title: Metabolic abnormalities and body composition of HIV-infected children on Lopinavir or Nevirapine-based antiretroviral therapy.
abstract: BACKGROUND
  Few studies have assessed metabolic and body composition alterations in perinatally HIV-infected African children on antiretroviral therapy (ART). We compared metabolic profiles and regional fat of children on ritonavir-boosted lopinavir (lopinavir/ritonavir), lamivudine and stavudine to those switched to nevirapine, lamivudine and stavudine.
  
  
  METHODS
  This study evaluated metabolic and body composition outcomes in 156 HIV-infected children completing a randomised trial that assessed the continued use of lopinavir/ritonavir-based ART or switch to nevirapine-based ART in Johannesburg, South Africa (2005-2010). Fasting total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides total and regional body fat (BF) were measured. A clinical assessment for lipodystrophy (LD) was conducted.
  
  
  RESULTS
  156 children (mean age 5.1±0.8 years, mean duration of treatment 4.2±0.7 years, mean time since randomisation 3.4±0.7 years) were enrolled. 85 were randomised to the lopinavir/ritonavir group and 71 to the nevirapine group. The lopinavir/ritonavir group had lower mean HDL (1.3±0.4 vs 1.5±0.4 mmol/l, p<0.001) and higher mean TC (4.4±1.0 vs 4.1±0.8 mmol/l, p=0.097), LDL (2.6±0.9 vs 2.3±0.7 mmol/l, p=0.018) and triglycerides (1.1±0.4 vs 0.8±0.3 mmol/l, p<0.001). The lopinavir/ritonavir group had more total BF by mean skinfold sum (43±11.1 vs 39±10.1 mm, p=0.031) and BF% by bioelectrical impedance analysis (17.0±7.0 vs 14.1±8.0%, p=0.022). Thirteen (8.4%) met criteria for LD.
  
  
  CONCLUSIONS
  Unfavourable alterations in lipid profile and triglycerides, and differences in fat are detectable in young HIV-infected South African children receiving lopinavir/ritonavir-based regimens versus those switched to nevirapine-based regimens. Interventions to mitigate these alterations are warranted to reduce long-term cardiovascular disease risk.
authors.affiliation: Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University Medical Center, 630 W. 168th Street, New York, NY 10032, USA. sma2@columbia.edu
authors.forename: Stephen
authors.initials: S
authors.lastname: Arpadi
authors.forename: Stephanie
authors.initials: S
authors.lastname: Shiau
authors.forename: Renate
authors.initials: R
authors.lastname: Strehlau
authors.forename: Leigh
authors.initials: L
authors.lastname: Martens
authors.forename: Faeezah
authors.initials: F
authors.lastname: Patel
authors.forename: Ashraf
authors.initials: A
authors.lastname: Coovadia
authors.forename: Elaine J
authors.initials: EJ
authors.lastname: Abrams
authors.forename: Louise
authors.initials: L
authors.lastname: Kuhn
mesh_terms: D019380:Anti-HIV Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001823:Body Composition / Q000187:drug effects*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy*; D039682:HIV-Associated Lipodystrophy Syndrome / Q000139:chemically induced*; D006801:Humans; D007223:Infant; D007333:Insulin Resistance / Q000502:physiology; D019259:Lamivudine / Q000627:therapeutic use; D008055:Lipids / Q000097:blood*; D061466:Lopinavir / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D019829:Nevirapine / Q000009:adverse effects* / Q000627:therapeutic use; D019438:Ritonavir / Q000009:adverse effects; D013019:South Africa; D018119:Stavudine / Q000627:therapeutic use
chemical_list: D019380:Anti-HIV Agents; D008055:Lipids; D061466:Lopinavir; D019259:Lamivudine; D019829:Nevirapine; D018119:Stavudine; D019438:Ritonavir