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PEDIATRICS Vol. 110 No. 5 November 2002, pp. e56

ELECTRONIC ARTICLE

Marked Dyslipidemia in Human Immunodeficiency Virus-Infected Children on Protease Inhibitor-Containing Antiretroviral Therapy

Elke Lainka, MD*, Selda Oezbek*, Manfred Falck, MD{ddagger}, Jennifer Ndagijimana, MD* and Tim Niehues, MD*

* Paediatric Immunology and Rheumatology Unit, the Children’s Hospital
{ddagger} Clinical Chemistry and Laboratory Research Unit, Heinrich Heine University, Düsseldorf, Germany

--> 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 HIV-infected 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. High-density 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.

Key Words: 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

Received for publication May 1, 2002; Accepted Jul 16, 2002.


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