Effects of highly active antiretroviral therapy (HAART) on cholesterol in HIV-1 infected children: a retrospective cohort study

Objective To determine the extent to which different highly active antiretroviral therapy (HAART) regimens pose risks for hypercholesterolemia in children with perinatal HIV-1. Methods A single center, retrospective cohort study examined different HAART regimens and total cholesterol (TC) levels. The primary outcomes were TC levels > 180, > 200 mg/dl. HAART was defined as multiple nucleoside analog reverse transcriptase inhibitors (NRTI), NRTI and protease inhibitor (PI) combinations (NRTI/PI), and NRTI and non-nucleoside analog reverse transcriptase inhibitor (NNRTI) combinations (NRTI/NNRTI). Controls were HIV-1 infected children while on no medications (No MED). Univariate and multivariable Cox regression models generated hazard ratios for each of the primary outcomes with duration of therapy in the model. Results Of the 178 HIV-1 infected children eligible for study, 72.4% had TC > 180 mg/dl, 53.4% had TC > 200 mg/dl. For TC > 200, the multivariable analysis showed increased risk with NRTI/NNRTI (HR: 1.86, 95%CI: 1.34-2.19) and NRTI/PI (HR: 3.45, 95%CI: 2.65-4.51) when compared to No MED. Compared to NRTI/NNRTI, NRTI/PI increased the risk for TC > 200 mg/dl (HR: 1.86, 95%CI: 1.45-2.39) in the multivariable model. Conclusions In vertically acquired HIV-1 infected children, HAART elevates the risk of hypercholesterolemia. NRTI/PI increased risk of TC levels threefold, while NRTI/NNRTI increased risk twofold over No MED. Copyright (C) 2009 John Wiley & Sons, Ltd.