Prevalence and Risk Factors for Hepatic Steatosis in Children With Perinatal HIV on Early Antiretroviral Therapy Compared to HIV-Exposed Uninfected and HIV-Unexposed Children
ObjectivesWe evaluated the prevalence and risk factors for hepatic steatosis in South African children with perinatally acquired HIV (PHIV) who started treatment early and remain on long-term antiretroviral therapy (ART) compared to HIV-uninfected children.DesignA cross-sectional study from April 20...
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Frontiers Media S.A.
2022-06-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2022.893579/full |
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| author | Penelope C. Rose Etienne D. Nel Mark F. Cotton Mark F. Cotton Richard D. Pitcher Kennedy Otwombe Kennedy Otwombe Sara H. Browne Steve Innes Steve Innes Steve Innes |
| author_facet | Penelope C. Rose Etienne D. Nel Mark F. Cotton Mark F. Cotton Richard D. Pitcher Kennedy Otwombe Kennedy Otwombe Sara H. Browne Steve Innes Steve Innes Steve Innes |
| author_sort | Penelope C. Rose |
| collection | DOAJ |
| description | ObjectivesWe evaluated the prevalence and risk factors for hepatic steatosis in South African children with perinatally acquired HIV (PHIV) who started treatment early and remain on long-term antiretroviral therapy (ART) compared to HIV-uninfected children.DesignA cross-sectional study from April 2019 to October 2021. PHIV, HIV-exposed uninfected (HEU) and HIV-unexposed (HU) children were enrolled from an ongoing cohort study.MethodsAll children had transient elastography (TE) with controlled attenuation parameter (CAP). Liver enzymes, lipogram, insulin and glucose were sent after an overnight fast. Multivariable linear regression analyses identified predictors of CAP. Hepatic steatosis was defined as CAP>248kPa.Results215 children (111 [52%] male; median age 14.1 years; IQR 12.7–14.9) participated in the study, 110 PHIV, 105 HIV-uninfected (36 HEU, 69 HU). PHIV initiated ART at a median age of 2.7 months (IQR 1.8–8.5). Hepatic steatosis prevalence was 9% in PHIV, 3% in HEU and 1% in HU children (p = 0.08). However, 8% of lean (body mass index z-score ≤ +1) PHIV had hepatic steatosis compared to zero lean HEU or HU children (p = 0.03). In multivariable linear regression analysis of all PHIV, body mass index (BMI) z-score was positively associated with CAP (p = 0.001) while CD4 count (p = 0.02) and duration of suppression of HIV viraemia (p = 0.009) were negatively associated with CAP, adjusting for age, sex and ethnicity.ConclusionsHepatic steatosis prevalence was higher in lean PHIV than lean HIV-uninfected South African children. Longer suppression of HIV viraemia and higher CD4 count were associated with lower CAP and might be protective factors for hepatic steatosis in PHIV children. |
| first_indexed | 2024-04-13T20:11:00Z |
| format | Article |
| id | doaj.art-a99d43cb92d34a63954d62b89be18c55 |
| institution | Directory Open Access Journal |
| issn | 2296-2360 |
| language | English |
| last_indexed | 2024-04-13T20:11:00Z |
| publishDate | 2022-06-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj.art-a99d43cb92d34a63954d62b89be18c552022-12-22T02:31:50ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602022-06-011010.3389/fped.2022.893579893579Prevalence and Risk Factors for Hepatic Steatosis in Children With Perinatal HIV on Early Antiretroviral Therapy Compared to HIV-Exposed Uninfected and HIV-Unexposed ChildrenPenelope C. Rose0Etienne D. Nel1Mark F. Cotton2Mark F. Cotton3Richard D. Pitcher4Kennedy Otwombe5Kennedy Otwombe6Sara H. Browne7Steve Innes8Steve Innes9Steve Innes10Department of Paediatrics and Child Health, Tygerberg Hospital and Stellenbosch University, Cape Town, South AfricaDepartment of Paediatrics and Child Health, Tygerberg Hospital and Stellenbosch University, Cape Town, South AfricaDepartment of Paediatrics and Child Health, Tygerberg Hospital and Stellenbosch University, Cape Town, South AfricaFamily Center for Research With Ubuntu (FAMCRU), Cape Town, South AfricaDivision of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South