688 
Prevalence of Dyslipidemia in HIV-infected Children Received NNRTI-based ART
Thanyawee Puthanakit*1, L Aurpibul2, T Sirisanthana2, and V Sirisanthana1
1Chiang Mai Univ, Thailand and 2Res Inst for Hlth Sci, Chiang Mai Univ, Thailand
Background: Dyslipidemia is a major long-term complication of ART.
However, non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimens
have been reported to be associated with changes in plasma lipids of potential
benefit with respect to the risk of developing cardiovascular disease (CVD) in
adults. The aim of this study is to determine the prevalence of dyslipidemia in children who received NNRTI-based ART.
Methods: A longitudinal study of
children aged 4 to 15 years who received nevirapine (NVP)
or efavirenz (EFV) in combination with stavudine (d4T) and lamivudine (3TC)
for at least 2 years. Plasma samples for
determination of lipids were collected at baseline and at weeks 24, 48, 72, and
96. Lipid
samples were obtained after a 12-hour fast. Primary outcome are pattern of
change in plasma lipid concentrations over time and percentage of children with
dyslipidemia. Dyslipidemia
was defined as ≥2 abnormal measurements. Hypercholesterolemia was defined
as total cholesterol (TC) ≥200 mg/dL and low-density
lipoprotein cholesterol (LDL-C) ≥160 mg/dL.
Hypo-high-density lipoprotein cholesterol (HDL-C) was defined as HDL-C ≤40
mg/dL. Hypertriglyceridemia
was defined as triglyceride (TG) ≥200 mg/dL.
Results: We included in analysis 116
HIV-infected children. At baseline, mean age was 8.2 (SD 2.6) years,
weight-for-age and height-for-age z-score was –1.8 (0.9) and –2.3 (1.5),
respectively; 52 children received NVP and 64 received EFV. Lipid values over
time are shown in the table as mean (SD). Significant rises in TC, LDL-C, and HDL-C, but decreases in TC:HDL-C ratio were observed. At week 96, children who
received NVP had significantly higher HDL-C level and lower TC:HDL-C ratio than those who received EFV (HDL-C: 58 [19] vs 50 [13]
mg/dL, p = 0.01;
TC: HDL-c ratio 3.4 (1.2) vs 3.8 (1.2), p
= 0.04). Hypercholesterolemia
was detected in 10%, hypo-HDL-C in 10% and hypertriglyceridemia in 4% of children.
|
Study week
|
TC
(mg/dL)
|
HDL-C
(mg/dL)
|
TC: HDL-C
ratio
|
LDL-C
(mg/dL)
|
TG
(mg/dL)
|
|
0
|
128 (31)
|
27(9)
|
5.2 (1.7)
|
80(33)
|
109(66)
|
|
24
|
167(32)
|
44(14)
|
4.1 (1.1)
|
100(28)
|
114(59)
|
|
48
|
173(38)
|
50(15)
|
3.6 (1.0)
|
100(31)
|
113(70)
|
|
72
|
177(40)
|
52(16)
|
3.7 (1.2)
|
104 (32)
|
113(78)
|
|
96
|
180(35)
|
53 (16)
|
3.6 (1.2)
|
102(29)
|
125(94)
|
Conclusions: There is a low prevalence of dyslipidemia among children treated with NNRTI-based ART. A
higher HDL-C and a lower TC:HDL-C ratio are observed
after initiation of treatment.
|
