Hyperlipidemia in HIV-infected children treated with protease inhibitors: relevance for cardiovascular diseases.
Cases of severely hypercholesterolemic HIV-infected children taking protease inhibitors (PIs) have been reported. Because high cholesterol levels (> or =15 mmol/L), as seen in homozygous familial hypercholesterolemia (FH), may lead to heart disease in childhood, the authors performed a systematic retrospective survey of all plasma lipid levels recorded for children who had received ritonavir or nelfinavir between 1995 and 2001 in Switzerland. Administration of PIs was associated with a significant increase in plasma cholesterol levels, which was more pronounced for those given ritonavir (from 3.3 +/- 0.7 mmol/L, n = 5 to 6.3 +/- 2.8 mmol/L, n = 19 [mean +/- SD]; p =.03) than for nelfinavir (from 3.0 +/- 0.7 mmol/L, n = 11 to 4.9 +/- 1.0 mmol/L, n = 30; p = <.001). Cholesterol levels exceeded 10.0 mmol/L in 3 of 49 (6%) PI-treated children and culminated at 13.8 mmol/L. Plasma cholesterol levels in PI-treated children were comparable with levels reported for heterozygous FH children but were all lower than in homozygous FH children. Because heterozygous FH patients usually develop heart disease in middle age, the authors conclude that the risk for heart disease in PI-treated children is minimal. Long-term monitoring of these children, however, will be necessary.
Department of Pediatrics, CHUV University Hospital, Lausanne, Switzerland.
Jean-Jacques
JJ
Cheseaux
Valérie
V
Jotterand
Christoph
C
Aebi
Hanspeter
H
Gnehm
Christian
C
Kind
David
D
Nadal
Christoph
C
Rudin
Claire-Anne Wyler
CA
Lazarevitch
Pascal
P
Nicod
Vincent
V
Mooser
D002318:Cardiovascular Diseases / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D002784:Cholesterol / Q000097:blood; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy*; D017320:HIV Protease Inhibitors / Q000009:adverse effects*; D006801:Humans; D006949:Hyperlipidemias / Q000139:chemically induced* / Q000150:complications; D006938:Hyperlipoproteinemia Type II / Q000150:complications; D016015:Logistic Models; D008297:Male; D014280:Triglycerides / Q000097:blood
D017320:HIV Protease Inhibitors; D014280:Triglycerides; D002784:Cholesterol