A UK study presented at the 26th International AIDS Conference reveals that two-thirds of young adults with perinatally acquired HIV exhibit metabolic abnormalities. 16% of this group, mostly in their 20s and 30s, meet the criteria for metabolic syndrome—a condition more typical in older populations.
The research, led by Maeve Barlow, a clinical research fellow at the University of Oxford, highlights the unique challenges faced by individuals who have lived with HIV since birth. These young adults, treated at the Mortimer Market Centre in London, show a higher prevalence of conditions like obesity, hypertension, and dyslipidemia compared to their peers without HIV.
Early Onset of Metabolic Issues in Young Adults With Perinatally Acquired HIV
The study compared nearly 200 individuals with perinatally acquired HIV to 5,500 people with horizontally acquired HIV. Despite being 20 years younger on average, the perinatal group showed similar rates of metabolic dysfunction. 31% of these young adults had obesity, compared to 18% in the general UK population of the same age group.
Barlow notes that many of these individuals have been exposed to metabolically toxic antiretroviral therapy (ART) and face additional challenges during adolescence, which may contribute to their health issues. The study also found a strong link between depression and metabolic syndrome, suggesting a bidirectional relationship that warrants integrated care.
Given these findings, Barlow advocates for earlier and more rigorous monitoring of metabolic health in this population. This includes annual HbA1c and lipid testing, starting at a younger age than current guidelines recommend. She also emphasizes the need for a holistic approach that addresses both physical and mental health.
The cohort’s demographic profile, 80% Black African ethnicity, with a median age of 29, contrasts sharply with the broader HIV population at Mortimer Market, which is predominantly male, white, and older.
While the study is cross-sectional and cannot prove causation, it highlights the critical need to address metabolic health in this population. As Barlow points out, waiting decades to observe long-term outcomes is not feasible when early intervention could prevent serious complications.
Addressing Metabolic Health in Perinatally Acquired HIV
Maeve Barlow, M.B.B.S., stresses the need for tailored interventions to address the unique challenges faced by young adults with perinatally acquired HIV.
Implications for Clinical Practice and Guidelines
The study’s findings significantly impact clinical guidelines, particularly in monitoring and managing metabolic health in individuals with perinatally acquired HIV. In the UK, current guidelines recommend checking HbA1c every two years and blood lipids annually after age 40. Barlow proposes that for the perinatal cohort, these tests should be conducted annually at all ages. She also advocates for closer monitoring of liver health, including regular liver function tests and, where available, FibroScans to detect metabolic dysfunction-associated steatotic liver disease. Monitoring for alcohol misuse, smoking habits, and mental health issues is equally vital for full care.