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Metabolic abnormalities in HIV type 1-infected children treated and not treated with protease inhibitors
A J Melvin1, S Lennon, K M Mohan
1Division of Pediatric Infectious Disease, Department of Pediatrics, University of Washington, Seattle, Washington 98105, USA. amelvi@chmc.org
Insights
HIV-infected children on protease inhibitor (PI) therapy show elevated total and LDL cholesterol levels compared to those not on PIs. Other lipid profiles and body composition remain largely unchanged.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Pharmacology
- Biochemistry
Background:
- Combination antiretroviral therapy (cART) is standard for HIV-1 infection in children.
- Protease inhibitors (PIs) are a key component of some cART regimens.
- Potential metabolic side effects of PIs in pediatric populations require investigation.
Purpose of the Study:
- To compare lipid profiles, insulin, glucose levels, and body composition in HIV-infected children with and without PI treatment.
- To identify specific metabolic and body composition changes associated with PI-based cART in children.
Main Methods:
- Cross-sectional cohort study comparing 23 PI-treated children with 12 no-PI treated children.
- Fasting blood samples analyzed for lipids, apolipoprotein B (apoB), insulin, and glucose.
- Dual energy X-ray absorptiometry (DEXA) and anthropometry used for body composition and fat distribution assessment.
Main Results:
- PI-treated children had significantly higher total cholesterol (5.33 vs. 3.69 mM) and LDL cholesterol (3.27 vs. 2.14 mM) (p < 0.0001).
- Elevated apoB, HDL, and triglyceride levels were also observed in the PI group.
- No significant differences in fasting glucose, insulin, or overall body composition were found, except for percent arm fat.
Conclusions:
- Treatment with PIs in HIV-1-infected children is associated with significant dyslipidemia, primarily elevated total and LDL cholesterol.
- Metabolic monitoring for lipid abnormalities is crucial in pediatric HIV patients receiving PI-containing cART.
- Further research may explore long-term cardiovascular implications and management strategies.
Abstract:
Our objective was to determine whether HIV-infected children treated with protease inhibitors (PIs) have different blood lipid, insulin, and glucose levels and body composition than HIV-infected children not treated with PIs. A cross-sectional cohort study was performed; in which 23 children were treated with combination antiretroviral therapy including a PI for at least 6 months and 12 children were treated with nucleoside reverse transcriptase inhibitors only (no-PI group). Levels of lipids, apolipoprotein B (apoB), insulin, and glucose were determined in the fasting state. Body composition and fat distribution were determined by anthropometric measurements and dual energy X-ray absorptiometry (DEXA) scan. Total cholesterol levels were higher in the PI-treated children (5.33 +/- 0.87 mM) than in the no-PI children (3.69 +/- 0.59 mM) (p < 0.0001). Similarly, low-density lipoprotein (LDL) levels were also elevated in the PI-treated children (3.27 +/- 0.76 vs. 2.14 +/- 0.51 mM) (p < 0.0001). ApoB and high-density lipoprotein (HDL), and to a lesser degree triglyceride levels, were also increased in the PI-treated children. Apart from percent arm fat as measured by DEXA, there were no differences between the two groups in measures of body composition or in their fasting glucose and insulin levels. The results from this cross-sectional cohort study suggest that the predominant lipid abnormalities associated with treatment with combination antiretroviral therapy including a PI in HIV-1-infected children are elevated total and LDL cholesterol.
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