Insulin resistance and glucose and lipid concentrations in a cohort of perinatally HIV-infected Latin American children.

As the perinatally HIV-infected population in the United States and Europe enters the third decade of life, they face high rates of traditional risk factors for cardiovascular disease, such as obesity, dyslipidemia, and insulin resistance, though they are still too young to have experienced clinical events (1). Earlier studies in HIV-infected children reported rates of insulin resistance of 8-52% based upon different thresholds (2-4). More recent studies have used fasting insulin and glucose measurements to calculate the homeostatic model assessment of insulin resistance (HOMA-IR), with rates of insulin resistance ranging from 6.5% in Thai children receiving effective antiretroviral therapy (ART) for 2 years (5) to 33% in an older American cohort predominantly treated with protease inhibitor (PI)-containing ART (6). The largest study to date, from the Pediatric HIV/AIDS Cohort Study (PHACS), found insulin resistance in 15% of 401 perinatally HIV-infected American children (7). Given these varying results and differences across geographic regions, which may reflect varied dietary habits and genetic susceptibility, we examined fasting insulin, glucose, and lipid results in a cohort of perinatally HIV-infected children followed in the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) International Site Development Initiative [NISDI] Pediatric Latin American Countries Epidemiologic Study [PLACES].