High Prevalence of Dyslipidemia and Insulin Resistance in HIV-Infected Pre-Pubertal African Children on Antiretroviral Therapy

Data describing the true extent of antiretroviral therapy (ART)-induced dyslipidemia and insulin resistance in perinatally-infected children on ART in Africa is sparse.

Fasting total cholesterol, LDL, HDL, triglycerides, insulin and glucose were performed on the first 100, of 190 pediatric ART clinic attendees. Diet assessment was performed by a trained dietician. Lipoatrophy was formally graded by consensus between two expert HIV pediatricians. Durations of previous ART exposures, clinical stage, pre-ART viral load, nadir and current CD4 were recorded. Dual energy X-ray Absorptiometry (DEXA) was performed on a subset of 42 patients selected semi-randomly.

Prevalences of insulin resistance, abnormal total cholesterol, LDL, HDL and triglyceride were 10%, 13%, 12%, 13 % and 9% respectively. Overall, 40% had at least one lipid abnormality or insulin resistance. Adjusted mean LDL cholesterol increased by 0.24mmol/L for each additional year of cumulative lopinavir/r exposure (p=0.03) after correcting for age, gender, body mass index, previous stavudine exposure, age at ART initiation, dietary fat and refined carbohydrate, while adjusted mean LDL cholesterol was 0.9mmol/L higher in children exposed to efavirenz within the previous six months (p=0.02). Adjusting for age, gender and ethnicity, DEXA revealed that greater trunk fat and lower peripheral subcutaneous fat were associated with elevated triglycerides but not with total cholesterol, LDL, HDL or HOMA. Similarly, the presence of visually obvious lipoatrophy was associated with elevated triglycerides but not with total cholesterol, LDL, HDL, HOMA or lactate.

Prevalences of insulin resistance and dyslipidemia were high. Cumulative lopinovir is an independent risk factor for dyslipidemia, with efavirenz exposure having only transitory effect.

Via: http://goo.gl/O0d0rL  Purchase full article at: http://goo.gl/K81dAo

By: Innes S1, Abdullah KL, Haubrich R, Cotton MF, Browne SH.

• 1# Children's Infectious Disease Clinical Research Unit, Stellenbosch University and Tygerberg Children's Hospital, Cape Town, South Africa ^Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, Ca. 

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