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Risk factors associated with adverse metabolic health in youth with perinatally acquired HIV living in the United Kingdom, no statin recommendations
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Foster, Carolinea,b; Blenkinsop, Alexandrac; Henderson, Merlea,d; Lyall, Hermioneb; Fidler, Saraha,d;
AIDS May 04, 2026
The Reprieve study led to the recommendation of empirical statin use from 40 years in adults with HHIV [27]. However, there are no recommendations for statins in PHIV despite high rates of dyslipidaemia reported in both high and low incomes settings (34-70%) and in the context of lifelong inflammation and increased cardiovascular risk [7,10,19,22-25,38]. With the metabolic impact of lifestyle interventions for youth limited and pharmacotherapy currently targeted to older adults with established morbidity, the optimal timing and modality of intervention strategies to prevent cardiovascular disease remains a research priority for this emerging adult population with PHIV [5,10,27,38]. People born with perinatally acquired HIV (PHIV) experience lifelong exposure to HIV-associated inflammation and increasingly antiretroviral therapy (ART), with the oldest entering their 5th decade of life; approaching the age clinical cardiovascular events and MetS-associated T2DM appear in the general population [2-5].
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Objective:
Non-AIDS-related morbidity and mortality in people with HIV are associated with adverse metabolic health, influenced by both traditional- and HIV-related risk factors. There is a paucity of data for youth with perinatal HIV (PHIV). We explored the relationship between markers of metabolic health and antiretroviral therapy (ART) in youth with PHIV.
Design:
Longitudinal observational cohort study; 26 months.
Methods:
85 youth enrolled in the "Bone Density in Youth living with PHIV" (BONDY) underwent assessment of metabolic health including fasting biochemistry, body mass index (BMI), total body dual energy x-ray absorptiometry scan and hepatic transient elastography.
Results:
Of 85 participants with PHIV, mean age 21.7 years, 58% were female and 82% black African.
Median ART exposure was 15 years, median CD4 count 623 cells/μL at enrolment with 82% viral load <200 copies/ml.
Median weight gain over 26 months was 3 kg, with BMI category overweight/obese increasing from 37% to 50% with 48% having dyslipidaemia.
Metabolic syndrome criteria were fulfilled in 7%, with 13% having hypertension, 18% hepatic steatosis and 7% fibrosis on transient elastography.
Bayesian regression analyses demonstrated no association of integrase strand transfer inhibitor (INSTI) and/or tenofovir alafenamide (TAF) use, and sex at birth or prior CDC-C diagnoses or current HIV viraemia on metabolic outcomes.
Conclusion:
While adverse metabolic outcomes are common in this youth cohort with PHIV, no association was observed with INSTI and/or TAF use. Given the relatively young age of this cohort, preventative interventions targeting traditional metabolic risk factors are required to avoid comorbidities in later life.
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