Cardiometabolic Health Burden in Pediatric HIV: Unmet Need in the Contemporary Antiretroviral Therapy Era

In children and adolescents with perinatally acquired HIV-1, early and prolonged exposure to HIV-1 and antiretroviral therapy (ART) can impact the premature development of cardiometabolic comorbidities. This narrative literature review aims to provide an overview of the impact of contemporary ART regimens on lipid profiles, body composition, and cardiovascular health in this population. Additionally, we propose recommendations for addressing cardiometabolic health in this understudied group. Studies show an increased risk of cardiovascular disease, adipose tissue dysfunction, and dyslipidemia among children and adolescents with perinatally acquired HIV-1. Clinical trial data support that contemporary ART regimens show better cardiometabolic profiles compared with older regimens. Emerging data suggest that chronic inflammation, epigenetic changes, gut barrier dysfunction, and oxidative stress are key mechanisms contributing to worsened cardiometabolic health in pediatric populations with HIV-1. People working with children and adolescents with HIV-1 should be aware of the increased risk of cardiometabolic health disorders in this population. More well-designed studies investigating cardiometabolic health in pediatric populations using contemporary ART regimens are needed. Early interventions during childhood and adolescence, critical developmental stages, may yield long-term benefits for health, quality of life, and longevity. A proactive, holistic approach to clinical management involving comprehensive care and early assessments of cardiometabolic health is essential to forestall the development of chronic disease.