Paper # 865 
2-Year Evolution of Triglycerides and Cholesterol in Thai HIV-1-infected Children Receiving First-line NVP- or EFV-based Regimen
S Kanjanavanit1, R Hansudewechakul2, S Kim3,4, B Warachit5, P Layangool6, C Ngampiyaskul7, N Homkham3,4, P Traisathit8, N Ngo-Giang-Huong3,4, Gonzague Jourdain*3,4, and the PHPT Observational Cohort Study Group
1Nakornping Hosp, Chiang Mai, Thailand; 2Prachanukroh Regional Hosp, Chiang Rai, Thailand; 3Faculty of Associated Med Sci, Chiang Mai Univ, Thailand; 4UMI174, Inst of Devt Res, Paris, France; 5Hat Yai Regional Hosp, Songkla, Thailand; 6Bhumibol Adulyadej Hosp, Bangkok, Thailand; 7Prapokklao Hosp, Chantaburi, Thailand; and 8Chiang Mai Univ, Thailand
Background: HIV infection by itself can
modify lipid metabolism. Since dyslipidemia has also been associated with long
term antiretroviral therapy (ART), we investigated lipid changes in HIV-1
infected children over the first 2 years of ART.
Methods: We analyzed data from all children ≥5
years old who started EFV or NVP (+ZDV or D4T and 3TC) between 2003 and 2007 in
the PHPT pediatric prospective cohort and had baseline lipid data. Following
ATP III classification, random total cholesterol was defined as high if 200
mg/dL and triglycerides if ≥150 mg/dL. Baseline factors were categorized
according to the median and tested for association with high lipid values
(Fisher test). Multivariate analysis used logistic regression models.
Results: The baseline characteristics of the 150
children (52% males) included were: median (IQR) age 9.1 years (7.1 to 10.8),
Thai norms based height for age Z-score (HAZ) -2.3 (-3.1 to -1.4), weight for
age (WAZ) -1.2 (-1.6 to -0.8), weight for height -.6 (-1.1 to .1), CD4 3%
(1%-10%), HIV RNA 5.0 log10 copies/mL (4.4 to 5.3), hemoglobin 10.9
g/dL (9.8 to 11.8), ALT 28 IU (19-44), random glucose 81 mg/dL (74 to 87),
cholesterol 130 mg/dL (106 to 154) and triglycerides 125 mg/dL (IQR 85-179). In
univariate analysis, at baseline, high cholesterol (5% of children) was
associated with HIV RNA below median (P =0.01); high triglycerides
(36% of children) with female sex (P=.04) and age above median (P =0.002).
The choice of initial EFV or NVP was independent from baseline cholesterol
(P=1.0) or triglycerides (P=0.59). Eight children (5%) died and 17 (11%)
dropped out, with no differences between treatment groups. After 6, 12, 18, and
24 months, median cholesterol was 160, 169, 176, 175 mg/dL, high in 24%, 22%,
27%, and 25% of the children; and median triglycerides were 113, 114, 115 and
110 mg/dL, high in 25%, 28%, 30% and 35%, respectively. In the univariate
analysis, there were no associations between the risks of high cholesterol or
triglycerides after 24 months of therapy and the treatment group (EFV or NVP)
(P=0.82 and P=0.84).The multivariate analysis adjusting for age, sex, and viral
load and high baseline value confirmed this finding (P=0.77 and P=0.39).
Conclusions: A significant proportion of these
children had high triglycerides before ART initiation and this proportion
remained stable over 24 months of treatment. High cholesterol was rare but
became more prevalent on treatment. This was irrespective of the use of either
nevirapine or efavirenz.
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