The association between mental health and metabolic outcomes in youth living with perinatally acquired HIV in the Cape Town Adolescent Antiretroviral Cohort

ABSTRACT

Youth living with perinatally acquired HIV (YLPHIV) have been found to have a range of mental disorders. Some adult HIV studies have linked mental health to adverse metabolic outcomes due to dysregulation of the sympathetic nervous system and hypothalamic–pituitary–adrenal axis, but this association has not previously been explored in YLPHIV.

We investigated the association of mental health measures with metabolic outcomes in YLPHIV and HIV-uninfected youth (HIV-U) and linear regression was used to assess the adjusted associations.

Overall, 203 YLPHIV (median age = 10.7years; 52% female; mean duration on ART 8 years, 12% CD4 count <500 cells/µL, 18% viral load >50 copies/mL) and 44 HIV-U (median age = 10.3 years; 55% female) were enrolled. YLPHIV had higher median total cholesterol (4.2 vs 3.9 mmol/L, p = 0.049) and triglyceride (0.9 vs 0.7 mmol/L, p < 0.001) compared to HIV-U. We found higher percentage of poor functional competence (40% vs 25%, p = 0.02) and self-concept (23% vs 9%, p = 0.03) and higher depression (6% vs 2%, p < 0.01), anger (6% vs 2%, p = 0.04) and disruptive behaviour (4% vs 0%, p < 0.01) in YLPHIV as compared to HIV-U. Among YLPHIV, higher scores of anger were associated with higher total cholesterol and higher low-density lipoprotein (ß = 0.010, p = 0.041 and ß = 0.012, p = 0.048 respectively) and disruptive behaviour with higher low-density lipoprotein (ß = 0.010, p = 0.043) after adjusting for age, sex and BMIZ.

This is the one of first study to investigate the association of mental health with metabolic outcomes among YLPHIV. The association of increased anger and disruptive behaviour with increased lipid concentration is a novel finding. Further longitudinal studies are needed to evaluate the causal relationships between mental health and metabolic outcomes.

KEYWORDS:

• Youth living with perinatally acquired HIV
• mental health
• metabolic outcome
• HIV
• antiretroviral therapy

Acknowledgements

We would like to thank the adolescents and their caregivers who participated in this study, as well as the study staff for their support of this research. We also wish to thank Red Cross War Memorial Children’s Hospital for supporting the study.

Author’s contribution

HZ, LM, JH, DS and SM designed and conceived the study. SM and NP collected the data. SM did the data analysis and took the lead in writing the manuscript. SM, JJ, JH, HZ, DS contributed to the interpretation of the results. JJ provided the expert advice on metabolic aspect of the manuscript, JH and DS provided the expert advice on mental health aspect of the study. JJ, LM, DS, HZ, JH, NP reviewed the manuscript and added conceptual and intellectual comments. All authors read the manuscript prior to submission.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This research was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD074051) and the South African Medical Research Council (SAMRC).