ABSTRACT. Objective. To assess the effects of antiretroviral combination therapy that contains protease inhibitor (PI) on carbohydrate and lipid metabolism in human immunodeficiency virus (HIV)-infected children.Methods. A cross-sectional, descriptive clinical study was conducted in an outpatient clinic. Thirty-seven HIVinfected children who ranged from 1 to 17 years of age received nucleoside reverse transcriptase inhibitor treatment together with PI (PI group, n ؍ 25) or without PI (non-PI group, n ؍ 12). Age, gender, weight, length, CD4 cell count, and viral load did not differ between groups. Nonfasting total cholesterol, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein (LDL) cholesterol, glucose, lactate, and blood gases were determined. In addition, c-peptide, insulin, hemoglobin A1c, free fatty acids, lipoprotein a, and apolipoproteins A1 and B were evaluated after fasting. PI and non-PI group values were compared with normal values taken from healthy children.Results. In nonfasting and fasting conditions, children of the PI group had higher total cholesterol (fasting PI group: 235 ؎ 71 mg/dL; non-PI group: 176 ؎ 25 mg/dL, mean ؎ standard deviation), triglycerides (156 ؎ 89 vs 87 ؎ 31 mg/dL), and LDL cholesterol levels (159 ؎ 58 vs 113 ؎ 23 mg/dL) compared with the non-PI group. Highdensity lipoprotein cholesterol and apolipoprotein A1 levels did not differ in both groups; there was a trend toward higher apolipoprotein B levels in the PI group. After fasting, 8 (47%) of 17 patients in the PI group presented with hypercholesterolemia as a result of an increase of LDL cholesterol and 11 (65%) had hypertriglyceridemia. It is interesting that the non-PI group showed no pathologic deviations. Compared with normal values, lipoprotein a and free fatty acids were increased in the PI and non-PI groups. Glucose, lactate, blood gases, c-peptide, insulin, and hemoglobin A1c were normal in both groups.Conclusion. PI-containing antiretroviral treatment of HIV-infected children was associated with hypercholesterolemia, hypertriglyceridemia, and an increase of LDL cholesterol. The long-term complications of dyslipidemia are of major concern in the growing HIV-infected child. Pediatrics 2002;110(5). URL: http://www.pediatrics. org/cgi/content/full/110/5/e56; antiretroviral therapy, HIV infection, dyslipidemia, carbohydrate metabolism.ABBREVIATIONS. HAART, highly active antiretroviral therapy; PI, protease inhibitor; NNRTI, nonnucleoside reverse transcriptase inhibitor; NRTI, nucleoside reverse transcriptase inhibitor; HIV, human immunodeficiency virus; 3TC, lamivudine; AZT, zidovudine; NFV, nelfinavir; DDI, didanosine; d4T, stavadine; RTV, nitonavir, ABC, abacavir; DDC, zalcitabine; SAQ, saquinavir; HDL, high-density lipoprotein; LDL, low-density lipoprotein; Lp(a), lipoprotein a; HbA1c, hemoglobin A1c. H ighly active antiretroviral therapy (HAART) that consists of protease inhibitors (PIs) or nonnucleoside reverse transcriptase inhibitors (NNRTIs) in combination with nucleoside reverse tran...
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