Marked dyslipidemia in human immunodeficiency virus-infected children on protease inhibitor-containing antiretroviral therapy.
OBJECTIVE
To assess the effects of antiretroviral combination therapy that contains protease inhibitor (PI) on carbohydrate and lipid metabolism in human immunodeficiency virus (HIV)-infected children.


METHODS
A cross-sectional, descriptive clinical study was conducted in an outpatient clinic. Thirty-seven HIV-infected children who ranged from 1 to 17 years of age received nucleoside reverse transcriptase inhibitor treatment together with PI (PI group, n = 25) or without PI (non-PI group, n = 12). Age, gender, weight, length, CD4 cell count, and viral load did not differ between groups. Nonfasting total cholesterol, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein (LDL) cholesterol, glucose, lactate, and blood gases were determined. In addition, c-peptide, insulin, hemoglobin A1c, free fatty acids, lipoprotein a, and apolipoproteins A1 and B were evaluated after fasting. PI and non-PI group values were compared with normal values taken from healthy children.


RESULTS
In nonfasting and fasting conditions, children of the PI group had higher total cholesterol (fasting PI group: 235 +/- 71 mg/dL; non-PI group: 176 +/- 25 mg/dL, mean +/- standard deviation), triglycerides (156 +/- 89 vs 87 +/- 31 mg/dL), and LDL cholesterol levels (159 +/- 58 vs 113 +/- 23 mg/dL) compared with the non-PI group. High-density lipoprotein cholesterol and apolipoprotein A1 levels did not differ in both groups; there was a trend toward higher apolipoprotein B levels in the PI group. After fasting, 8 (47%) of 17 patients in the PI group presented with hypercholesterolemia as a result of an increase of LDL cholesterol and 11 (65%) had hypertriglyceridemia. It is interesting that the non-PI group showed no pathologic deviations. Compared with normal values, lipoprotein a and free fatty acids were increased in the PI and non-PI groups. Glucose, lactate, blood gases, c-peptide, insulin, and hemoglobin A1c were normal in both groups.


CONCLUSIONS
PI-containing antiretroviral treatment of HIV-infected children was associated with hypercholesterolemia, hypertriglyceridemia, and an increase of LDL cholesterol. The long-term complications of dyslipidemia are of major concern in the growing HIV-infected child.
Lainka
Elke
E
Paediatric Immunology and Rheumatology Unit, the Children's Hospital, Düsseldorf, Germany.
Oezbek
Selda
S
Falck
Manfred
M
Ndagijimana
Jennifer
J
Niehues
Tim
T
D000553:Ambulatory Care / Q000706:statistics & numerical data; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects* / Q000379:methods; D002648:Child; D003430:Cross-Sectional Studies; D004040:Dietary Carbohydrates / Q000378:metabolism; D004359:Drug Therapy, Combination; D005215:Fasting / Q000378:metabolism; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy*; D017320:HIV Protease Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D006937:Hypercholesterolemia / Q000139:chemically induced; D006949:Hyperlipidemias / Q000139:chemically induced* / Q000453:epidemiology; D008297:Male; D018894:Reverse Transcriptase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use
D004040:Dietary Carbohydrates; D017320:HIV Protease Inhibitors; D018894:Reverse Transcriptase Inhibitors