Hypertriglyceridemia and hypercholesterolemia in human immunodeficiency virus-1-infected children treated with protease inhibitors.
BACKGROUND
Adverse effects associated with highly active antiretroviral therapy (HAART), particularly protease inhibitors (PIs), have been identified in adult and pediatric patients. In this study, we monitored, for cholesterol and triglyceride levels, a cohort of HIV-1-infected children receiving a HAART regimen.


METHODS
HIV-infected patients <17 years old belonging to a cohort that has been followed since 1997 were enrolled in the study. Patients were receiving either a three- or four-drug antiretroviral regimen that included two nucleoside reverse transcriptase inhibitors (lamivudine and zidovudine) combined with one or two PIs (ritonavir and/or saquinavir). Cholesterol and triglyceride levels were measured on fasting serum samples drawn at the time of enrollment and every 3 months thereafter. Clinical evaluation was performed on a monthly basis.


RESULTS
Twenty four patients were included. Median age at HIV infection diagnosis was 15 months. Twenty one patients received a four-drug antiretroviral regimen, while three patients received ritonavir plus zidovudine and lamivudine. Median follow-up was 27 months; 62.5% of patients had hypercholesterolemia and 79.2% had hypertriglyceridemia, most typically after 15 months of treatment. None of the patients had physical changes in body fat distribution suggesting lipodystrophy.


CONCLUSIONS
Hyperlipidemia is a frequent complication in HIV-1-infected children undergoing antiretroviral treatment that includes PIs. Additional studies with larger cohorts and a longer follow-up are needed to propose a rationale and alternatives for patients who develop dyslipidemia while receiving PIs.
Solórzano Santos
Fortino
F
Infectious Diseases Department, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México, D.F., México. forsosa@starmedia.com
Gochicoa Rangel
Laura G
LG
Palacios Saucedo
Gerardo
G
Vázquez Rosales
Guillermo
G
Miranda Novales
María Guadalupe
MG
D000293:Adolescent; D023241:Antiretroviral Therapy, Highly Active; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D017320:HIV Protease Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D006937:Hypercholesterolemia / Q000097:blood* / Q000209:etiology; D015228:Hypertriglyceridemia / Q000097:blood* / Q000209:etiology; D007223:Infant; D019259:Lamivudine / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D019438:Ritonavir / Q000008:administration & dosage* / Q000009:adverse effects; D019258:Saquinavir / Q000008:administration & dosage* / Q000009:adverse effects; D015215:Zidovudine / Q000008:administration & dosage* / Q000009:adverse effects
D017320:HIV Protease Inhibitors; D019259:Lamivudine; D015215:Zidovudine; D019258:Saquinavir; D019438:Ritonavir