Serum lipids, glucose homeostasis and abdominal adipose tissue distribution in protease inhibitor-treated and naive HIV-infected children.
OBJECTIVE
To determine the extent and degree of abnormalities of serum lipids, glucose homeostasis and abdominal adipose tissue distribution in protease inhibitor (PI)-treated and PI-naive HIV-infected children.


METHODS
A cross-sectional study involving HIV-infected children, 3-18 years of age, in a paediatric tertiary care centre.


METHODS
Total, HDL and LDL-cholesterol, triglycerides, glucose, insulin, proinsulin and C-peptide were determined in the fasting state. Insulin resistance was assessed using the homeostatic model assessment-insulin resistance (HOMA-IR). Abdominal adipose tissue distribution was determined by single-slice computed tomography at the umbilical level.


RESULTS
Thirty PI-treated and 20 PI-naive children were evaluated (76% prepubertal). PI-treated children had significantly higher total cholesterol (P = 0.0021), LDL-cholesterol (P = 0.019) and triglycerides (P = 0.0018). Serum glucose, insulin, proinsulin and C-peptide, the insulin : glucose ratio, HOMA-IR and abdominal adipose tissue distribution were similar in the two groups. Clinical and immunological HIV categories, viral load, CD4 cell count and stavudine therapy were not significantly associated with serum lipids, insulin resistance or abdominal adipose tissue distribution. The predictor variable most strongly associated with fasting serum insulin and HOMA-IR was the Tanner stage. Age was the most significant predictor variable of the visceral : subcutaneous adipose tissue ratio.


CONCLUSIONS
In this cohort of predominantly prepubertal HIV-infected children, PI therapy was associated with an atherogenic dyslipidemia but not with insulin resistance or abnormal abdominal adipose tissue distribution. The results suggest that children, particularly prepubertal children, are less susceptible than adults to PI-induced changes in glucose homeostasis and abdominal adipose tissue distribution.
Bitnun
Ari
A
Division of aInfectious Diseases, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Canada. ari.bitnun@utoronto.ca
Sochett
Etienne
E
Babyn
Paul
P
Holowka
Stephanie
S
Stephens
Derek
D
Read
Stanley
S
King
Susan M
SM
D000005:Abdomen; D000273:Adipose Tissue / Q000000981:diagnostic imaging*; D000293:Adolescent; D023241:Antiretroviral Therapy, Highly Active; D001786:Blood Glucose / Q000032:analysis / Q000378:metabolism*; D002096:C-Peptide / Q000097:blood; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D002784:Cholesterol / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000378:metabolism; D006706:Homeostasis; D006801:Humans; D007328:Insulin / Q000097:blood; D008055:Lipids / Q000097:blood*; D008297:Male; D015999:Multivariate Analysis; D011384:Proinsulin / Q000097:blood; D011480:Protease Inhibitors / Q000627:therapeutic use*; D012044:Regression Analysis; D014057:Tomography, X-Ray Computed; D014280:Triglycerides / Q000097:blood
D001786:Blood Glucose; D002096:C-Peptide; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D007328:Insulin; D008055:Lipids; D011480:Protease Inhibitors; D014280:Triglycerides; D011384:Proinsulin; D002784:Cholesterol