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Blood Lipid Levels and Body Composition in HIV-Infected Children Treated with Protease Inhibitors A. MELVIN*, S. LENNON, K. MOHAN, and J. PURNELL.
Univ. of Washington Objective: To determine if HIV-infected children treated with combination antiretroviral therapy including protease inhibitors (PI) will have different blood lipid levels and body composition than HIV-infected children not treated with protease inhibitors.
Methods: Levels of lipids and apolipoprotein B were determined in the fasting state. Body composition and fat distribution were determined by anthropometric measurements and DEXA scan.
Results: 18 children treated with 3-5 antiretroviral agents including at least one PI for a median of 19 months (range 8-39) and nine children treated with 1-2 NRTIs only (nPI group) were included in this analysis. The PI-treated children ranged in age from 4 to 14yrs (median 9yrs) and the nPI 6 to 18yrs (median 10yrs). Median CD4 cell count at the time of the analysis was 858 cells/mm3 in the PI-treated children and 539 cells/mm3 in the nPI children. 14/17 children in the PI-treated group had plasma RNA levels <50 copies/ml while the median RNA level in the nPI group was 4,200 (<400 - 118,660) copies/ml. Median total cholesterol level was 208mg/dl (range 147-238) for the PI-treated children and 144mg/dl (range 96-156) for the nPI children (p<0.001). LDL cholesterol levels were also higher in the PI group (median PI 124mg/dl, nPI 79mg/dl) (p<0.001). Eleven (61%) of the PI-treated children had total cholesterol levels >200mg/dl and 4 (34%) had LDL cholesterol levels >130mg/dl. No nPI children had total or LDL cholesterol elevated to this degree. Apolipoprotein B levels were higher in the PI group (PI 89, nPI 68), however there were no differences in triglyceride, VLDL, HDL, HDL2 and HDL3 levels. BMI, waist/hip ratio, and distribution of body fat were also not different between the groups.
Summary: HIV-infected children treated with PIs demonstrate increased levels of total and LDL cholesterol with a significant number having levels for which intervention is recommended.
Key Words: children, cholesterol, protease inhibitors
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