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HIV Med. 2018 Mar;19(3):175-183. doi: 10.1111/hiv.12566. Epub 2017 Nov 21.

Improvement in lipids after switch to boosted atazanavir or darunavir in children/adolescents with perinatally acquired HIV on older protease inhibitors: results from the Pediatric HIV/AIDS Cohort Study.

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Department of Obstetrics, Gynecology and Reproductive Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
Department of Epidemiology, Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
Department of Pediatrics, University of Miami, Miami, FL, USA.
Keck School of Medicine of USC, The Saban Research Institute of Children's Hospital Los Angeles, Los Angeles, CA, USA.
Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
Department of Pediatrics, University of Florida College of Medicine, Jacksonville, FL, USA.
Department of Pediatrics, Drexel University College of Medicine, Philadelphia, PA, USA.
Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA, USA.
Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.



Dyslipidaemia is common in perinatally HIV-infected (PHIV) youth receiving protease inhibitors (PIs). Few studies have evaluated longitudinal lipid changes in PHIV youth after switch to newer PIs.


We compared longitudinal changes in fasting lipids [total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and TC:HDL-C ratio] in PHIV youth enrolled in the Pediatric HIV/AIDS Cohort Study (PHACS) Adolescent Master Protocol (AMP) study who switched to atazanavir/ritonavir (ATV/r)- or darunavir/ritonavir (DRV/r)-based antiretroviral therapy (ART) from an older PI-based ART and those remaining on an older PI. Generalized estimating equation models were fitted to assess the association of a switch to ATV/r- or DRV/r-based ART with the rate of change in lipids, adjusted for potential confounders.


From 2007 to 2014, 47 PHIV children/adolescents switched to ATV/r or DRV/r, while 120 remained on an older PI [primarily lopinavir/r (72%) and nelfinavir (24%)]. Baseline age ranged from 7 to 21 years. After adjustment for age, Tanner stage, race/ethnicity, and HIV RNA level, a switch to ATV/r or DRV/r was associated with a more rapid annual rate of decline in the ratio of TC:HDL-C. (β = -0.12; P = 0.039) than remaining on an older PI. On average, TC declined by 4.57 mg/dL/year (P = 0.057) more in the switch group. A switch to ATV/r or DRV/r was not associated with the rate of HDL-C, LDL-C, or TG change.


A switch to ATV/r or DRV/r may result in more rapid reduction in TC and the TC:HDL-C ratio in PHIV youth, potentially impacting long-term cardiovascular disease risk.


atazanavir; children; darunavir; lipids; longitudinal; perinatally HIV-infected

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