Background: Lipid disorders are very common in HIV-infected children treated with HAART. Nevertheless, there are few longitudinal studies on this issue in children. Objectives: To assess the effect of HAART on cholesterol and triglycerides plasma levels, and the possible contribution of each individual antiretroviral.

Patients and methods: Children included in the study were selected out from the Madrid cohort study, a large cohort of HIV-infected children. Only children starting 2 NRTI plus either a PI or a NNRTI were included, provided they had baseline cholesterol and triglycerides available before HAART, and serial assessment for at least 12 months with their first HAART regimen. Comparison were made among each individual antiretroviral.

Results: In 122 children with baseline lipid levels, the first HAART regimen was started and maintained for at least 12 months since 1997. Median age at the initiation of HAART was 6.2 years (1 month-18 years). 39% were antiretroviral naïve, and 61% had prior mono or dual NRTI therapy. Among the PIs, nelfinavir was used in 46, ritonavir in 16, indinavir in 23, saquinavir in 10 and lopinavir/r in 4 children. Among the NNRTI, 16 children started efavirenz and 7 nevirapine. At baseline 7% and 12% of children treated with PI had cholesterol and triglycerides greater than 200 mg/dl and 170 mg/dl, respectively. At 12 months, cholesterol and triglycerides raised above these values in 41% (p<0.01) and 17%(p: 0.4). These proportions in cholesterolemia were 67%, 40%, 20%, 50%, and 67% for ritonavir, nelfinavir, indinavir, saquinavir, and lopinavir/r, respectively. Median increases at 12 months were 74 mg/dl for ritonavir, 38 mg/dl for nelfinavir, 17 mg/dl for indinavir, 19 mg/dl for saquinavir, and 29 mg/dl for lopinavir/r, whereas no significant changes were observed over time in triglyceridemia. In comparative analysis at 12 months, ritonavir resulted in significantly higher increases in cholesterol than nelfinavir, indinavir and saquinavir (p<0.05). NNRTI were not associated with significant increases in either cholesterol or triglycerides.

Conclusions: HIV-infected children experienced significant increases in cholesterolemia with most PI-containing-regimens. Ritonavir is associated with the greatest raise in plasma cholesterol in the first year of HAART.