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Pancreatic endocrine dysfunction linked to growth failure in HIV-infected children
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NEW YORK (Reuters Health) - Altered pancreatic endocrine secretion may be associated with growth failure in HIV-infected children, according to a report in the September 1st issue of The Journal of Infectious Diseases.
Metabolic alterations are common among HIV-infected individuals, the authors explain, but pancreatic endocrine function in HIV-infected subjects has not been studied in detail.
Dr. Mariangela Rondanelli and colleagues from University of Pavia, Italy evaluated pancreatic endocrine secretion in 14 HIV-infected children, age 5 to 11 years, and 16 age- and sex-matched controls and examined its possible association with failure to thrive.
Levels of insulin, glucagon, C-peptide, and glucose and measures of insulin resistance were significantly higher for the HIV-infected children than for the controls at all three annual evaluations, the authors report.
Most HIV-infected children (11 of 14) showed significantly impaired responses to glucagon challenge, whereas all healthy controls had normal glycemic responses. The ratio of insulin to glucagon was significantly correlated with the growth velocity of HIV-infected children, the researchers note, and bone age and the ratio of bone age to chronological age were significantly lower in the HIV-infected children. Other hormone levels and lipid levels were similar in HIV-infected children and controls, and virus loads and CD4+ cell counts in HIV-infected children did not correlate with any of the parameters studied.
"The results of the prospective study reported here constitute, to our knowledge, the first evidence of altered pancreatic endocrine secretion and its association with growth failure, which is one of the most sensitive indicators of disease progression," the investigators write.
"Simple biochemical parameters, such as glucagon and insulin levels, could be routinely measured in consecutive clinical assessments, to document metabolic alterations that, although apparently are only secondary, may, in fact, be very important in the regulation of growth among HIV-infected children," the authors conclude.
"The long-term consequences of these endocrine pancreatic changes and the possible influence of beta cell dysfunction on lipodystrophy in individuals receiving combination therapy require investigation both in adults and children," the researchers add.
J Infect Dis 2004;190:908-912.
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