title: Lipid profiles in young HIV-infected children initiating and changing antiretroviral therapy.
abstract: BACKGROUND
  Both HIV infection and antiretroviral therapy are associated with dyslipidemias in adults, but there are fewer data on outcomes in young children. Here we examined lipid profile changes in a cohort of young children before and after suppression on an initial ritonavir-boosted lopinavir (LPV/r)-based regimen and after switch to a nevirapine (NVP)-based regimen.
  
  
  METHODS
  One hundred ninety-five HIV-infected children who initiated LPV/r-based therapy when <24 months of age at 1 site in Johannesburg, South Africa, and who achieved viral suppression (<400 copies/mL sustained for ≥ 3 months) were randomized to either continue on the LPV/r-based regimen (n = 99) or to switch to a NVP-based regimen (n = 96). Nonfasting concentrations of total cholesterol (TC), low-density lipoprotein, high-density lipoprotein (HDL), and triglycerides (TG) were measured pretreatment, at randomization when suppressed, and at 9, 20, and 31 months postrandomization.
  
  
  RESULTS
  Median age at treatment initiation was 9 months, and the initial regimen was maintained for an average of 9 months before randomization. TC, low-density lipoprotein, and HDL increased from pretreatment to randomization (P < 0.0001) and TC/HDL ratio and TG decreased (P < 0.0001). After switching to NVP, HDL was significantly higher (P < 0.02) and TC/HDL and TG significantly lower (P < 0.0001) through 31 months postswitch relative to remaining on the LPV/r-based regimen.
  
  
  CONCLUSIONS
  Initiating antiretroviral therapy was associated with changes to a more favorable lipid profile in young children. Switching from a LPV/r-based regimen to a NVP-based regimen accentuated and continued these improvements. Investigation of safe and effective methods for managing dyslipidemias in children of different ages in resource-limited settings is warranted.
authors: Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, University of the Witwatersrand, Johannesburg, South Africa.
authors: Renate
authors: R
authors: Strehlau
authors: Ashraf
authors: A
authors: Coovadia
authors: Elaine J
authors: EJ
authors: Abrams
authors: Leigh
authors: L
authors: Martens
authors: Stephen
authors: S
authors: Arpadi
authors: Tammy
authors: T
authors: Meyers
authors: Louise
authors: L
authors: Kuhn
mesh_terms: D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000009:adverse effects; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects / Q000379:methods*; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D007223:Infant; D008055:Lipids / Q000097:blood*; D061466:Lopinavir / Q000008:administration & dosage / Q000009:adverse effects; D008297:Male; D019438:Ritonavir / Q000008:administration & dosage / Q000009:adverse effects; D013019:South Africa; D016896:Treatment Outcome
chemical_list: D019380:Anti-HIV Agents; D008055:Lipids; D061466:Lopinavir; D019438:Ritonavir