Hypercholesterolemia evident in children treated with protease inhibitors

מתוך medicontext.co.il
WESTPORT, CT (Reuters Health) – Many HIV-infected children being treated with a protease inhibitor (PI) develop elevated levels of total cholesterol, according to results of a cross-sectional cohort study conducted in Seattle.

Dr. Ann J. Melvin and colleagues from the University of Washington evaluated measures of metabolism in 23 children treated with antiretroviral therapy that included a PI for at least 6 months and 12 children treated with nucleoside reverse transcriptase inhibitors only.

Total cholesterol, LDL cholesterol, and apolipoprotein B levels were significantly higher in patients treated with PIs than in their counterparts, the investigators report in AIDS Research and Human Retroviruses for August 10. Total cholesterol levels were above the 95th percentile for age in 15 PI-treated children versus 0 controls (p = 0.001). The corresponding figures for triglyceride levels were 10 and 1 (p = 0.06).

Mean insulin and glucose levels were similar between the two groups, while controls tended to have increased total body fat and body mass index. The investigators attribute this finding to more advanced HIV disease in children using PIs. Abdominal fat in children treated with PIs was not increased.

Dr. Melvin's group notes that only one patient, an 18-year-old girl who had been using a PI for 36 months, exhibited all three components of the PI metabolic syndrome: hypertriglyceridemia, insulin resistance, and abnormal body composition.

Dr. Melvin reflected on this finding, telling Reuters Health, "There may be something that happens at puberty that is different. It's been shown that puberty has an effect in some of the familial lipodystrophic syndromes, so perhaps the same mechanisms are involved here."

She noted that the medical community struggles with question of how to monitor and treat children taking protease inhibitors. "Even when they're on PIs, these children don't tend to grow really well, so the idea of low-fat diets and dietary modification is difficult," she said. Of particular concern, she added, is the fact that many of the PIs need to be taken with a high-fat meal to be adequately absorbed.

"We need more information about what these moderately elevated cholesterol and triglyceride levels mean for these kids," she concluded.

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