Incidence and Risk Factors of Dyslipidemia in HIV-Infected Children Receiving Antiretroviral Therapy

  • รุจนี สุนทรขจิต Bamrasnaradura Infectious Diseases Institute, Department of Disease Control, Ministry of Public Health
  • ดวงมณี สุวรรณมาศ Bamrasnaradura Infectious Diseases Institute
  • รัชนี เชื้อเทศ Bamrasnaradura Infectious Disease Institute
  • บุษกร สันติสุขลาภผล Bamrasnaradura Infectious Diseases Institute, Department of Disease Control, Ministry of Public Health
  • นฤภัค บุญญฤทธิภัทร์ Bamrasnaradura Infectious Diseases Institute, Department of Disease Control, Ministry of Public Health
Keywords: Dyslipidemia, children wuth HIV infection, Protease inhibitor


This study aimed to evaluate the incidence and associated risk factors of dyslipidemia in HIV- infected children receiving protease inhibitor (PI) based regimens and the first-line regimen (2NRTIs/NNRTI). One hundred and forty HIV-infected children receiving antiretroviral therapy were enrolled and followed up for 12 months. Seventy-two children received PI based regimens in the form of boosted PI and 68 received 2NRTIs/NNRTI regimens. The mean of age onsets of current regimens in PI based group was higher than 2NRTIs/NNRTI group because all children in PI group had treatment failure from the first-line regimens. The definition for hypercholesterolemia and hypertriglyceridemia were higher than 200 mg/dl and 150mg/ dl respectively. The results showed that children on PI based regimens had risk to develop dyslipidemia nearly 9 times greater than 2NRTIs/NNRTI regimens (RR=8.88, 95%CI 4.059-19.428, P<0.01), 61.1% met criteria for hypercholesterolemia ( mean cholesterol level 220.56 ± 6.61 mg/dl) and 72.2% for hypertriglyceridemia (mean triglyceride level 255.53 ± 17.48 mg/dl ), these were significantly higher than 2NRTIs/NNRTI regimens( 25.0% for hypercholesterolemia , mean cholesterol level 184.24 ± 3.96 mg/dl and 16.2% for hypertriglyceridemia (mean triglyceride level 115.0 ± 7.67 mg/dl , P<0.01). Body mass undex (BMI) before receiving the current regimens and viral load <50 copies/ml were significantly associated with dyslipidemia. In this study, the children receiving double boosted PI regimens had no significantly higher incidence of hyperlipidemia than single boosted PI regimens. The treatment of HIV-infected children with boosted PI should be concerned for long-term complications of dyslipidemia.


Download data is not yet available.


1. Pujari SN, Dravid A, Naik E,Bhagat S,Tash K, Nadler JP, et al. Lipodystrophy and dyslipidemia among patients taking first-line, World Health Organization-recommended highly active antiretroviral therapy regimens in Western India. J Acquir Immune Defic Syndr. 2005; 39(2): 199-202

2 Chuapai Y, Kiertiburanakul S, Malathum K, Sungkanuparph S. Lipodystrophy and dyslipidemia in human immunodeficiency virus-infected Thai patients receiving antiretroviral therapy. J Med Assoc Thai. 2007; 90(3): 452-8

3. Manuthu EM, Joshi MD, Lule GN, Karari E.Prevalence of dyslipidemia and dysglycaemia in HIV infected patients. East Afr Med J. 2008; 85(1): 10-7
4. Buchacz K, Weidle PJ, Moore D, Were W, Mermin J, Downing R, et al. Changes in lipid profile over 24 months among adults on firstline highly active antiretroviral therapy in the home-based AIDS care program in rural Uganda. J Acquir Immune Defic Syndr. 2008; 47(3): 304-11

5. Moyle GJ, Baldwin C. Lipid elevations during non-nucleoside RTI (NNRTI) therapy: a cross sectional analysis. Antiviral Ther 1999; 4: 58

6. Gallent JE, Staszewski S, Pozniak AL, DeJesus E, Suleiman J, Miller M, et al. Efficacy and safety of tenofovir DF vs stavudine in combination therapy in antiretroviral-naive patients. JAMA. 2004; 292: 191-201

7. Fontas E, van Leth F, Sabin CA, Friis-Moller N, Rickenbach M, d'Arminio A, et al. Lipid profiles in HIV-infected patients receiving combination antiretroviral therapy: are different antiretroviral drugs associated with different lipid profiles?. JID 2004; 189: 1056-74

8. Thiebaut R, Daucourt V, Mercie P, Ekouevi DK, Malvy D, Morlat P, et al. Lipodystrophy, metabolic disorders, and human immunodeficiency virus infection: Aquitaine Cohort, France,1999. Clin Infect Dis. 2000; 31: 1482-7

9. Hiransuthikul N, Hiransuthikul P, Kanasook Y. Lipid profiles of Thai adult HIV-infected patients receiving protease inhibitors. Southeast Asian J Trop Med Public Health. 2007; 38(1): 69-77

