Dyslipidaemia Among Children Living with HIV after 48 Weeks of First-line Antiretroviral Therapy

Abstract

Background Antiretroviral therapy (ART) associated dyslipidaemia has been reported among children living with HIV (CLHIV) in both developed and developing countries. Not much data is available on changes in blood lipid profile among CLHIV on first-line ART in India. Aims: To study the changes in the Lipid profile among CLHIVs, 12 months after initiating a non-nucleoside reverse transcriptase inhibitor-based (NNRTI) ARTMethods A prospective multicentric study enrolled HIV infected children, between 2-12 years of age, initiating NNRTI-based ART in south India. Clinical details, anthropometry and fasting blood for estimating serum total cholesterol (TC), triglyceride (TGL), high-density cholesterol (HDL-c), low-density cholesterol (LDL-c), plasma viral load and CD4 cell counts was collected. These measurements were repeated at 6th and 12th month after ART initiation. Proportion of children with abnormal lipid profile at baseline and 12 months after ART were compared using McNemar test. Generalized linear model was applied to predict factors associated with changes in serum lipid levels 12 months post-ART.ResultsOf the 393 HIV-infected children, 66 % received Zidovudine and 14 % Stavudine in their ART regimen. After 12 months of ART, TC, LDL-c and HDL-c increased from baseline by a mean of 31mg/dL, 13.7 mg/dL and 19mg/dl, respectively. TC/HDL-c ratio decreased from a mean of 5.1 to 3.5 (all changes, P <0.000). At baseline and 12 months, respectively, TC was >200 mg/dL for 3% and 13% of patients, LDL-c was >130 mg/dL for 5% and 8%, HDL-c was <35 mg/dL for 70% and 16%, and TG were >150 mg/dL for 38% and 24%. Baseline HIV viral load >400 copies/mL (P, 0.01) was associated with increase in HDL-c and lower TG levels (P, 0.008). Baseline CD4 % <15 and younger age group were significantly associated with increase in TC (P, 0.02) and decrease in TGL (P,0.02) after 12-months of ART.Conclusion Significant changes in serum lipid profile occurs early in children started on first-line ART. Increase in the cardio protective HDL-c was proportionally greater than increases in TC or TGL. Regular monitoring of lipid levels will help in early identification of metabolic complications of ARTDisclosures All authors: No reported disclosures.