Sarah M Ramteke1, Stephanie Shiau1,2,3,4, Marc Foca5, Renate Strehlau3,4, Francoise Pinillos3,4, Faeezah Patel3,4, Avy Violari6, Afaaf Liberty6, Ashraf Coovadia3,4, Louise Kuhn1,2,3,4, Stephen M Arpadi1,2,3,4,5,6. 1. Gertrude H. Sergievsky Center, Columbia University, New York. 2. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York. 3. Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Johannesburg, South Africa. 4. Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. 5. Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York. 6. Perinatal HIV Research Unit, Chris Hani Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa.
Abstract
BACKGROUND: Prior research in sub-Saharan Africa reports dyslipidemia in perinatally human immunodeficiency virus (HIV)-infected children receiving ritonavir-boosted lopinavir (LPV/r) compared with efavirenz; however, interpretation of findings is limited by lack of comparison data from HIV-uninfected children. METHODS: We conducted a cross-sectional analysis of lipid profiles and growth within a larger longitudinal cohort study of perinatally HIV-infected and HIV-uninfected children aged 4-9 years in Johannesburg, South Africa. At enrollment, anthropometrics, viral load, CD4, total cholesterol (TC), high-density lipoprotein, low-density lipoprotein (LDL), and triglycerides were measured. Weight-for-age Z-score (WAZ), height-for-age Z-score (HAZ), and body mass index-for-age Z-score (BAZ) were calculated. United States pediatric thresholds for dyslipidemia were used. RESULTS: Five hundred fifty-three HIV-infected and 300 HIV-uninfected children (median age 6.9 years) of similar demographic characteristics were enrolled. Of the HIV-infected children, 94.8% were on combination antiretroviral therapy (cART) (65.4% on LPV/r- and 28.6% on efavirenz-based regimens). Among the treated, 94.3% had a viral load <200 copies/mL. Median CD4% was 34.4. The HIV-infected children had lower mean WAZ (-0.7 vs -0.3, P < .01) and HAZ (-1.1 vs -0.7, P < .01) compared with HIV-uninfected children. A lower proportion of HIV-infected children were overweight (BAZ >1) compared with HIV-uninfected children (14.4% vs 21.7%, P = .04). Whether on LPV/r or efavirenz, a higher proportion of HIV-infected children had borderline/elevated TC or abnormal triglycerides than HIV-uninfected children, although a higher proportion of those on LPV/r had borderline/elevated TC, borderline/elevated LDL, or abnormal triglycerides than those on efavirenz. CONCLUSIONS: In a South African cohort of HIV-infected children and population-appropriate HIV-uninfected children, unfavorable alterations in lipid profiles were detected in HIV-infected children regardless of treatment regimen compared with HIV-uninfected children. The HIV-infected children were of smaller size than HIV-uninfected children, but there was a high prevalence of overweight in both groups. Strategies for optimizing growth and early life management of lipid alterations may be warranted.
