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Low serum carnitine in HIV-infected children on antiretroviral treatment
M A Vilaseca1, R Artuch, C Sierra
1Department of Biochemistry, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain. vilaseca@hsjdbcn.org
Insights
Thirty-seven percent of children with human immunodeficiency virus (HIV) on antiretroviral therapy showed low carnitine levels. This deficiency may be linked to malabsorption or impaired synthesis in these pediatric patients.
Area of Science:
- Pediatric infectious diseases
- Nutritional biochemistry
- Pharmacology of antiretroviral therapy
Background:
- HIV infection and its treatments can affect energy and lipid metabolism in adults.
- Carnitine deficiency is a potential concern in HIV-infected children undergoing antiretroviral therapy.
Purpose of the Study:
- To investigate the prevalence of carnitine deficiency in HIV-infected children receiving antiretroviral treatment.
- To analyze the relationship between serum carnitine levels, its precursors (methionine and lysine), clinical status, and antiretroviral therapy.
Main Methods:
- A cross-sectional study involving 79 HIV-infected children on antiretroviral therapy.
- Serum carnitine and amino acid levels were measured using enzymatic-spectrometric and ion exchange chromatography methods, respectively.
- Reference values were established from healthy children.
Main Results:
- HIV-infected children exhibited significantly lower serum free and total carnitine, acylcarnitines, methionine, and lysine compared to controls.
- Carnitine deficiency was identified in 37% of the studied children.
- Lower carnitine levels were associated with protease inhibitor-based antiretroviral regimens.
Conclusions:
- A significant proportion of HIV-infected children on antiretroviral therapy present with low serum carnitine concentrations.
- Potential contributing factors include malabsorption or defective carnitine synthesis.
- Further investigation into carnitine supplementation may be warranted.
Objective:
HIV-infection and antiretroviral therapies are associated with energy dysfunction and lipid metabolism in adults. Our aim was to detect a possible carnitine deficiency in HIV-infected children on antiretroviral treatments. We analysed the relation among serum carnitine, its amino-acid precursors (methionine and lysine), clinical evaluation and antiretroviral therapy.
Design And Setting:
Cross-sectional study performed in a tertiary care hospital.
Subjects:
A total of 79 HIV-infected children on antiretroviral therapy, monitored prospectively in our hospital.
Interventions:
Antiretroviral therapy included nucleoside analogues plus protease inhibitors and/or non-nucleoside analogues. Carnitine was analysed by an enzymatic-spectrometric procedure, and amino acids by ion exchange chromatography. Reference values of carnitine and amino acids were established in apparently healthy children who underwent presurgical analysis for minor surgery.
Results:
Serum free and total carnitine, acylcarnitines, methionine and lysine were significantly lower in HIV-infected children compared with our reference values for similar ages (P<0.0001; Student's t-test). Low carnitine values were observed in 37% of our HIV-infected children. A significantly positive correlation was observed between serum total carnitine and methionine or lysine (P<0.0001 and P=0.005, respectively; Pearson test). No relation was observed between serum carnitine and clinical stage of HIV infection, immunological or nutritional status or lipodystrophy. Free and total carnitine were significantly lower (P=0.002 and 0.033, respectively) in HIV-infected patients on protease inhibitors (N=56) compared with those on other treatments (N=23).
Conclusions:
Low serum carnitine concentration was observed in 37% of our HIV-infected children on antiretroviral therapy. Malabsorption or defective synthesis may also account for the low serum carnitine values detected in these patients.
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