Lipid Profiles in Young HIV-infected Children Initiating and Changing Antiretroviral Therapy

Background: Both HIV infection and antiretroviral therapy are associated with dyslipidemias in adults, but there are fewer data on outcomes in young children. Here we examined lipid profile changes in a cohort of young children before and after suppression on an initial ritonavir-boosted lopinavir (LPV/r)-based regimen and after switch to a nevirapine (NVP)-based regimen.

Methods: One hundred ninety-five HIV-infected children who initiated LPV/r-based therapy when <24 months of age at 1 site in Johannesburg, South Africa, and who achieved viral suppression (<400 copies/mL sustained for ≥ 3 months) were randomized to either continue on the LPV/r-based regimen (n = 99) or to switch to a NVP-based regimen (n = 96). Nonfasting concentrations of total cholesterol (TC), low-density lipoprotein, high-density lipoprotein (HDL), and triglycerides (TG) were measured pretreatment, at randomization when suppressed, and at 9, 20, and 31 months postrandomization.

Results: Median age at treatment initiation was 9 months, and the initial regimen was maintained for an average of 9 months before randomization. TC, low-density lipoprotein, and HDL increased from pretreatment to randomization (P < 0.0001) and TC/HDL ratio and TG decreased (P < 0.0001). After switching to NVP, HDL was significantly higher (P < 0.02) and TC/HDL and TG significantly lower (P < 0.0001) through 31 months postswitch relative to remaining on the LPV/r-based regimen.

Conclusion: Initiating antiretroviral therapy was associated with changes to a more favorable lipid profile in young children. Switching from a LPV/r-based regimen to a NVP-based regimen accentuated and continued these improvements. Investigation of safe and effective methods for managing dyslipidemias in children of different ages in resource-limited settings is warranted.