Metabolic Disorders in HIV-Infected Adolescents Receiving Protease Inhibitors
Table 4
Clinical characteristics of patients and risk factors for metabolic syndrome in HIV-infected adolescents receiving protease inhibitor- (PI-) based highly active antiretroviral therapy (HAART).
Characteristics and factors
Metabolic syndrome ()
Nonmetabolic syndrome ()
Univariate analysis
Multivariate analysis
Crude OR (95% CI)
p value
Adjusted OR (95% CI)
value
Demographics and anthropometrics
Age (years), median (IQR)
19.1 (16.4–21.4)
16.5 (14.3–17.6)
1.4 (1.07–1.9)
0.014
Gender, (%)
Male
5 (62.5)
37 (51.4)
1.6 (0.3–7.1)
0.553
Female
3 (37.5)
35 (48.6)
1
Family history of CVD or HT, (%)
Yes
3 (37.5)
17 (23.6)
1.9 (0.4–8.9)
0.396
No
5 (62.5)
55 (76.4)
1
Family history of T2DM, (%)
Yes
4 (50.0)
20 (27.8)
2.6 (0.6–11.4)
0.205
No
4 (50.0)
52 (72.2)
1
Family history of dyslipidemia, (%)
Yes
3 (37.5)
16 (22.2)
2.1 (0.4–9.7)
0.344
No
5 (62.5)
56 (77.8)
1
Waist circumference (cm), median (IQR)
82 (80.3–94.7)
66.2 (61.2–70.1)
1.26 (1.1–1.4)
0.001
BMI (kg/m2), median (IQR)
23.4 (22.3–26.9)
17.6 (16.1–19.4)
2.1 (1.3–3.4)
0.001
Percentage weight-for-height (%), median (IQR)
128.7 (119.6–139.4)
98.5 (87.8–106.1)
1.15 (1.06–1.24)
<0.001
Waist-to-height ratio, median (IQR)
0.54 (0.51–0.58)
0.43 (0.39–0.46)
1.46 × 1017 (2.72 × 1017 to 7.88 × 1026)
0.001
Obesity, (%)
8 (100)
7 (9.7)
—
<0.001
SBP (mmHg), median (IQR)
125 (119–129)
113 (105–119)
1.18 (1.05–1.32)
0.004
DBP (mmHg), median (IQR)
77 (68–88)
69 (64–73)
1.12 (1.02–1.22)
0.018
High blood pressure, (%)
Yes
3 (37.5)
4 (5.6)
10.2 (1.8–58.7)
0.009
No
5 (62.5)
68 (94.4)
1
Acanthosis nigricans, (%)
5 (62.5)
6 (8.3)
18.3 (3.5–96.2)
0.001
Lipoatrophy, (%)
1 (12.5)
21 (29.2)
0.3 (0.04–3.0)
0.336
Lipohypertrophy, (%)
4 (50.0)
4 (5.6)
17 (3.1–94.4)
0.001
25.7 (3.2–202.8)
0.002
Lipodystrophy, (%)
4 (50.0)
22 (30.6)
2.3 (0.5–9.9)
0.275
Tanner staging, (%)
Pre-pubertal stage
0 (0.0)
5 (6.9)
—
—
Pubertal stage
8 (100.0)
67 (93.1)
Metabolic parameters
Total cholesterol (mmol/L), median (IQR)
5.58 (4.53–6.95)
4.34 (3.90–5.04)
1.03 (1.007–1.04)
0.005
Triglycerides (mmol/L), median (IQR)
4.44 (1.88–5.03)
1.48 (1.06–2.19)
1.005 (1.00–1.009)
0.032
LDL-cholesterol (mmol/L), median (IQR)
2.57 (2.27–4.13)
2.40 (2.05–2.93)
1.022 (0.99–1.046)
0.057
HDL-cholesterol (mmol/L), median (IQR)
1.05 (0.91–1.11)
1.22 (1.02–1.45)
0.95 (0.89–1.01)
0.107
FPG (mmol/L), median (IQR)
5.00 (4.44–7.41)
4.63 (4.39–4.91)
1.06 (1.00–1.12)
0.050
2-hour PG (mmol/L), median (IQR)
8.77 (7.16–13.15)
6.58 (5.50–7.30)
1.03 (1.0–1.06)
0.007
Fasting insulin (pmol/L), median (IQR)
177 (142–304)
91 (58–131)
1.02 (0.99–1.04)
0.157
2-hour insulin (pmol/L), median (IQR)
1793 (790–3552)
