Skip Navigation LinksHome > July 2013 - Volume 32 - Issue 7 > Lipid Changes in Kenyan HIV-1–infected Infants Initiating Hi...
Pediatric Infectious Disease Journal:
doi: 10.1097/INF.0b013e31828afb2a
HIV Reports

Lipid Changes in Kenyan HIV-1–infected Infants Initiating Highly Active Antiretroviral Therapy by 1 Year of Age

Langat, Agnes MB ChB, MPH, MMed Paed*; Benki-Nugent, Sarah MS, PhD; Wamalwa, Dalton MB ChB, MPH, MMed Paed*; Tapia, Ken MS§; Ngugi, Evelyn MB ChB*; Diener, Lara MPH§; Richardson, Barbra A. PhD‡§‖; Melvin, Ann MD, MPH; John-Stewart, Grace C. MD, PhD§

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Abstract

Background: Early highly active antiretroviral therapy (HAART) is recommended for HIV-1–infected infants. There are limited data on lipid changes during infant HAART.

Methods: Nonfasting total (TC), low density lipoprotein (LDL) and high density lipoprotein (HDL) cholesterol and triglycerides (TG) were measured at 0, 6 and 12 months. Correlates of lipid levels and changes post-HAART were assessed using linear regression.

Results: Among 115 infants, pre-HAART median age was 3.8 months, CD4% was 19% and weight-for-age Z score was –2.42. Pre-HAART median lipid levels were: TC, 108.7 mg/dL; LDL, 42.5 mg/dL; HDL, 29.4 mg/dL and TG, 186.9 mg/dL. Few infants had abnormally high TC (6.2%) or LDL (5.6%), but many had low HDL (76.5%) or high TG (69.6%). Higher pre-HAART weight-for-age and height-for-age Z scores were each associated with higher pre-HAART TC (P = 0.04 and P = 0.01) and LDL (P = 0.02 and P = 0.008). From 0 to 6 months post-HAART, TC (P < 0.0001), LDL (P < 0.0001) and HDL (P < 0.0001) increased significantly, and 23.1% (P = 0.002), 14.0% (P = 0.2), 31.3% (P < 0.0001) and 50.8% (P = 0.2) of infants had abnormally high TC, high LDL, low HDL and high TG, respectively. Changes in TC and HDL were each associated with higher gain in weight-for-age Z score (P = 0.03 and P = 0.01) and height-for-age Z score (P = 0.01 and P = 0.007). Increased change in LDL was associated with higher gain in height-for-age Z score (P = 0.03). Infants on protease inhibitor–HAART had smaller HDL increase (P = 0.004).

Conclusions: Infants had substantive increases in lipids, which correlated with growth. Increases in HDL were attenuated by protease inhibitor–HAART. It is important to determine clinical implications of these changes.

© 2013 by Lippincott Williams & Wilkins, Inc.

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