Cardio-Metabolic Health of Offspring Exposed in Utero to Human Immuno-Deficiency Virus and Anti-Retroviral Treatment: A Systematic Review.

BACKGROUND: Antiretroviral treatment (ART) use during pregnancy continues to rise as it is known to decrease the likelihood of HIV transmission from mother to child. However, it is still unknown whether foetal exposure to (ART) may affect the foetal environment, predisposing the offspring to cardiometabolic risk. Therefore, the aim of this study was to systematically review the cardio-metabolic effects of in utero exposure to HIV/ART on offspring. METHODS: We carried out a systematic review and obtained literature from the Google scholar, PubMed, ProQuest, Web of Science, and Scopus databases. Two independent reviewers evaluated the titles, abstracts, and full-length English contents. Data from the eligible studies were included. RESULTS: The search yielded 7596 records. After assessing all of these records, 35 of the full-length articles were included in this systematic review. Several studies showed that low birth weight, small head circumference, and altered mitochondrial content were more common among HIV-exposed uninfected (HEU) children compared to HIV-unexposed uninfected children (HUU). A few studies demonstrated elevated triglyceride levels, lower levels of insulin, and increased blood pressure, oxidative stress, vascular dysfunction, cardiac damage, and myocardial dysfunction among HEU children compared with HUU children. CONCLUSION: Most findings showed that there were cardio-metabolic health risk factors among HEU children, indicating that maternal exposure to HIV and ART may negatively affect foetal health, which may lead to cardio-metabolic morbidity later in life.

Oxidative stress is associated with markers of renal dysfunction in children aged 6-9 years old in a South African population.

Introduction: although studies have shown a relationship between albuminuria and oxidative stress in adults, limited information on the subject is available in children. The aim of this study was to assess the relationship between oxidative stress and albuminuria in South African children of African ancestry. Methods: a cross-sectional study involving 6-9 years old children in randomly selected rural and urban schools of the Eastern Cape Province of South Africa was conducted. Anthropometric measurements were done and urine samples were collected for the determination of titres of albumin, creatinine, 8-hydroxy-2-deoxy-guanosine (8-OHdG) and thiobarbituric acid reactive substances (TBARS). The urinary albumin to creatinine ratio (ACR) was calculated and used to determine albuminuria. Results: creatinine and 8-OHdG were significantly higher (p<0.05) in urban children than in rural children while albumin, ACR and TBARS were significantly higher (p<0.05) in rural compared to urban children. The prevalence of albuminuria was 14.05% of which microalbuminuria was 8.83% while macroalbuminuria was 5.22%. Albuminuria was higher in rural children than their urban counterparts and was more prevalent in females. TBARS was positively (p<0.05) associated with creatinine and albumin in the cohort as well as in females and urban children while 8-OHdG was positively associated with albumin in the cohort. Conclusion: findings of this study showed that oxidative stress was associated with markers of renal dysfunction with a 14% prevalence of albuminuria observed in South African children of African ancestry.

Cardiometabolic risk factors and early indicators of vascular dysfunction: a cross-sectional cohort study in South African adolescents.

OBJECTIVES: Prevalence of child and adolescents' overweight and obesity in low- and middle-income countries has increased dramatically. Simultaneously, the incidence of pre-hypertension/hypertension is also increasing in children, which, in turn, predisposes these children to the risk of cardiovascular disease (CVD) in later life. The present study assessed cardiometabolic risk factors and early indicators of vascular dysfunction in adolescents from a low socio-economic rural area in South Africa. DESIGN: Cross-sectional cohort study. SETTING: The study was conducted in public schools in Mthatha, OR Tambo district municipality, Eastern Cape Province, South Africa. PARTICIPANTS: A total of 244 adolescents (188 females) of African ancestry aged 13-16 years were enrolled. PRIMARY AND SECONDARY OUTCOME MEASURES: Anthropometric and haemodynamic measures and pulse wave velocity (PWV) were related to overweight/obesity and hypertension. Blood markers of cardiometabolic syndrome were assessed as well as vascular function (via PWV). RESULTS: One-third (33.0%) of the adolescents exceeded the age and sex-specific body mass index percentiles for overweight (≥85th) or obesity (>95th) with a prevalence of 61.1% pre-hypertensives in this group. Overweight/obesity and hypertension were associated with higher triglycerides (lean:overweight: 0.79<1.01 mmol/L; normotensive:hypertensive: 0.82<0.89 mmol/L). Fasting glucose was higher in hypertensive as compared to normotensive adolescents (4.85>4.69 mmol/L, p<0.05). PWV was elevated in 25.9% of the children and significantly correlated with asymmetric dimethylarginine and systolic blood pressure (p<0.001). CONCLUSION: Overweight/obesity and hypertension show a high prevalence in rural South African youth. Almost half of the studied adolescents are at risk for developing CVD. The high association between cardiometabolic risk factors and PWV further suggests that hypertension in adolescents may promote the progression of CVD in adulthood. Early detection of those at risk and the implementation of preventive strategies in underprivileged young people is urgently needed to stop the progression of vascular damage and manifestation of CVD in rural African children.

Relationship between High Blood Pressure and Microalbuminuria in Children Aged 6-9 Years in a South African Population.

Though the association between high blood pressure and microalbuminuria is well established in adults, there is a paucity of information on microalbuminuria in children. This study investigated the relationship between high blood pressure and microalbuminuria in 6-9-year-old children. A cross-sectional study, which included 306 primary school children of age 6-9 years old from urban areas (n = 154) and rural areas (n = 152) of the Eastern Cape Province of South Africa, was conducted. Participants' anthropometric data were determined and systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) were measured and converted to BP percentiles for age, sex and height. Creatinine and albumin concentrations were assayed in early morning midstream urine and the albumin to creatinine ratio (ACR) was calculated. There was a 42.8% prevalence of elevated blood pressure/high blood pressure (E-BP/H-BP) and a 10.1% prevalence of microalbuminuria. Among the 131 children with E-BP/H-BP, 17 had elevated ACR with a prevalence of 13.95%. SBP and HR increased with increasing range of ACR and, furthermore, SBP was significantly (p < 0.05) higher in children with moderately and severely increased ACR. SBP was associated with ACR and increased SBP predicted microalbuminuria (R2 = 0.42, adj R2 = 0.039, B: 0.120, p = < 0.05). In conclusion, microalbuminuria was present in 6-9-year-old South African children of African Ancestry and a weak association was observed with SBP in children.