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IAC: Dyslipidemia in Children Abated by Switched Regimens


TORONTO -- Increased cholesterol and triglycerides in HIV-infected children being treated with highly active antiretroviral therapy (HAART) can be markedly reduced by switching regimens, researchers reported here.

TORONTO, Aug. 14 -- Children treated for HIV infection are at increased risk of dyslipidemia, but a switch in regimens may dampen the impact of those metabolic changes.

In a mini-satellite symposium held in conjunction with the 16th International AIDS Conference, Alessandra Vigano, M.D., chief of pediatrics infectious disease at the University of Milan in Italy reviewed studies that involved long-term treatment of children with highly active antiretroviral therapy (HAART).

"This population is particularly vulnerable because children are growing and are likely to have long-term exposure to highly active antiretroviral therapy," Dr. Vigano said during the Bristol-Myers Squibb Canada-sponsored symposium, Metabolic Complications: New Insights and Evolving Management Strategies.

Various studies have shown that abnormalities in lipids occur 13% to 52% of the time in all patients taking combination antiretroviral therapy. Dr. Vigano suggested that these abnormalities occur more frequently in children with lipodystrophy and that the phenomenon is associated with protease inhibitors.

She cited one European study in which 280 children ages three to 18 underwent lipid testing. The median age of the children was nine. She said that study found that 27% of those children had hypercholesterolemia with levels of cholesterol greater than 200 mg/dl. She also said the study found that 21% of the children had elevated triglycerides, and 10% of them had both high cholesterol and high triglycerides.

In a study that Dr. Vigano reported in 2005, 14 children were switched from a regimen of Zerit (stavudine), Epivir (lamivudine), and a protease inhibitor to a new regimen of Viread (tenofovir), Epivir and Sustiva (efavirenz) in a 48-week randomized trial.

At the start of the trial nearly half the children were in the 95th percentile of cholesterol level. After 48 weeks, none of the children was in the 95th percentile. After 12 weeks on the new regimen, there were less than 10% of the children in the 95th percentile.

The story was similar for triglycerides with the percentage of children in the 95th percentile falling from 42% at baseline to less than 10% after 48 weeks.

In a 96-week study, 24 children were switched from Zerit to Viread and from a protease inhibitor to Sustiva. "Switching from Zerit to Viread was associated with restoration of physiological fat accrual and a lack of lipoatrophy progression." Dr. Vigano said.

"These changes may well yield possible positive effects on pubertal development, fertility, psychological wellness and normal lipid and glucose metabolism," she said.

While the studies indicate that treatment changes can alter unhealthy lipid abnormalities in children, Dr. Vigano noted that there has been little research on the subject. "Data on the long-term consequences of these metabolic complications are lacking," she said. "An important goal in treating pediatric HIV-infection will be to design drugs with fewer side effects or to better mange those of the current drugs."

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