586 (376–1463)
1.002 (1.0–1.004)
0.049
HOMA-IR, median (IQR)
6.2 (5.0–8.9)
2.7 (1.7–4.0)
1.1 (1.0–1.2)
0.048
HbA1c (%), median (IQR)
5.4 (5.2–6.9)
5.2 (4.9–5.5)
3.8 (0.9–16.2)
0.072
HIV-specific disease characteristic
CDC stage, (%)
Severely symptomatic (Stage C)
3 (37.5)
22 (30.6)
1.36 (0.3–6.2)
0.689
Nonsevere stage
5 (62.5)
50 (69.4)
1
Nadir CD4 cell counts (cells/mm3), median (IQR)
107.5 (35.5–244)
184 (33–395)
0.99 (0.99–1.00)
0.348
<100 cells/mm3, (%)
3 (37.5)
28 (39.4)
1
100–350 cells/mm3, (%)
4 (50.0)
22 (31.0)
1.7 (0.3–8.4)
0.516
>350 cells/mm3, (%)
1 (12.5)
21 (29.6)
0.4 (0.04–4.6)
0.496
CD4 cell counts (cells/mm3), median (IQR)
682 (490–832)
656 (525.5–802)
0.99 (0.997–1.001)
0.664
<350 cells/mm3, (%)
1 (12.5)
9 (12.5)
1
350–500 cells/mm3, (%)
1 (12.5)
6 (8.3)
1.5 (0.08–28.9)
0.788
>500 cells/mm3, (%)
6 (75.0)
57 (79.2)
0.95 (0.1–8.8)
0.962
Viral load (copies/mL), median (IQR)
40 (40-40)
40 (40-40)
0.99 (0.99–1.00)
0.731
≤40 copies/mL, (%)
7 (87.5)
57 (79.2)
1.8 (0.2–16.2)
0.581
>40 copies/mL, (%)
1 (12.5)
15 (20.8)
1
Duration of PIs (months), median (IQR)
89.3 (70.4–123.0)
72.3 (53.2–80.0)
1.027 (1.001–1.05)
0.038
1.04 (1.00–1.08)
0.023
Duration of HAART (months), median (IQR)
126.7 (90.7–129.1)
106.5 (78.8–129.7)
1.007 (0.98–1.03)
0.546
Ever received didanosine ≥ 6 months, (%)
6 (75.0)
50 (69.4)
1.32 (0.25–7.1)
0.746
Ever received stavudine ≥ 6 months, (%)
7 (87.5)
44 (61.1)
4.4 (0.5–38.2)
0.173
9.5 (0.5–165.4)
0.122
Ever received tenofovir ≥ 6 months, (%)
6 (75.0)
51 (70.8)
1.2 (0.2–6.6)
0.805
Ever received zidovudine ≥ 6 months, (%)
8 (100.0)
65 (90.3)
—
—
Ever received efavirenz ≥ 6 months, (%)
4 (50.0)
39 (54.2)
0.8 (0.2–3.6)
0.823
Ever received nevirapine ≥ 6 months, (%)
3 (37.5)
31 (43.1)
0.8 (0.18–3.6)
0.763
Ever received lopinavir/ritonavir ≥ 6 months, (%)
8 (100.0)
71 (98.6)
—
—
Ever received atazanavir ≥ 6 months, (%)
4 (50.0)
19 (26.4)
2.8 (0.6–12.3)
0.175
Ever received darunavir ≥ 6 months, (%)
3 (37.5)
10 (13.9)
3.7 (0.8–18.1)
0.103
Ever received indinavir ≥ 6 months, (%)
8 (100.0)
32 (44.4)
—
0.005
Ever received full dose ritonavir ≥ 6 months, (%)
1 (12.5)
7 (9.7)
1.3 (0.14–12.4)
0.804
Input variables: age, gender, family history of T2DM, family history of dyslipidemia, PI duration, lipohypertrophy, and exposure to stavudine ≥6 months. Fisher’s exact test. Viral load ≤ 40 copies/mL was expressed as 40 in the statistical analysis. OR, odds ratio; CI, confidence interval; IQR, interquartile range; CVD, cardiovascular disease; HT, hypertension; T2DM, type 2 diabetes mellitus; SBP, systolic blood pressure; DBP, diastolic blood pressure; CDC, Centers for Disease Control; FPG, fasting plasma glucose; PG, plasma glucose.
