Marked Dyslipidemia in Human Immunodeficiency Virus-infected Children on Protease Inhibitor-containing Antiretroviral Therapy

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.