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
Year: 2017
Type: article
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.
Source: HIV Medicine
DOI: 10.1111/hiv.12566
Authors: J Jao, W Yu, K Patel, TL Miller, B Karalius, ME Geffner, LA DiMeglio, A Mirza, JS Chen, M Silio, EJ McFarland, RB Van Dyke, D Jacobson, the Pediatric HIV/AIDS Cohort Study (PHACS) Adolescent Master Protocol (AMP) study
Institutions: Icahn School of Medicine at Mount Sinai, Harvard University, University of Miami, University of Southern California, Saban Research Institute, Indiana University School of Medicine, University of Florida, University of Florida Health Science Center, Drexel University, Tulane University, University of Colorado Anschutz
Language: English
Subfield: Emergency Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funders: Sanofi, Tulane University, International Maternal Pediatric Adolescent AIDS Clinical Trials Network, Centers for Disease Control and Prevention, National Institute on Alcohol Abuse and Alcoholism, National Heart, Lung, and Blood Institute, National Institute of Mental Health, National Institute on Drug Abuse, National Institute on Deafness and Other Communication Disorders, National Institute of Allergy and Infectious Diseases, National Institute of Neurological Disorders and Stroke, National Institute of Child Health and Human Development, National Institute of Dental and Craniofacial Research, Office of AIDS Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development
Awards: G1121950248, Metabolic Effects of In Utero Antiretrovirals on HIV Exposed Uninfected Infants, Pediatric HIV/AIDS Cohort Study (PHACS) Coordinating Center (CC) (U01), Pediatric HIV/AIDS Cohort Study (PHACS): Data and Operations Center (DOC)., G8582443069, The University of North Carolina Center for AIDS Research
OpenAlex ID: W2768544943