Metabolic abnormalities in HIV type 1-infected children treated and not treated with protease inhibitors

Our objective was to determine whether HIV-infected children treated with p rotease inhibitors (PIs) have different blood lipid, insulin, and glucose l evels and body composition than HIV-infected children not treated with Pts. A cross-sectional cohort study was performed; in which 23 children were tr eated with combination antiretroviral. therapy including a PI for at least 6 months and 12 children were treated with nucleoside reverse transcriptase inhibitors only (no-PI group). Levels of lipids, apolipoprotein B (apoB), insulin, and glucose were determined in the fasting state. Body composition and fat distribution were determined by anthropometric measurements and du al energy X-ray absorptiometry (DEXA) scan. Total cholesterol levels were h igher in the PI-treated children (5.33 +/- 0.87 mM) than in the no-PI child ren (3.69 +/- 0.59 mM) (p < 0.0001). Similarly, low-density lipoprotein (LD L) levels were also elevated in the PI-treated children (3.27 +/- 0.76 vs. 2.14 +/- 0.51 mM) (p < 0.0001). ApoB and high-density lipoprotein (HDL), an d to a lesser degree triglyceride levels, were also increased in the PI-tre ated children. Apart from percent arm fat as measured by DEXA, there were n o differences between the two groups in measures of body composition or in their fasting glucose and insulin levels. The results from this cross-secti onal cohort study suggest that the predominant lipid abnormalities associat ed with treatment with combination antiretroviral therapy including a PI in HIV-1-infected children are elevated total and LDL cholesterol.