Metabolic abnormalities in children treated and not treated with protease inhibitors

In a report published in AIDS Research Human Retroviruses (August 10th), Melvin and colleagues compared lipids, insulin and glucose levels and body composition in a group of children receiving with a protease inhibitor (PI) containing regimen to a group receiving nucleosides only in a cross sectional cohort study.

23 children were treated with PI containing antiretroviral therapy for at least six months and 12 children treated with nucleoside reverse transcriptase inhibitors only. Total cholesterol levels, low density lipoprotein (LDL), apolipoprotein B, high density lipoprotein (HDL) and to a lesser degree triglyceride levels were increased in the PI treated children compared to the control group. 15 PI treated children had total cholesterol levels above the 95th percentile for age compared to none of the control group (p=0.001).

No differences were reported between the two groups in measures of body composition (apart from percentage of arm fat) or fasting glucose and insulin levels.

The authors concluded that these findings suggest that the predominant lipid abnormalities associated with treatment with PI containing regimens in HIV-1 infected children are elevated total and LDL cholesterol.

Comment

The elevations seen in this small study were modest and did not warrant intervention with either modification of diet, antiretroviral regime or lipid lowering agents. Only one child had all three components of the metabolic syndrome (hypertiglyceridaemia, insulin resistance and lipodystrophy). She was a post-pubertal 18 year old, whose route of acquisition of HIV was unspecified. We need more data particularly on younger children with perinatally acquired infection, for whom chronic elevations in lipids from an early age may result in serious cardiovascular abnormalities. More data are also needed with regard to lipodystrophy, body image and teenage adherence on HAART. There are currently no paediatric guidelines for management of these problems.

Melvin AJ et al. Metabolic abnormalities in hiv type 1-infected children treated and not treated with protease inhibitors. AIDS Res Hum Retroviruses 2001 Aug 10;17(12):1117-23.
http://www.ncbi.nlm.nih.gov/pubmed/11522181?dopt=Abstract