The Determinants of Elevated Pathobiological Determination of Atherosclerosis in Youth risk score in Perinatally HIV Infected Adolescents in South Africa.

BACKGROUND: Youth living with perinatally acquired HIV-infection (YLPHIV) are at risk of developing atherosclerotic cardiovascular disease.

METHODS: We determined the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) coronary arteries (CA) and abdominal aorta (AA) risk scores among YLPHIV those are ≥15 years old in Cape Town Adolescent and Antiretroviral Cohort (CTACC). PDAY score was calculated using: non-high-density lipoprotein (HDL), HDL-cholesterol, hyperglycemia, hypertension, obesity, smoking; a score >1 was considered elevated. HIV-viremia was categorized as sustained (SV)=VL>50, transient (TV)=mix of VL>50 and ≤50, or sustained-virologic suppression (VS)=VL<50 copies/mL throughout the study. Among YLPHIV, logistic models were fit to assess factors associated with elevated PDAY.

RESULTS: Overall, 218 YLPHIV (median age 16.8 (IQR 15.9-17.8) years, male 47%) were included. Among YLPHIV, 8% (n=17) had SV, and 54% (n=118) had TV. Median ART duration was 12 (IQR:8-14) years. Among YLPHIV, 30.3% and 18.4% had elevated PDAY for CA and AA respectively.Among YLPHIV, SV [adjusted OR (aOR)=18.4,p<0.01] and TV (aOR=2.10,p=0.04) compared to VS and ART duration in years (aOR=1.12,p=0.03) were associated with elevated CA. Male sex was associated with both elevated CA and AA (aOR=2.14,p=0.02, and aOR=3.43,p=0.01, respectively) and association of SV with elevated AA (aOR=3.24,p=0.09).

CONCLUSIONS: A substantial proportion of YLPHIV have PDAY scores reflecting increased aggregate atherosclerotic risk. Among YLPHIV, viremia, lifetime ART-duration and male sex contribute to this risk, highlighting the importance of HIV control, and the need to monitor cardiometabolic health.