Association of hypercholesterolemia incidence with antiretroviral treatment, including protease inhibitors, among perinatally HIV-infected children.
BACKGROUND
Antiretroviral therapy has been associated with hypercholesterolemia in HIV-infected children. Few longitudinal studies have been conducted to examine this association, however.


OBJECTIVE
To evaluate the incidence of and risk factors for development of hypercholesterolemia in a large pediatric study.


METHODS
Prospective cohort study (Pediatric AIDS Clinical Trials Group 219C).


METHODS
A total of 2122 perinatally HIV-infected children free of hypercholesterolemia at entry.


RESULTS
Development of hypercholesterolemia (total cholesterol >or=220 mg/dL at 2 consecutive visits). Cox proportional hazards models were used to evaluate risk factors.


RESULTS
Thirteen percent of children had hypercholesterolemia at entry, and an additional 13% developed hypercholesterolemia during follow-up for an incidence rate of 3.4 cases per 100 person-years (95% confidence interval [CI]: 3.0 to 3.9). After adjustment for age, boosted protease inhibitor (PI) use (hazard ratio [HR] = 13.9, 95% CI: 6.73 to 28.6), nonboosted PI use (HR = 8.65, 95% CI: 4.19 to 17.9), and nonnucleoside reverse transcriptase inhibitor use (HR = 1.33, 95% CI: 1.04 to 1.71) were associated with increased risk of hypercholesterolemia, and higher viral load was protective (>50,000 vs. <or=400 copies/mL; HR = 0.59, 95% CI: 0.39 to 0.90). Self-reported adherent subjects had higher risk.


CONCLUSIONS
PIs were significant risk factors for hypercholesterolemia. Higher viral load was protective and may reflect nonadherence. Further follow-up is critical to evaluate long-term consequences of chronic PI exposure and hypercholesterolemia.
Tassiopoulos
Katherine
K
Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, MA 02115, USA. ktassiop@hsph.harvard.edu
Williams
Paige L
PL
Seage
George R
GR
Crain
Marilyn
M
Oleske
James
J
Farley
John
J
D000293:Adolescent; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D002784:Cholesterol / Q000097:blood*; D015331:Cohort Studies; D005260:Female; D006678:HIV / Q000187:drug effects / Q000302:isolation & purification; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D017320:HIV Protease Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D006937:Hypercholesterolemia / Q000139:chemically induced* / Q000453:epidemiology; D015994:Incidence; D008297:Male; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D019562:Viral Load
D017320:HIV Protease Inhibitors; D002784:Cholesterol