4.7 Article

Lower Preprandial Insulin and Altered Fuel Use in HIV/Antiretroviral-Exposed Infants in Cameroon

Journal

JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM
Volume 100, Issue 9, Pages 3260-3269

Publisher

ENDOCRINE SOC
DOI: 10.1210/jc.2015-2198

Keywords

-

Funding

  1. Icahn School of Medicine at Mount Sinai Global Health Innovation Fund
  2. Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) [K23HD070760]
  3. National Institutes of Health National Center for Advancing Translational Sciences [KL2TR000076]
  4. NICHD [K23HD070774]
  5. National Institute of Diabetes and Digestive and Kidney Diseases [P60DK020541]
  6. NICHD
  7. National Institute of Allergy and Infectious Diseases [1U19AI091175]
  8. National Institute on Drug Abuse
  9. National Institute of Mental Health
  10. National Institute on Deafness and Other Communication Disorders
  11. National Heart, Lung, and Blood Institute
  12. National Institute of Neurological Disorders and Stroke
  13. National Institute on Alcohol Abuse and Alcoholism [U01 HD052102-04]
  14. Tulane University School of Medicine [U01 HD052104-01]

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Context: Intrauterine HIV/antiretroviral (ARV) and postnatal ARVs are known to perturb energy metabolism and could have permanent effects on future metabolic health. Such maladaptive effects could be mediated by changes in mitochondrial function and intermediary metabolism due to fetal and early-life ARV exposure in HIV/ARV-exposed uninfected (NEU) infants. Objective:The objective of the study vvasto understand the relationship(s) between mitochondrial fuel use (assessed via acylcarnitines and branched chain amino acids) and preprandial insulin in infants exposed to in utero HIV/ARV plus postnatal zidovudine or nevirapine compared with HIV/ ARV-unexposed uninfected (HUU) infants. Design: This was a prospective cohort study with the following three groups: 1) intrauterine HIV/ ARV/postnatal zidovudine-exposed (HEU-A), 2) intrauterine HIV/ARV/postnatal nevirapine-exposed (HEU-N), and 3) HUU infants. Principal component analysis and linear regression modeling were performed to assess the association between in utero HIV/ARV exposure and infant insulin. Setting: The study was conducted at Cameroonian urban antenatal centers. Participants: HIV-infected and -uninfected pregnant woman/infant dyads participated in the study. Main Outcome: Preprandial insulin was the main outcome measured. Results: Of 366 infants, 38 were HEU-A, 118 HEU-N. Forty intermediary metabolites were consolidated into seven principal components. In a multivariate analysis, both HEU-A (p =.116, P=.012) and HEU-N (p =.070, P=.022) demonstrated lower insulin compared with HUU infants. However, at high levels of plasma metabolites, HEU-A (13 =.027, P=.050) exhibited higher insulin levels than HEU-N or HUU infants. A unique array of short-chain acylcarnitines ([3 =.044, P=.001) and branched-chain amino acids (p =.033, P=.012) was associated with insulin. Conclusion: HEU-A and HEU-N infants have lower preprandial insulin levels at 6 weeks of age and appear to use metabolic fuel substrates differently than HUU infants. Futurestudies are warranted to determine whether observed differences have lasting metabolic implications, such as later insulin resistance.

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