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Dyslipidemia and Lipodystrophy in HIV-Infected Thai Children on Highly Active Antiretroviral Therapy (HAART)


Keswadee Lapphra, MD*,
Niran Vanprapar, MD*, Wanatpreeya Phongsamart, MD*,
Pimpanada Chearskul, MD*, Kulkanya Chokephaibulkit, MD*

* Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University


Background: Previous cross sectional studies revealed that dyslipidemia occurs in 50-70% of children receiving highly active antiretroviral therapy (HAART). However, there is no information in children in developing countries where children may have a different nutritional status.
Objective: To evaluate the incidence and associated risk factors of dyslipidemia following HAART in HIV-infected Thai children. The occurrence of clinical lipodystrophy among these children was also evaluated.
Material and Method: Twenty-three HIV-infected children who initiated HAART from “Access to Care Program” sponsored by MOPH around October 2001. Non-fasting blood tests for lipid profile were performed at enrollment and every 6 months. Triglyceride level was not analysed due to a non-fasting condition. The assessment of clinical lipodystrophy was done every 1-2 months.
Results. As of October 2003, 19 (83%) children experienced dyslipidemia. There were 10, 13, 5, and 8 children who had dyslipidemia at 6, 12, 18, and 24 months of HAART. The mean total cholesterol, low density lipoprotein (LDL), and high density lipoprotein (HDL) tended to increase over time while the children were on HAART. There was a correlation of elevated total cholesterol and CD4 percentage gain particularly at 18-24 months of treatment (r = 0.596, p = 0.007). Two children developed peripheral lipoatrophy. There were no dyslipidemia-associated risk factors identified. Most of the children had transient abnormal lipid profile. There were only 3 children that had persistent abnormality throughout the 24 months of HAART.
Conclusion: Dyslipidemia was found from 6-12 months of HAART, and were mostly transient over time. Peripheral lipoatrophy were found in 2 children. Further follow-up will elucidate the long-term incidence, the association factors, and clinical consequences.

Keyword : HIV, Children, Dyslipidemia, HAART

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