Published online June 2, 2008
PEDIATRICS Vol. 122 No. 1 July 2008, pp. e129-e138 (doi:10.1542/peds.2007-2467)
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Chantry, C. J.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Chantry, C. J.
Related Collections
Right arrow Infectious Disease & Immunity
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Facebook   Add to Reddit   Add to Technorati   Add to Twitter  
What's this?

ARTICLE

Lipid and Glucose Alterations in HIV-Infected Children Beginning or Changing Antiretroviral Therapy

Caroline J. Chantry, MDa, Michael D. Hughes, PhDb, Carmelita Alvero, MSb, Joseph S. Cervia, MDc, William A. Meyer, III, PhDd, Janice Hodge, BSe, Peggy Borum, PhDf, Jack Moye, Jr, MDg for the PACTG 1010 Team

a Department of Pediatrics, University of California Davis Medical Center, Sacramento, California
b Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts
c Departments of Internal Medicine and Pediatrics, Albert Einstein College of Medicine, Bronx, New York
d Quest Diagnostics, Baltimore, Maryland
e Frontier Science and Technology Research Foundation, Amherst, New York
f Departments of Food Science and Human Nutrition and Pediatrics, University of Florida, Gainesville, Florida
g National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland

OBJECTIVE. The objective of this study was to describe lipid profiles and glucose homeostasis in HIV-positive children after initiating or changing antiretroviral therapy and their associations with viral, immune, antiretroviral therapy, and growth factor parameters.

METHODS. Ninety-seven prepubertal HIV-positive children aged 1 month to <13 years were observed for 48 weeks after beginning or changing antiretroviral therapy. Fasting lipid panels, serum glucose, insulin, insulin-like growth factor-1 and binding proteins-1 and -3, plasma viral load, and CD4% were measured. Each child was matched on age, gender, and race/ethnicity to children from the National Health and Nutrition Examination Survey, used to give z scores for each child's lipid values. Multivariate regression was used to evaluate the association of changes in z scores over 48 weeks with suppression of HIV-1 RNA, change in CD4% and growth factors, and antiretroviral therapy, adjusted for entry z score, CD4%, log10 HIV-1 RNA, Centers for Disease Control and Prevention category, and total fat and cholesterol dietary intake.

RESULTS. Lipid, apolipoprotein, and insulin levels all increased significantly by 48 weeks. Multivariate analysis of changes demonstrated that increased HDL and decreased total-HDL cholesterol ratio were associated with CD4% increase and with insulin-like growth factor-1, which increased to normal (versus remained stable or became low) over 48 weeks. Total cholesterol levels increased among children who achieved HIV-1 RNA of <400 copies per mL. Antiretroviral therapy regimens that included both a protease inhibitor and a non–nucleoside reverse transcriptase inhibitor were associated with greater increases in total-HDL cholesterol ratio than regimens that contained a protease inhibitor or a non–nucleoside reverse transcriptase inhibitor but not both.

CONCLUSIONS. In these HIV-positive children with predominantly mild-to-moderate disease, initiation or change in antiretroviral therapy was associated with significant increases in multiple lipid measures and insulin resistance. Favorable lipid changes were associated with CD4% increases, suggesting a protective effect of immune reconstitution on atherosclerosis, and with increased insulin-like growth factor-1 levels, supporting the theory that reduced growth hormone resistance may be a mechanism by which lipid profiles are improved. Finally, antiretroviral therapy regimens that contain both a non–nucleoside reverse transcriptase inhibitor and a protease inhibitor are associated with worse lipid profiles than regimens that contain 1 but not both of these drug classes.

Key Words: children • cholesterol • glucose • HIV • insulin • insulin resistance • triglycerides • apolipoprotein • viral load • immune reconstitution • insulin like growth factor-1 • insulin like growth factor binding protein

Abbreviations: HAART—highly active antiretroviral therapy • IGF-1—insulin-like growth factor-1 • GH—growth hormone • ART—antiretroviral therapy • PI—protease inhibitor • PACTG—Pediatric AIDS Clinical Trials Group • VL—viral load • IGFBP—insulin-like growth factor–binding protein • NHANES—National Health and Nutrition Examination Survey • CDC—Centers for Disease Control and Prevention • NNRTI—non–nucleoside reverse transcriptase inhibitor

Accepted Jan 9, 2008.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Facebook Facebook   Add to Reddit Reddit   Add to Technorati Technorati   Add to Twitter Twitter    What's this?