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Changes in lipid profiles after switching young children from a suppressive lopinavir/ritonavir-based regimen to a nevirapine-based regimen
Presented by Renate Strehlau (South Africa).
R. Strehlau1, A. Coovadia1, L. Martens1, T. Meyers2, G. Sherman3, E. Abrams4, L. Kuhn5
1WITS ECHO, Rahima Moosa Mother and Child Hospital (previously Coronation Hospital), Pediatrics, Johannesburg, South Africa, 2WITS ECHO, Harriet Shezi Pediatric Clinic, Chris Hani Baragwanath Hospital, Pediatrics, Johannesburg, South Africa, 3WITS ECHO, Department of Haematology, University of Witwatersrand, Haematology, Johannesburg, South Africa, 4College of Physicians and Surgeons, Columbia University Mailman School of Public Health, International Center of AIDS Care and Treatment Programs, New York, United States, 5Gertrude H. Sergievsky Center, Mailman School of Public health, Columbia University, Epidemiology, New York, United States
Background: Antiretroviral therapy (ART) has been associated with dyslipidaemia in HIV-infected children. We aimed to evaluate whether switching young HIV-infected children from a suppressive lopinavir/ritonavir (LPV/r)-based regimen to a nevirapine-based regimen, would influence their lipid profiles.
Methods: As part of a clinical trial in Johannesburg, South Africa, 151 HIV-infected children who had initiated ART at < 24 months of age, and achieved viral suppression (HIV RNA < 400 copies/ml), were randomized to either remain on their initial regimen of LPV/r, stavudine and lamivudine (n=74) or to switch to nevirapine, stavudine and lamivudine (n=77). Non-fasting lipograms, including total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL) and triglycerides (TG) were measured before ART initiation, at the time of randomization and nine months after regimen change. Differences in lipid profiles between the two groups were examined.
Results: The mean time on ART before randomization was 9.4 months (range 5.9 - 14.5 months), average age at randomization was 20 months and 51.7% were male. TC, LDL and HDL levels increased after initiation of ART and TG levels decreased. At randomization, lipid profiles between the two groups showed no significant differences. Nine months after regimen change, TC and HDL were significantly higher among children switched to the nevirapine-based regimen (mean TC 4.13, HDL 1.36mmol/l) compared with those remaining on the LPV/r-based regimen (mean TC 3.73, HDL 1.07mmol/l). Significantly lower TG levels were found if switched to nevirapine-based therapy (mean TG 1.36mmol/l) than if retained on the LPV/r-based regimen (mean TG 1.53mmol/l).
Conclusion: Switching from a LPV/r-based to a nevirapine-based regimen resulted in measurable changes in the lipid profile of HIV-infected children starting therapy at a young age. The clinical significance of these non-fasting lipid changes requires further investigation.
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