AfricaPerinatal HIV Research Unit, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South AfricaSchool of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South AfricaDepartment of Medicine, University of California, San Diego, San Diego, CA, United StatesDepartment of Paediatrics and Child Health, Tygerberg Hospital and Stellenbosch University, Cape Town, South AfricaFamily Center for Research With Ubuntu (FAMCRU), Cape Town, South AfricaDesmond Tutu HIV Centre, University of Cape Town, Cape Town, South AfricaObjectivesWe evaluated the prevalence and risk factors for hepatic steatosis in South African children with perinatally acquired HIV (PHIV) who started treatment early and remain on long-term antiretroviral therapy (ART) compared to HIV-uninfected children.DesignA cross-sectional study from April 2019 to October 2021. PHIV, HIV-exposed uninfected (HEU) and HIV-unexposed (HU) children were enrolled from an ongoing cohort study.MethodsAll children had transient elastography (TE) with controlled attenuation parameter (CAP). Liver enzymes, lipogram, insulin and glucose were sent after an overnight fast. Multivariable linear regression analyses identified predictors of CAP. Hepatic steatosis was defined as CAP>248kPa.Results215 children (111 [52%] male; median age 14.1 years; IQR 12.7–14.9) participated in the study, 110 PHIV, 105 HIV-uninfected (36 HEU, 69 HU). PHIV initiated ART at a median age of 2.7 months (IQR 1.8–8.5). Hepatic steatosis prevalence was 9% in PHIV, 3% in HEU and 1% in HU children (p = 0.08). However, 8% of lean (body mass index z-score ≤ +1) PHIV had hepatic steatosis compared to zero lean HEU or HU children (p = 0.03). In multivariable linear regression analysis of all PHIV, body mass index (BMI) z-score was positively associated with CAP (p = 0.001) while CD4 count (p = 0.02) and duration of suppression of HIV viraemia (p = 0.009) were negatively associated with CAP, adjusting for age, sex and ethnicity.ConclusionsHepatic steatosis prevalence was higher in lean PHIV than lean HIV-uninfected South African children. Longer suppression of HIV viraemia and higher CD4 count were associated with lower CAP and might be protective factors for hepatic steatosis in PHIV children.https://www.frontiersin.org/articles/10.3389/fped.2022.893579/fullpaediatricNAFLDliverfatty liverhepatic fibrosis |
| spellingShingle | Penelope C. Rose Etienne D. Nel Mark F. Cotton Mark F. Cotton Richard D. Pitcher Kennedy Otwombe Kennedy Otwombe Sara H. Browne Steve Innes Steve Innes Steve Innes Prevalence and Risk Factors for Hepatic Steatosis in Children With Perinatal HIV on Early Antiretroviral Therapy Compared to HIV-Exposed Uninfected and HIV-Unexposed Children Frontiers in Pediatrics paediatric NAFLD liver fatty liver hepatic fibrosis |
| title | Prevalence and Risk Factors for Hepatic Steatosis in Children With Perinatal HIV on Early Antiretroviral Therapy Compared to HIV-Exposed Uninfected and HIV-Unexposed Children |
| title_full | Prevalence and Risk Factors for Hepatic Steatosis in Children With Perinatal HIV on Early Antiretroviral Therapy Compared to HIV-Exposed Uninfected and HIV-Unexposed Children |
| title_fullStr | Prevalence and Risk Factors for Hepatic Steatosis in Children With Perinatal HIV on Early Antiretroviral Therapy Compared to HIV-Exposed Uninfected and HIV-Unexposed Children |
| title_full_unstemmed | Prevalence and Risk Factors for Hepatic Steatosis in Children With Perinatal HIV on Early Antiretroviral Therapy Compared to HIV-Exposed Uninfected and HIV-Unexposed Children |
| title_short | Prevalence and Risk Factors for Hepatic Steatosis in Children With Perinatal HIV on Early Antiretroviral Therapy Compared to HIV-Exposed Uninfected and HIV-Unexposed Children |
| title_sort | prevalence and risk factors for hepatic steatosis in children with perinatal hiv on early antiretroviral therapy compared to hiv exposed uninfected and hiv unexposed children |
| topic | paediatric NAFLD liver fatty liver hepatic fibrosis |
| url | https://www.frontiersin.org/articles/10.3389/fped.2022.893579/full |
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