Effect of Specific ART Drugs on Lipid Changes and the Need for Lipid Management in Children With HIV

The current study assessed the effects of particular antiretroviral therapies (ART) on lipids among children with HIV.

The study patients received care from two hospitals in London during 1995-2007; 449 children were followed for a median 4.5 years.

Using mixed-effects models adjusted for confounders, investigators screened the children for lipid-lowering management according to American Academy of Pediatric criteria (low-density lipoprotein cholesterol above 190 mg/dL or 4.9 mmol/L for no known cardiovascular disease risk factors; LDL above 160 mg/dL or 4.1 mmol/L for two or more risk factors).

On average, ART-naïve children had normal lipids except for low high-density lipoprotein cholesterol (HDL) (median 0.8). All cholesterol subsets were elevated for the four drugs reviewed. Protease inhibitors had greater rises in total cholesterol, with maximal non-HDL rise for lopinavir and ritonavir at four or more years of exposure, 0.8 (0.57-1.03). While non-nucleoside reverse transcriptase inhibitors raised non-HDL, this was associated with clinically significant increased HDL. Nevirapine boosted non-HDL by 0.38 (0.09-0.31) at two to three years and HDL by 0.34 (0.28-0.41). Efavirenz raised non-HDL by 0.2 (0.09-0.31) and HDL by 0.12 (0.08-0.17) at one year.

"Ten percent had LDL above the 95th percentile, but only three met the 4.9 cutoff for pharmacologic intervention," found the researchers. "Intervention strategies (dietary and exercise advice, treatment switching and pharmacotherapy) are required for persistent hyperlipidemia and should be assessed in randomized control trials."

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