Presentation:
Antiretroviral therapy (ART) scale-up has dramatically reduced rates of pediatric HIV mortality and morbidity. Children living with perinatally acquired HIV (PHIV) are living through adolescence and well into adulthood, such that adolescents now represent the largest growing population living with HIV. This presentation aims to discuss the literature describing the prevalence of cardiometabolic complications and the research gaps that remain, as well as opportunities to optimize research and care. There are continued challenges in determining the risk of cardiometabolic co-morbidities in adolescents and young adults with PHIV, and their risk factors differ compared to adults with horizontally acquired HIV. Data suggest evidence for subclinical cardiometabolic complications in PHIV in the setting of newer ART and include: 1) Cardiovascular: evidence of functional cardiac abnormalities, subclinical vascular disease and endothelial dysfunction; 2) Metabolic: evidence of alterations in adipose tissues, dyslipidemia and insulin resistance. In addition, previous exposure to thymidine analogues continue to cause increase risk of metabolic complications in this population. Novel techniques available techniques in imaging and omics may help identify early cardiometabolic abnormalities in this population as well as mechanistic pathways. Further studies are needed to understand the long term risk and management strategies in adolescents with PHIV to prevent complications to avoid diabetes and cardiovascular disease.