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Metabolic effects of initiating lopinavir/ritonavir-based regimens among young children

Patel, Kunjala,b; Lindsey, Janeb; Angelidou, Konstantiab; Aldrovandi, Gracec; Palumbo, Pauld for the IMPAACT P1060 Study Team

doi: 10.1097/QAD.0000000000001980
CLINICAL SCIENCE
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Objective: The aim of this study was to estimate the long-term metabolic effects of initiating a lopinavir/ritonavir (LPV/r)-based regimen as a first-line therapy for HIV-infected children less than 3 years of age in resource-limited settings.

Design: A prospective cohort study after conclusion of the P1060 randomized clinical trials (ClinicalTrials.gov Identifier: NCT00307151), with an overall follow-up of 7 years.

Methods: Longitudinal total cholesterol and triglyceride measures were compared between 222 and 227 children randomized to initiate LPV/r and nevirapine (NVP)-based regimens, respectively. Adipokines (adiponectin and leptin) and biomarkers of inflammation [C-reactive protein and interleukin (IL)-6], microbial translocation (lipopolysaccharide) and immune activation (sCD14), measured in 117 participants at a median of 45 weeks of follow-up, were also compared by a randomized arm.

Results: Mean total cholesterol and the percentage of participants with borderline or high total cholesterol was higher in the LPV/r arm from years 3 to 7 of follow-up than in the NVP arm (adjusted relative differences ranging from 10.9 to 23.4 mg/dl and adjusted relative risks ranging from a 60% increased risk to a more than four-fold increased risk for cholesterol ≥170 mg/dl at 7 years of follow-up). Initiation of a LPV/r-based regimen was not associated with high triglycerides over follow-up or large differences in markers of metabolic syndrome, inflammation, microbial translocation or immune activation.

Conclusion: Given the virologic superiority of LPV/r-based regimens in young children and open questions regarding the roll-out of dolutegravir in resource-limited settings, children are currently being maintained on LPV/r-based regimens. Our results suggest continual assessment of total cholesterol among young children initiating a LPV/r-based regimen to monitor cardiometabolic health.

aDepartment of Epidemiology, Harvard T.H. Chan School of Public Health, Boston MA

bCenter for Biostatistics in AIDS Research (CBAR), Boston, Massachusetts

cDepartment of Pediatrics, University of California, Los Angeles, California

dDivision of Infectious Diseases and International Health, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.

Correspondence to Kunjal Patel, Department of Epidemiology, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA. Tel: +1 617 432 3174; e-mail: kpatel@hsph.harvard.edu

Received 2 May, 2018

Accepted 28 June, 2018

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Copyright © 2018 Wolters Kluwer Health, Inc.