10. Anastos K, Lu D, Shi Q, Tien PC, Kaplan RC, Hessol NA, et al. Association of serum lipid levels with HIV serostatus, specific antiretroviral agents and treatment regimens. J Acquir Immune Defic Syndr. 2007;45(1): 34-42

11. Taylor P, Worrell C, Steinberg SM, Hazra R, Jankelevich S, Wood LV, et al. Natural history of lipid abnormalities and fat redistribution among human immunodeficiency virus-infected children receiving long-term, protease inhibi tor-containing, highly active antiretroviral therapy regimens. Pediatrics.2004; 114: e235-e242

12. Friis-Moller N, Weber R, Reiss P, thiebaut R, Kirek O, d'Arminio Monforte A, et al. Cardiovascular disease risk factors in HIV patientsassociation with antiretroviral therapy: result from DAD study. AIDS 2003; 17: 1179-93

13. Aurpibul L, Puthanakit T, Lee B, Mangklabruks A, Sirisanthana T, Sirisanthana V. Lipodystrophy and metabolic changes in HIV-infected children on non-nucleoside reverse transcriptase inhibitor-based antiretroviral therapy. Antivir
Ther.2007; 12(8): 1247-54
14. Lapphra K, Vanprapar N, Phongsamart W, Chearskul P, Chokephaibulkit K. Dyslipidemia and lipodystrophy in HIV-infected Thai children on highly active antiretroviral therapy (HAART). J Med Assoc Thai. 2005; 88(7): 956-66

15. Funk MB, Linde R, Wintergerst U, Notheis G, Hoffmann F, Schuster T, et al. Preliminary experiences with triple therapy including nelfinavir and two reverse transcriptase inhibitors in previously untreated HIV-infected children. AIDS. 1999; 13: 1653-8

16. Mueller BU, Nelson RP, Sleasman J, Zuckerman J, Chiozzi MH, Steinberg SM, et al. A phase I/II study of the protease inhibitor ritonavir in children with human immunodeficiency virus infection. Pediatrics. 1998; 101: 335-43

17. Nadal D, Steiner F, Cheseaux JJ, Wyler Lazarevitch A, Aebi C, Kind C, et al. Longterm responses to treatment including ritonavir or nelfinavir in HIV-1-infected children. Infection. 2000; 28: 287-96

18. Amaya RA, Kozinetz CA, McMeans A, Schwarzwald H, Kline MW. Lipodystrophy syndrome in human immunodeficiency virus-infected children. Pediatr Infect Dis J. 2002; 21: 405-10

19. Carter RJ, Wiener J, Abrams EJ, Farley J, Nesheim S, Palumbo P, et al. Dyslipidemia among perinatally HIV-infected children enrolled in the PACTS-HOPE cohort, 1999- 2004: A longitudinal analysis. J Acquir Immune Defic Syndr. 2006; 41: 453-60

20. Jaquet D, Levine M, Ortega-Rodriguez E, Faye A, Polak M, Vilmer E, et al. Clinical and metabolic presentation of lipodystrophy syndrome in HIV-infected children. AIDS. 2000; 14: 2123-8

21. Melvin AJ, Lennon S, Mohan KM, Purnell JQ. Metabolic abnormalities in HIV type 1-infected children treated and not treated with protease inhibitors. AIDS Research and Human Retroviruses. 2001; 17(12): 1117-23

22. European Paediatric Lipodystrophy Group. Antiretroviral therapy, fat redistribution and hyperlipidaemia in HIV-infected children in Europe. AIDS 2004; 18: 1443-51

23. Farley J, Gona P, Crain M, Cervia J, Oleske J, Seage G. et al. Prevalence of elevated cholesterol and associated risk factors among perinatally HIV-infected children (4-19 years old) in pediatric AIDS clinical trials group 219C. J Acquir Immune Defic Syndr 2005; 38(4): 480-7

24. Beregszaszi M, Dollfus C, Levine M, Faye A, Deghmoun S, Bellal N, et al. Longitudinal evaluation and risk factors of lipodystrophy and associated metabolic changes in HIV-infected children. J Acquir Immune Defic Syndr 2005; 40(2): 161-8

25. Lainka E, Oezbek S, Falck M, Ndagijimana J, Niehues T. Marked dyslipidemia in human immunodeficiency virus-infected children on protease inhibitor-containing antiretroviral therapy. Pediatrics 2002; 110(5): 1-7

26. Bitnun A, Sochett E, Babyn P, Holowka S, Stephens D, Read S, et al. Serum lipids, glucose homeostasis and abdominal adipose tissue distribution in protease inhibitor-treated and naive HIV-infected children. AIDS 2003; 17: 1319-27

27. Periard D, Telenti A, Sudre P, Cheseaux JJ, Halfon P, Reymond MJ, et al. Atherogenic dyslipidemia in HIV-infected individuals treated with protease inhibitors. The Swiss HIV Cohort Study. Circulation 1999; 100 :700-5

28. Cheseaux JJ, Jotterand V, Aebi C, Gnehm H, Kind C, Nadal D, et al. Hyperlipidemia in HIVinfected children treated with protease inhibitors: relevance for cardiovascular diseases. J Acquir Immune Defic Syndr. 2002; 30: 288-93
Original Article