Numerous studies have shown that antiretroviral therapy - especially protease inhibitors (PIs) - are linked to metabolic side effects including abnormal blood fat levels in HIV positive adults. This is of concern, since blood lipid abnormalities are associated with increased risk of cardiovascular disease.

Though cardiovascular disease, being a progressive condition, is much less common among children, PIs can also boost blood lipids in HIV positive pediatric patients on HAART, according to a study in the April 15, 2008 Journal of Acquired Immune Deficiency Syndromes.

Investigators with the International Maternal Pediatric Adolescent AIDS Clinical Trials 219C Team evaluated the incidence of and risk factors for development of elevated blood cholesterol (hypercholesterolemia) in this large pediatric treatment study.

PACTG 219C included 2122 perinatally infected HIV positive children. The researchers analyzed development of hypercholesterolemia, defined as a total cholesterol level of 220 mg/dL or higher on 2 consecutive visits. Cox proportional hazards models were used to evaluate risk factors.

Results

• 13% of the children had hypercholesterolemia at study entry.

• An additional 13% developed hypercholesterolemia during follow-up, for an incidence rate of 3.4 cases per 100 person-years.

• After adjusting for age, the following factors were associated with increased risk of hypercholesterolemia:

• Use of ritonavir-boosted PIs: hazard ratio (HR) 13.9;

• Use of non-boosted PIs: HR 8.65);

• Use of non-nucleoside reverse transcriptase inhibitors (NNRTIs): HR 1.33.

• Participants with good self-reported adherence also had a higher risk of hypercholesterolemia.

• Having a high HIV viral load – potentially an indicator of poor adherence -- was protective against elevated cholesterol (>50,000 vs < 400 copies/mL: HR 0.59).

Conclusion

“PIs were significant risk factors for hypercholesterolemia,” the study authors wrote. “Higher viral load was protective and may reflect non-adherence.”

Harvard School of Public Health, Boston, MA; University of Alabama at Birmingham School of Medicine, Birmingham, AL; University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, NJ; University of Maryland School of Medicine, Baltimore, MD.

4/04/08