+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

High Prevalence of Dyslipidemia and Insulin Resistance in HIV-infected Prepubertal African Children on Antiretroviral Therapy

High Prevalence of Dyslipidemia and Insulin Resistance in HIV-infected Prepubertal African Children on Antiretroviral Therapy

Pediatric Infectious Disease Journal 35(1): E1-E7

Data describing the true extent of antiretroviral therapy (ART)-induced dyslipidemia and insulin resistance in perinatally infected children on ART in Africa are sparse. Fasting total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides, insulin and glucose were performed on the first 100 of 190 pediatric ART clinic attendees. Diet assessment was performed by a trained dietician. Lipoatrophy was formally graded by consensus between 2 expert HIV pediatricians. Durations of previous ART exposures, clinical stage, pre-ART viral load, nadir and current CD4 were recorded. Dual-energy X-ray absorptiometry was performed on a subset of 42 patients selected semi-randomly. Prevalences of insulin resistance, abnormal total cholesterol, LDL, HDL and triglyceride were 10%, 13%, 12%, 13% and 9%, respectively. Overall, 40% had at least 1 lipid abnormality or insulin resistance. Adjusted mean LDL cholesterol increased by 0.24 mmol/L for each additional year of cumulative lopinavir/r exposure (P = 0.03) after correcting for age, gender, body mass index, previous stavudine exposure, age at ART initiation, dietary fat and refined carbohydrate, whereas adjusted mean LDL cholesterol was 0.9 mmol/L higher in children exposed to efavirenz within the previous 6 months (P = 0.02). Adjusting for age, gender and ethnicity, dual-energy X-ray absorptiometry revealed that greater trunk fat and lower peripheral subcutaneous fat were associated with elevated triglycerides but not with total cholesterol, LDL, HDL or homeostatic model assessment. Similarly, the presence of visually obvious lipoatrophy was associated with elevated triglycerides but not with total cholesterol, LDL, HDL, homeostatic model assessment or lactate. Prevalences of insulin resistance and dyslipidemia were high. Cumulative lopinavir is an independent risk factor for dyslipidemia, with efavirenz exposure having only transitory effect.

Please choose payment method:

(PDF emailed within 0-6 h: $19.90)

Accession: 057987710

Download citation: RISBibTeXText

PMID: 26421804

DOI: 10.1097/inf.0000000000000927

Related references

High prevalence of antiretroviral drug resistance mutations in HIV-1 non-B subtype strains from African children receiving antiretroviral therapy regimen according to the 2006 revised WHO recommendations. Journal of Acquired Immune Deficiency Syndromes 49(5): 566-569, 2009

High Prevalence of Lipid Abnormalities and Insulin Resistance Among Antiretroviral Naïve HIV-infected Children in India. Pediatric Infectious Disease Journal 37(3): 253-257, 2017

Lack of association between dyslipidemia and insulin resistance in HIV-infected persons treated with highly active antiretroviral therapy. Nutrition 20(11-12): 1022-1025, 2004

Low prevalence of insulin resistance among HIV-infected children receiving nonnucleoside reverse transcriptase inhibitor-based highly active antiretroviral therapy in Thailand. HIV Medicine 10(2): 72-78, 2008

Serum retinol-binding protein 4 correlates with obesity, insulin resistance, and dyslipidemia in HIV-infected subjects receiving highly active antiretroviral therapy. Metabolism: Clinical and Experimental 58(11): 1523-1529, 2009

Prevalence of lipodystrophy and metabolic abnormalities in HIV-infected African children after 3 years on first-line antiretroviral therapy. Pediatric Infectious Disease Journal 34(2): E23-E31, 2015

Prevalence of antiretroviral drug resistance and resistance-associated mutations in antiretroviral therapy-naïve HIV-infected individuals from 40 United States cities. HIV Clinical Trials 8(1): 1-8, 2007

Community-onset Staphylococcus aureus bacteraemia in hospitalised African children: high incidence in HIV-infected children and high prevalence of multidrug resistance. Paediatrics and International Child Health 32(3): 140-146, 2013

High prevalence of non-adherence to antiretroviral therapy among undisclosed HIV-infected children in Ghana. Aids Care 31(1): 25-34, 2018

Prevalence of antiretroviral drug resistance mutations in chronically HIV-infected, treatment-naive patients: implications for routine resistance screening before initiation of antiretroviral therapy. Clinical Infectious Diseases 40(3): 468-474, 2005

Tuberculosis incidence is high in HIV-infected African children but is reduced by co-trimoxazole and time on antiretroviral therapy. Bmc Medicine 14: 50, 2016

High prevalence of echocardiographic abnormalities in older HIV-infected children taking antiretroviral therapy. Aids 32(18): 2739-2748, 2018

High prevalence of primary antiretroviral resistance among HIV-1-infected adults and children in Bahia, a northeast state of Brazil. Journal of Acquired Immune Deficiency Syndromes 45(2): 251-253, 2007

Dyslipidemia in HIV Infected Children Receiving Highly Active Antiretroviral Therapy. Indian Journal of Pediatrics 83(3): 226-231, 2017

Short communication: The relationship between mitochondrial dysfunction and insulin resistance in HIV-infected children receiving antiretroviral therapy. Aids Research and Human Retroviruses 29(9): 1211-1217, 2014