773 Prevalence of Hypercholesterolemia and Associated Risk Factors Among Perinatally HIV-infected Children (4 -19 Years) in PACTG 219C J. Farley*1, P. Gona2, M. Crain3, J. Cervia4, J. Lindsey2, J. Oleske5 1Univ of Maryland Sch of Med, Baltimore; 2Harvard Sch of Public Hlth, Boston, MA; 3Univ of Alabama at Birmingham Sch of Medicine; 4Long Island Jewish Med Ctr, New Hyde Park, NY; and 5Univ of Med and Dentistry of New Jersey, Newark
Background: The HIV protease inhibitors (PI) are known to disturb lipid metabolism in adults leading to hypercholesterolemia. We hypothesized that elevated total cholesterol (chol) in HIV-infected children would be more common among older children with increased duration of protease inhibitor therapy and excellent adherence and may be associated with hypertension and obesity.
Methods: PACTG 219C is a prospective cohort study to examine long-term outcomes in HIV-infected children and in HIV- children born to HIV-infected women. In this study, the first recorded measurement of random total chol is the outcome of interest, and patients (pts) are classified as abnormal if their chol is higher than the 95th percentile of the gender, race, and age specific standards (TC > 95). Complete pt treatment history obtained at enrollment, as well as laboratory and adherence interview recorded on the date closest to the chol measurement, are used as independent variables.
Results: Among 1,927 HIV-infected participants between 4 and 19 yrs of age at first chol measurement date, 247 children had TC > 95 (prevalence 12.8 %, 95% CI, 11.3-14.4). The sex distribution was balanced and the median age was 10 yrs. On univariate analysis, TC > 95 was significantly associated with white race (prev. 19%), younger age < 6 yrs (prev.19%), current PI use (prev. 17%), > 3 yrs of PI exposure (prev.16%), parent/pt report of no missed doses past 3 days (prev.15%), HIV-1 RNA < 400 copies/ml. (prev. 22%), and CD4% > 25 (prev.14%). TC > 95 was not associated with hypertension or obesity. Receipt of an NNRTI non-PI regimen was protective (p = 0.033). In a multivariate logistic regression model limited to those currently receiving a PI, with TC > 95 as the dependent variable, the following independent variables were highly statistically significant (all p < 0.004): present PI usage, 2 or more PIs currently taken, report of no missed doses past 3 days, younger age, and white/Hispanic ethnicity. Current PI usage was associated with 3.6 times the risk of TC > 95. Each additional PI currently being taken resulted in 72% increase in risk. Duration of treatment with the specific PIs Lopinavir/Ritonavir or Nelfinavir was associated with increased risk (p = 0.011 and 0.028, respectively).
Conclusions: Hypercholesterolemia was associated with PI use (particularly dual/triple PI), excellent adherence, younger age, and white/Hispanic ethnicity, but not hypertension or obesity.
