Assessing risk factors for hypertension in young adults with perinatally acquired HIV infection: A case-control study.

OBJECTIVES: Although the risk of AIDS-associated diseases has declined dramatically with combination antiretroviral therapy (cART), the incidence rates of chronic non-AIDS-associated diseases in perinatally HIV-infected adults have risen and have not been well characterized. Both traditional and HIV-associated risk factors have been found to contribute to hypertension in non-perinatally HIV-infected adults; whether these same factors contribute to hypertension in perinatally infected adults is not known. The purpose of this study was to determine the socio-demographic, clinical, virological and immunological factors associated with systemic hypertension among a cohort of perinatally HIV-infected adolescents and young adults. METHODS: We conducted a case-control study among a population of adults aged 18-35 years with perinatally acquired HIV infection receiving care at the University of Maryland Medical Center. Covariates assessed included traditional risk factors such as age, family history of hypertension, and smoking, as well as numerous HIV- and antiretroviral-associated covariates, including CD4 nadir. RESULTS: Approximately 31% of the cohort met criteria for hypertension. There were no significant differences in the odds of most traditional or HIV-associated risk factors among perinatally HIV-infected adults with hypertension compared with those with no diagnosis of hypertension. Exposure to lopinavir/ritonavir was associated with greater odds of not having hypertension, while a concurrent diagnosis of chronic kidney disease (CKD) was associated with greater odds of having hypertension. CONCLUSIONS: The results of this study suggest that most traditional and HIV-related risk factors do not appear to increase the odds of having hypertension in this cohort of individuals. The aetiology of hypertension in this population remains to be elucidated.

Hyperinsulinemic hypoglycemia precipitated by weight loss.

OBJECTIVE: To describe a case of hyperinsulinemic hypoglycemia precipitated by weight loss. METHODS: We present a detailed case report and results of a related literature search on hyperinsulinemic hypoglycemia precipitated by weight loss. RESULTS: The presence of an insulinoma was unveiled by voluntary weight loss and reduction of insulin resistance. Hypoglycemia occurred during the postprandial period and not at night. The diagnostic workup was accomplished without hospital admission. CONCLUSION: Classically, insulinomas present with weight gain and fasting hypoglycemia but may present with postprandial hypoglycemia and weight loss. Voluntary weight loss, by lowering insulin resistance, accelerates the time to clinical presentation of an asymptomatic insulinoma.