Purpose: To determine the presence of vascular markers of premature atherosclerosis and metabolic correlates in a prospectively followed cohort of antiretroviral treated HIV-infected children.

Methods: Vascular assessment included: carotid intima-media thickness and brachial artery reactivity using vascular ultrasound; peripheral pulse wave velocity (PWV) using photoplethysmography; central PWV, arterial stiffness and impedance indices using an Echo-Doppler method; and only at followup, augmentation index and PWV by applanation tonometry. Disease markers, oral glucose tolerance, fasting lipid profiles and abdominal fat (single slice CT scan) were also determined.

Results: Twenty children were assessed at baseline (median age 12.6 [range 8.5–18.5] years; 50% female) and follow-up 21–25 months later. All were on combination antiretroviral therapy at baseline, but 5 were off therapy at follow-up with fewer receiving protease inhibitors. Resting systolic blood pressure and pulse pressure increased significantly over the study period (both p < 0.0001), as did elastic modulus, stiffness index and input impedance (p = 0.0018, p = 0.0004, p = 0.0082, respectively). PWV measures by the different methods were not shown to correlate significantly. Dyslipidemia and abnormal glucose metabolism were present in 14 and 2 at baseline, and in 7 and 0 at follow-up, respectively. Visceral, subcutaneous and total abdominal fat content increased over time, but not significantly so.

Conclusions: An increase in measures of large arterial wall stiffness was observed over time. The reduction in dyslipidemia at follow-up may be related to fewer children receiving protease inhibitors. The potential risk of premature atherosclerosis in HIV-infected children on anti-retroviral therapy warrants long-term monitoring of metabolic profiles and vascular function.