Format

Send to

Choose Destination
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.

Author information

1
Department of Obstetrics, Gynecology and Reproductive Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
2
Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
3
Department of Epidemiology, Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
4
Department of Pediatrics, University of Miami, Miami, FL, USA.
5
Keck School of Medicine of USC, The Saban Research Institute of Children's Hospital Los Angeles, Los Angeles, CA, USA.
6
Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
7
Department of Pediatrics, University of Florida College of Medicine, Jacksonville, FL, USA.
8
Department of Pediatrics, Drexel University College of Medicine, Philadelphia, PA, USA.
9
Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA, USA.
10
Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.

Abstract

OBJECTIVES:

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.

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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.

KEYWORDS:

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

Supplemental Content

Full text links

Icon for Wiley Icon for PubMed Central
Loading ...
Support Center