% Confidence Interval 0.01, 0.08), p=0.02.ConclusionsThe high prevalence of components of MetS, particularly low HDL and early insulin resistance, are of concern. With increasing survival of CALWH into adulthood and increased lifetime exposure to ART, the frequency of MetS in this population may rise, increasing the lifetime risk for associated health problems, such as type 2 diabetes, myocardial infarction, stroke, and nonalcoholic fatty liver disease.