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Antiretrovirals Raise Cholesterol in HIV-Infected Children

Last Updated: August 15, 2011.

Children with HIV receiving antiretroviral therapy have increased cholesterol levels; and hypercholesterolemia in children perinatally infected with HIV remains elevated over time, according to two studies published in the Aug. 15 issue of the Journal of Acquired Immune Deficiency Syndromes.

MONDAY, Aug. 15 (HealthDay News) -- Children with HIV receiving antiretroviral therapy have increased cholesterol levels; and hypercholesterolemia in children perinatally infected with HIV remains elevated over time, according to two studies published in the Aug. 15 issue of the Journal of Acquired Immune Deficiency Syndromes.

Margaret P. Rhoads, M.B.B.S., from the Imperial College London, and colleagues investigated the effects of individual antiretrovirals on lipids in 449 children infected with HIV, and the eligibility for dietary or pharmacologic intervention during an average 4.5 years of follow-up. Antiretroviral-naive children had low levels of high-density lipoprotein cholesterol (HDL), but other lipids were normal. For all four drugs evaluated, all subsets of cholesterol were increased. Treatment with lopinavir/ritonavir resulted in the highest increase in non-HDL. The nonnucleoside reverse transcriptase inhibitors raised non-HDLs, but this was correlated with a significant increase in HDL. Nevirapine and efavirenz raised both non-HDL and HDL. In 10 percent of cases low-density lipoprotein was above the 95th percentile, but only three children needed pharmacologic intervention.

Denise L. Jacobson, Ph.D., M.P.H., from the Harvard School of Public Health in Boston, investigated the trends in clinical course and management of incident hypercholesterolemia in 240 children perinatally infected with HIV. Factors influencing hypercholesterolemia resolution, changes in antiretroviral regimen, and use of lipid-lowering medications were assessed during an average follow-up of 1.9 years. Resolution to normal cholesterol was found in 81 children within two years of follow-up, and was more likely in children who were 13 years or older (adjusted hazard ratio [aHR], 2.39) and who changed antiretroviral regimen (aHR, 2.37).

"The majority of children who develop hypercholesterolemia maintain elevated levels over time, potentially placing them at risk for premature cardiovascular morbidity," Jacobson and colleagues write.

Abstract - Rhoads
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Abstract - Jacobson
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