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PEDIATRICS Vol. 114 No. 2 August 2004, pp. e235-e242

ELECTRONIC ARTICLE

Natural History of Lipid Abnormalities and Fat Redistribution Among Human Immunodeficiency Virus-Infected Children Receiving Long-Term, Protease Inhibitor-Containing, Highly Active Antiretroviral Therapy Regimens

Perdita Taylor, MD*, Carol Worrell, MD*, Seth M. Steinberg, PhD{ddagger}, Rohan Hazra, MD*, Shirley Jankelevich, MD*, Lauren V. Wood, MD*, Sheryl Zwerski, RN, MSN, CRNP*, Robert Yarchoan, MD* and Steven Zeichner, MD, PhD*

* Pediatric HIV Working Group, HIV and AIDS Malignancy Branch, Bethesda, Maryland
{ddagger} Biostatistics and Data Management Section, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland

Objective. To characterize the type and frequency of biochemical lipid abnormalities and physical changes in body composition associated with the use of protease inhibitor (PI)-containing antiretroviral therapy among human immunodeficiency virus-infected children treated for up to 6 years.

Methods. A retrospective study of human immunodeficiency virus-infected pediatric patients enrolled in research protocols between August 1995 and December 2001 was performed. All patients who had received a PI for ≥2 years as part of their investigational antiretroviral treatment regimens during the study period were eligible. Of the 110 patients identified as having received PI therapy, 94 met the study criteria.

Results. Of the 94 patients evaluated, 9 patients (10%) developed fat redistribution as well as dyslipidemia, 49 patients (52%) developed dyslipidemia without associated physical changes, and 36 patients (38%) exhibited no elevation of lipid levels or physical signs of fat redistribution. For all 9 patients with fat redistribution, the onset of the physical changes was closely associated with changes during pubertal development. Fat redistribution was also associated with lower viral loads and higher, more sustained levels of dyslipidemia. The onset of dyslipidemia and fat redistribution peaked between 10 and 15 years of age.

Conclusion. Among pediatric patients receiving PI therapy, there seems to be an age range in which children are at greater risk of developing hypercholesterolemia and subsequent fat redistribution, suggesting that unidentified physiologic changes associated with puberty may predispose pediatric patients treated with PI therapy to developing lipodystrophy.

Key Words: human immunodeficiency virus • protease inhibitor • lipid • fat

Abbreviations: HAART, highly active antiretroviral therapy • PI, protease inhibitor • HIV, human immunodeficiency virus • NRTI, nucleoside reverse transcriptase inhibitor • AIDS, acquired immunodeficiency syndrome • DEXA, dual-energy x-ray absorptiometry

Received for publication Feb 5, 2004; Accepted Apr 1, 2004.


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