Early Increases in Concentrations of Total, LDL, and HDL Cholesterol in HIV‐infected Children Following New Exposure to Antiretroviral Therapy

Sztam, Kevin A.; Jiang, Hongyu; Jurgrau, Andrea; Deckelbaum, Richard J.; Foca, Marc

doi:10.1097/mpg.0b013e3181f5e9d4

Cited by 11 publications

(16 citation statements)

References 25 publications

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“…This pattern corresponds with prior descriptions of viremia-associated dyslipidaemia and changes after therapy. 4,25 However, even when virologically-suppressed, a large proportion of children still had low HDL and high TG. After randomization, only those switched from their LPV/r-based regimen to the NVP-based regimen showed further significant improvements in HDL, TC:HDL ratio and TG levels.…”

Section: Discussionmentioning

confidence: 99%

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Lipid Profiles in Young HIV-Infected Children Initiating and Changing Antiretroviral Therapy

Strehlau

Coovadia

Abrams

et al. 2012

JAIDS Journal of Acquired Immune Deficiency Syndromes

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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 195 HIV-infected children who initiated LPV/r-based therapy when <24 months of age at one site in Johannesburg, South Africa, and who achieved viral suppression (<400copies/ml sustained for ≥ 3 months) were randomised to either continue on the LPV/r-based regimen (n=99) or to switch to a NVP-based regimen (n=96). Non-fasting concentrations of total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL) and triglycerides (TG) were measured pre-treatment, at randomization when suppressed, and at 9, 20 and 31 months post-randomization. Results Median age at treatment initiation was 9 months and the initial regimen was maintained for an average of 9 months before randomization. TC, LDL and HDL increased from pre-treatment 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 post-switch relative to remaining on the LPV/r-based regimen. Conclusion 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.

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Section: Discussionmentioning

confidence: 99%

“…While metabolic abnormalities have been well described among HIV-infected children and youth on treatment , 2-9,16,20,25 fewer studies have characterized patterns of dyslipidemia among young children prior to ART. Among untreated adults, there is an early decrease in HDL followed by decreases in LDL and increases in TG.…”

Section: Discussionmentioning

confidence: 99%

Lipid Profiles in Young HIV-Infected Children Initiating and Changing Antiretroviral Therapy

Strehlau

Coovadia

Abrams

et al. 2012

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…Evaluating metabolic changes in children as they start or change ART can be helpful to determine specific effects of ART because children have fewer confounding psychosocial factors (such as smoking, alcohol, obesity) that can independently impact metabolic outcomes. Children newly exposed to ART experienced a rapid rise in LDL cholesterol over the first 6 months that continued through 12 months [77]. Ten percent of a cohort of 449 children in the United Kingdom had LDL-cholesterols over the 95% for age and protease inhibitors (PIs) caused greater rises in total cholesterol than non-nucleoside reverse transcriptase inhibitors (NNRTIs).…”

Section: Nutritional Interventionsmentioning

confidence: 99%

Interventions to Address Chronic Disease and HIV: Strategies to Promote Exercise and Nutrition Among HIV-Infected Individuals

et al. 2012

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Food insecurity, micronutrient deficits, dyslipidemia, insulin resistance, obesity, cardiovascular disease, and bone disorders complicate the treatment of HIV infection. Nutrition and exercise interventions can be effective in ameliorating these symptoms that are associated with HIV and antiretroviral therapy (ART). In this literature review, we examine the most recent nutrition and exercise interventions for HIV-infected patients. Macronutrient supplementation can be useful in treating malnutrition and wasting. Multivitamin (vitamin B complex, vitamin C, and vitamin E) supplements and vitamin D may improve quality of life and decrease morbidity and mortality. Nutritional counseling and exercise interventions are effective for treating obesity, fat redistribution, and metabolic abnormalities. Physical activity interventions improve body composition, strength, and fitness in HIV-infected individuals. Taken collectively, the evidence suggests that a proactive approach to nutrition and physical activity guidance and interventions can improve outcomes and help abrogate the adverse metabolic, cardiovascular, and psychological consequences of HIV and its treatments.

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“…[1][2][3][4][5][6][7][8] Significant proportions of ART-treated children have elevated total cholesterol (TC), low density lipoprotein (LDL) and triglycerides, and abnormal glucose and insulin homeostasis. [1][2][3][4][5][6][7][8] Multiple factors underlie the aetiology of these metabolic derangements, including specific ART drugs, particularly protease inhibitors (PIs) which are an important cause of dyslipidemia and impaired glucose homeostasis. 1-3 7-10 Exposure to nucleoside (NRTI) and non-nucleoside reverse transcriptase inhibitors (NNRTIs) has also been associated with dyslipidemia.…”

Section: Introductionmentioning

confidence: 99%

Metabolic abnormalities and body composition of HIV-infected children on Lopinavir or Nevirapine-based antiretroviral therapy

Arpadi

Shiau

Strehlau

et al. 2012

Archives of Disease in Childhood

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Background Few studies have assessed metabolic and body composition alterations in young perinatally HIV-infected African children on antiretroviral therapy (ART). We compared metabolic profiles and regional fat of children on a combination of 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 randomized trial that assessed the continued use of lopinavir/ritonavir-based or switch to NVP-based ART in Johannesburg, South Africa (2005–2010). Fasting total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and triglycerides were measured. Total and regional body fat (BF) were estimated by anthropometry and bioelectrical impedance analysis (BIA). A clinical assessment for lipodystrophy was conducted. Modified intent-to-treat analyses were conducted. Results 156 children (mean age 5.1±0.8 years, mean duration of treatment 4.2±0.7 years, mean time since randomization 3.4±0.7 years) were enrolled. 85 were randomized to the lopinavir/ritonavir- 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±0.7mmol/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 BIA (17.0±7.0 vs. 14.1±8.0%, p=0.022). Thirteen (8.4%) met criteria for lipodystrophy. Conclusions Unfavorable alterations in lipid profile and triglycerides, and differences in fat are detectable in young HIV-infected South African children receiving lopinavir/ritonavir-based vs. those switched to nevirapine-based regimens. Interventions to mitigate these alterations are warranted to reduce long-term cardiovascular disease risk.

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Early Increases in Concentrations of Total, LDL, and HDL Cholesterol in HIV‐infected Children Following New Exposure to Antiretroviral Therapy

Cited by 11 publications

References 25 publications

Lipid Profiles in Young HIV-Infected Children Initiating and Changing Antiretroviral Therapy

Lipid Profiles in Young HIV-Infected Children Initiating and Changing Antiretroviral Therapy

Interventions to Address Chronic Disease and HIV: Strategies to Promote Exercise and Nutrition Among HIV-Infected Individuals

Metabolic abnormalities and body composition of HIV-infected children on Lopinavir or Nevirapine-based antiretroviral therapy

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