title: High Prevalence of Dyslipidemia and Insulin Resistance in HIV-infected Prepubertal African Children on Antiretroviral Therapy.
abstract: BACKGROUND
  Data describing the true extent of antiretroviral therapy (ART)-induced dyslipidemia and insulin resistance in perinatally infected children on ART in Africa are sparse.
  
  
  METHODS
  Fasting total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides, insulin and glucose were performed on the first 100 of 190 pediatric ART clinic attendees. Diet assessment was performed by a trained dietician. Lipoatrophy was formally graded by consensus between 2 expert HIV pediatricians. Durations of previous ART exposures, clinical stage, pre-ART viral load, nadir and current CD4 were recorded. Dual-energy X-ray absorptiometry was performed on a subset of 42 patients selected semi-randomly.
  
  
  RESULTS
  Prevalences of insulin resistance, abnormal total cholesterol, LDL, HDL and triglyceride were 10%, 13%, 12%, 13% and 9%, respectively. Overall, 40% had at least 1 lipid abnormality or insulin resistance. Adjusted mean LDL cholesterol increased by 0.24 mmol/L for each additional year of cumulative lopinavir/r exposure (P = 0.03) after correcting for age, gender, body mass index, previous stavudine exposure, age at ART initiation, dietary fat and refined carbohydrate, whereas adjusted mean LDL cholesterol was 0.9 mmol/L higher in children exposed to efavirenz within the previous 6 months (P = 0.02). Adjusting for age, gender and ethnicity, dual-energy X-ray absorptiometry revealed that greater trunk fat and lower peripheral subcutaneous fat were associated with elevated triglycerides but not with total cholesterol, LDL, HDL or homeostatic model assessment. Similarly, the presence of visually obvious lipoatrophy was associated with elevated triglycerides but not with total cholesterol, LDL, HDL, homeostatic model assessment or lactate.
  
  
  CONCLUSIONS
  Prevalences of insulin resistance and dyslipidemia were high. Cumulative lopinavir is an independent risk factor for dyslipidemia, with efavirenz exposure having only transitory effect.
authors.affiliation: From the *Department of Paediatrics and Child Health, Children's Infectious Disease Clinical Research Unit, Stellenbosch University and Tygerberg Children's Hospital, Cape Town, South Africa; and †Department of Medicine, University of California San Diego, La Jolla, California.
authors.forename: Steve
authors.initials: S
authors.lastname: Innes
authors.forename: Kameelah L
authors.initials: KL
authors.lastname: Abdullah
authors.forename: Richard
authors.initials: R
authors.lastname: Haubrich
authors.forename: Mark F
authors.initials: MF
authors.lastname: Cotton
authors.forename: Sara H
authors.initials: SH
authors.lastname: Browne
mesh_terms: D023241:Antiretroviral Therapy, Highly Active; D015415:Biomarkers; D044383:Black People; D018791:CD4 Lymphocyte Count; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D050171:Dyslipidemias / Q000097:blood / Q000150:complications* / Q000453:epidemiology*; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology* / Q000821:virology; D006801:Humans; D007333:Insulin Resistance; D008297:Male; D015995:Prevalence; D011627:Puberty; D012307:Risk Factors; D019562:Viral Load
chemical_list: D015415:Biomarkers