BACKGROUND: Prior research in sub-Saharan Africa reports dyslipidemia in perinatally human immunodeficiency virus (HIV)-infected children receiving ritonavir-boosted lopinavir (LPV/r) compared with efavirenz; however, interpretation of findings is limited by lack of comparison data from HIV-uninfected children. METHODS: We conducted a cross-sectional analysis of lipid profiles and growth within a larger longitudinal cohort study of perinatally HIV-infected and HIV-uninfected children aged 4-9 years in Johannesburg, South Africa. At enrollment, anthropometrics, viral load, CD4, total cholesterol (TC), high-density lipoprotein, low-density lipoprotein (LDL), and triglycerides were measured. Weight-for-age Z-score (WAZ), height-for-age Z-score (HAZ), and body mass index-for-age Z-score (BAZ) were calculated. United States pediatric thresholds for dyslipidemia were used. RESULTS: Five hundred fifty-three HIV-infected and 300 HIV-uninfected children (median age 6.9 years) of similar demographic characteristics were enrolled. Of the HIV-infected children, 94.8% were on combination antiretroviral therapy (cART) (65.4% on LPV/r- and 28.6% on efavirenz-based regimens). Among the treated, 94.3% had a viral load <200 copies/mL. Median CD4% was 34.4. The HIV-infected children had lower mean WAZ (-0.7 vs -0.3, P < .01) and HAZ (-1.1 vs -0.7, P < .01) compared with HIV-uninfected children. A lower proportion of HIV-infected children were overweight (BAZ >1) compared with HIV-uninfected children (14.4% vs 21.7%, P = .04). Whether on LPV/r or efavirenz, a higher proportion of HIV-infected children had borderline/elevated TC or abnormal triglycerides than HIV-uninfected children, although a higher proportion of those on LPV/r had borderline/elevated TC, borderline/elevated LDL, or abnormal triglycerides than those on efavirenz. CONCLUSIONS: In a South African cohort of HIV-infected children and population-appropriate HIV-uninfected children, unfavorable alterations in lipid profiles were detected in HIV-infected children regardless of treatment regimen compared with HIV-uninfected children. The HIV-infected children were of smaller size than HIV-uninfected children, but there was a high prevalence of overweight in both groups. Strategies for optimizing growth and early life management of lipid alterations may be warranted.
Authors: Mary-Ann Davies; Olivia Keiser; Karl Technau; Brian Eley; Helena Rabie; Gilles van Cutsem; Janet Giddy; Robin Wood; Andrew Boulle; Matthias Egger; Harry Moultrie Journal: S Afr Med J Date: 2009-10
Authors: Matthew S Freiberg; Chung-Chou H Chang; Lewis H Kuller; Melissa Skanderson; Elliott Lowy; Kevin L Kraemer; Adeel A Butt; Matthew Bidwell Goetz; David Leaf; Kris Ann Oursler; David Rimland; Maria Rodriguez Barradas; Sheldon Brown; Cynthia Gibert; Kathy McGinnis; Kristina Crothers; Jason Sico; Heidi Crane; Alberta Warner; Stephen Gottlieb; John Gottdiener; Russell P Tracy; Matthew Budoff; Courtney Watson; Kaku A Armah; Donna Doebler; Kendall Bryant; Amy C Justice Journal: JAMA Intern Med Date: 2013-04-22 Impact factor: 21.873
Authors: Kunjal Patel; Jiajia Wang; Denise L Jacobson; Steven E Lipshultz; David C Landy; Mitchell E Geffner; Linda A Dimeglio; George R Seage; Paige L Williams; Russell B Van Dyke; George K Siberry; William T Shearer; Luciana Young; Gwendolyn B Scott; James D Wilkinson; Stacy D Fisher; Thomas J Starc; Tracie L Miller Journal: Circulation Date: 2013-12-23 Impact factor: 29.690
Authors: Stephanie Shiau; Stephen M Arpadi; Megan Burke; Afaaf Liberty; Cara Thurman; Faeezah Patel; Renate Strehlau; Elaine J Abrams; Ashraf Coovadia; Avy Violari; Louise Kuhn Journal: AIDS Care Date: 2019-07-09
Authors: Melody Wu; Stephanie Shiau; Renate Strehlau; Afaaf Liberty; Faeezah Patel; Megan Burke; Pamela M Murnane; Avy Violari; Michael T Yin; Elaine J Abrams; Louise Kuhn; Stephen Arpadi Journal: AIDS Care Date: 2021-12-21
Authors: Avy Violari; Mark F Cotton; Louise Kuhn; Diana B Schramm; Maria Paximadis; Shayne Loubser; Sharon Shalekoff; Bianca Da Costa Dias; Kennedy Otwombe; Afaaf Liberty; James McIntyre; Abdel Babiker; Diana Gibb; Caroline T Tiemessen Journal: Nat Commun Date: 2019-01-24 Impact factor: 14.919