Original Research

Earlier antiretroviral initiation is independently associated with better arterial stiffness in children living with perinatally acquired HIV with sustained viral suppression in Mozambique

Igor S. Dobe, Ana O. Mocumbi, Noorjean Majid, Birhanu Ayele, Sara H. Browne, Steve Innes
Southern African Journal of HIV Medicine | Vol 22, No 1 | a1282 | DOI: https://doi.org/10.4102/sajhivmed.v22i1.1282 | © 2021 Igor Samuel Dobe | This work is licensed under CC Attribution 4.0
Submitted: 29 June 2021 | Published: 14 October 2021

About the author(s)

Igor S. Dobe, Division Non-Communicable Diseases, Instituto Nacional de Saúde, Maputo, Mozambique
Ana O. Mocumbi, Division Non-Communicable Diseases, Instituto Nacional de Saúde, Maputo, Mozambique; and, Department of Internal Medicine, Faculty of Medicine, University Eduardo Mondlane, Maputo, Mozambique
Noorjean Majid, Dream Center Sant’Egídeo, Maputo, Mozambique
Birhanu Ayele, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Science, Stellenbosch University, Stellenbosch, South Africa
Sara H. Browne, Department of Medicine, Division of Infectious Diseases, University of California San Diego, San Diego, United States of America
Steve Innes, Department of Paediatrics and Child Health, Family Centre for Research with Ubuntu (FAMCRU), Stellenbosch University, Cape Town, South Africa; and, Desmond Tutu HIV Centre, University of Cape Town, South Africa


Background: Cardiovascular disease is a major driver of morbidity and mortality in adults living with HIV. The drivers of cardiovascular disease in children living with perinatally acquired HIV (PHIV) with sustained HIV viral suppression are unclear.

Objectives: We explored the contribution of HIV-specific risk factors to arterial stiffness independently of traditional risk factors (metabolic syndrome [MetS]) in prepubertal children with PHIV with sustained viral suppression in a low-income country in Africa.

Method: For this cross-sectional analysis, arterial stiffness was assessed by pulse wave velocity z-score (PWVz), measured using a Vicorder device. Metabolic syndrome components were measured. We retrospectively collected the antiretroviral therapy (ART) exposures, HIV stage, CD4 count and HIV viral load. A multivariate linear regression model was constructed for MetS components, retaining age and gender as obligatory variables. We then added HIV-related metrics to assess whether these had an independent or additive effect.

Results: We studied 77 virally suppressed children with PHIV without evidence of cardiovascular disease (from medical history and physical examination). In the initial model, the PWVz was independently associated with each MetS component. The PWVz was higher in participants with proportionally greater visceral fat (waist/height ratio), elevated lipids (triglyceride/high-density lipoprotein ratio) and insulin resistance (log homeostatic model assessment [HOMA]). The addition of age at ART initiation increased the model R2 value from 0.36 to 0.43. In the resulting model, younger age at ART initiation was independently associated with a better PWVz (P < 0.001).

Conclusion: Earlier ART initiation was independently associated with lower large artery stiffness. This effect was independent of the effect of elevated lipids, visceral fat and insulin resistance.


viral suppression; long-term ART; pulse wave velocity; large arterial elasticity; arteriosclerosis


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