Lipid Changes in Kenyan HIV-1–infected Infants Initiating Highly Active Antiretroviral Therapy by 1 Year of Age

Abstract

Background Early highly active antiretroviral therapy (HAART) is recommended for HIV-1 infected infants. There are limited data on lipid changes during infant HAART. Methods Non-fasting total (TC), low density lipoprotein (LDL), and high density lipoprotein (HDL) cholesterol, and triglycerides (TG) were measured at 0, 6 and 12 months. Correlates of lipid levels and changes post-HAART were assessed using linear regression. Results Among 115 infants, pre-HAART median age was 3.8 months, CD4% was 19%, and weight-for-age z-score (WAZ) was −2.42. Pre-HAART median lipid levels were: TC, 108.7 mg/dl, LDL, 42.5 mg/dl, HDL, 29.4 mg/dl and TG, 186.9 mg/dl. Few infants had abnormally high TC (6.2%) or LDL (5.6%), but many had low HDL (76.5%) or high TG (69.6%). Higher pre-HAART WAZ and HAZ were each associated with higher pre-HAART TC (P=0.04 and P=0.01) and LDL (P=0.02 and P=0.008). From 0–6 months post-HAART, TC (P<0.0001), LDL (P<0.0001), and HDL (P<0.0001) increased significantly, and 23.1% (P=0.002), 14.0% (P=0.2), 31.3% (P<0.0001), and 50.8% (P=0.2) of infants had abnormally high TC, high LDL, low HDL, and high TG, respectively. Changes in TC and HDL were each associated with higher gain in WAZ (P=0.03 and P=0.01) and HAZ (P=0.01 and P=0.007). Increased change in LDL was associated with higher gain in HAZ (P=0.03). Infants on protease inhibitor (PI)-HAART had smaller HDL increase (P=0.004). Conclusions Infants had substantive increases in lipids, which correlated with growth. Increases in HDL were attenuated by PI-HAART. It is important to determine clinical implications of these changes.

Changes in elevated cholesterol in the era of tenofovir in South Africa: risk factors, clinical management and outcomes

“…This study found increased rates of elevated TC in a South African adult population on ART and found that, consistent with previous reports , TDF had a favourable impact on TC compared with other NRTIs. A strength of our study is that close to 95% of our patients were initiated on EFV, eliminating the possibility that the difference in TC levels associated with the NRTIs used (TDF vs .…”

“…The impact of ART on lipid profiles varies depending on the ART regimen used , further complicated by the fact that HIV alone has been shown to affect lipid profiles . Briefly, the non‐nucleoside reverse transcriptase inhibitors (NNRTIs) efavirenz (EFV) and nevirapine (NVP) as well as the nucleoside reverse transcriptase inhibitors (NRTIs) stavudine (d4T) and zidovudine (ZDV) have all been shown to increase total cholesterol (TC), low‐density lipoprotein cholesterol (LDL‐c), high‐density lipoprotein cholesterol (HDL‐c) and triglycerides . Similarly, most protease inhibitors (PIs) are also thought to increase TC and LDL‐c, but have been shown to decrease HDL‐c .…”

Dyslipidemia, Diet and Physical Exercise in Children on Treatment With Antiretroviral Medication in El Salvador

“…6 Dyslipidemia has been observed even in the absence of any HIV treatment, 5,6 but usually worsens with antiretroviral drugs (ART), 5,7,8 especially if protease inhibitors (PIs) are used. 9,10 To the best of our knowledge, there is no published study reporting on the prevalence of dyslipidemia and its association with PI among HIV-infected children in Central America.…”

Nutritional Treatment Approach for Children with HIV Receiving ART

“…HIV infection has become a chronic disease in children because of prolonged survival resulting from ART and also because of its adverse effects [19,56]. Because of the deleterious effects of metabolic changes, prevention of morbidity, in the short term and the long term, is important to avoid further complications in adulthood [16].…”

“…These metabolic disorders may result in increased cardiovascular diseases in the medium and long terms as well as reduced bone mineral density [13][14][15][16][17][18][19]. These metabolic disorders may result in increased cardiovascular diseases in the medium and long terms as well as reduced bone mineral density [13][14][15][16][17][18][19].…”