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Brief Report: Youth Living With Perinatally Acquired HIV Have Lower Physical Activity Levels as They Age Compared With HIV-Exposed Uninfected Youth
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In this large US cohort, we observed increases in physical activity levels through adolescence in both YPHIV and YPHEU, but these increases were smaller in YPHIV compared with YPHEU. By late adolescence, YPHIV had significantly lower physical activity levels than YPHEU.....Systematic reviews of longitudinal studies have found a decline in physical activity levels during adolescence in youth without HIV.14,15
CONCLUSIONS
YPHIV have lower increases in physical activity as they age compared with YPHEU, and this results in lower activity levels by their late teens. Early interventions to attenuate this decline could be beneficial for long-term cardiometabolic health. Further research is warranted to understand this change and how other social determinants can modify the biological tendency of activity to decline with age in this population.
JAIDS May 1 2021 - Sahera Dirajlal-Fargo, DO,aPaige L. Williams, PhD,b,cCarly Broadwell, PhD,cElizabeth J. McFarland, MD,dKathleen M. Powis, MD,e,fDenise L. Jacobson, PhD,candJennifer Jao, MD,gfor the Pediatric HIV/AIDS Cohort Study (PHACS)
Abstract
Background:
Few studies have evaluated physical activity patterns or their association with vascular inflammation among youth living with perinatally acquired HIV (YPHIV).
Methods:
We assessed YPHIV and youth perinatally HIV-exposed but uninfected (YPHEU) in the PHACS Adolescent Master Protocol with at least one Block physical activity questionnaire (PAQ) completed between ages 7–19 years. Physical activity metrics were as follows: (1) daily total energy expenditure (TEE) and (2) physical activity duration (PAD) defined as the minutes of daily moderate and vigorous activities. In a subgroup, we measured serum biomarkers of coagulation (fibrinogen and P-selectin) and endothelial dysfunction (soluble intracellular cell adhesion molecule-1, soluble vascular cell adhesion molecule-1, and E-selectin) obtained within 3 months of a single PAQ. Repeated measures linear regression models were used to compare the trajectories of log-transformed TEE and PAD by HIV status, adjusting for confounders. Spearman correlations were calculated to assess the relationship of TEE and PAD with vascular biomarkers.
Results:
Five hundred ninety-six youth (387 YPHIV and 209 YPHEU) completed 1552 PAQs (median PAQs completed = 3). The median age at enrollment (Q1, Q3) was 11 (9, 13) years. TEE and PAD increased with age in both YPHIV and YPHEU. However, even after adjusting for confounders, YPHIV had significantly less increase per year than YPHEU for TEE (5.7% [95% confidence interval (CI): -9.9% to -1.4%, P = 0.010] less) and PAD (5.2% [95% CI: -9.2% to -1.1%, P = 0.016] less). Among 302 youth with biomarker measures (187 YPHIV and 114 YPHEU), we observed little correlation with TEE or PAD.
Conclusions:
Both groups had increases in physical activity levels as they aged, but YPHIV had smaller increases throughout adolescence compared with YPHEU, which may impact long-term health.
In our analysis, YPHIV showed a more blunted increase in physical activity measures as they aged through adolescence compared with YPHEU. Although the difference over time between the groups is small, it may have clinical significance as children who are active but become less active as they age have a higher risk of becoming obese in young adulthood when compared with individuals who are consistently active throughout childhood and adolescence.16Among YPHIV, those with a less severe history of HIV disease (eg, higher nadir CD4%) had steeper increases in PAD and intensity, suggesting, not surprisingly, that better childhood HIV health status and potentially overall health status contribute to improved physical activity even later in adolescence. YPHIV have a dampened increase in vigorous physical activity as they age compared with YPHEU, but this did not translate to a difference in the proportion meeting sufficient physical activity. This lack of difference between groups may be because HIV status does not influence an underlying phenomenon to fall short of meeting national guidelines when one already has little activity.
INTRODUCTION
Physical activity has gained renewed attention as a strategy to minimize the risk of cardiovascular disease (CVD) in adults living with HIV. Several studies have evaluated and reviewed the effects of exercise on health in adults living with HIV and have shown benefits in body composition, lipid profile, inflammatory biomarkers, and vascular disease1–3,. Low physical activity levels decrease total life expectancy in uninfected adults,4 and as such physical inactivity is comparable to other modifiable risk factors such as smoking and obesity. There are limited data describing physical activity patterns and barriers to exercise in youth living with perinatally acquired HIV (YPHIV). Several small cross-sectional studies suggest that YPHIV have lower physical activity duration (PAD) and intensity compared with uninfected youth.5–8 However, few studies have evaluated longitudinal changes in physical activity in the pediatric HIV population or its relationship with vascular inflammation.5,6,9 We evaluated participants enrolled in a Pediatric HIV/AIDS Cohort Study (PHACS) network study for the purposes of (1) assessing physical activity patterns across age in YPHIV compared with youth perinatally HIV-exposed but uninfected (YPHEU) and (2) investigating the association between physical activity measures and biomarkers of vascular dysfunction. These data will be useful in obtaining information about general activity levels and patterns in YPHIV and may inform development of targeted strategies designed to promote exercise as a nonpharmacological tool to decrease morbidity related to CVD.
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