Improvement in lipids after switch to boosted atazanavir or darunavir in children/adolescents with perinatally acquired HIV on older protease inhibitors: results from the Pediatric HIV/AIDS Cohort Study

• Published in: HIV medicine Vol. 19; no. 3; pp. 175 - 183
• Main Authors: Jao, J, Yu, W, Patel, K, Miller, TL, Karalius, B, Geffner, ME, DiMeglio, LA, Mirza, A, Chen, JS, Silio, M, McFarland, EJ, Van Dyke, RB, Jacobson, D, Yogev, Ram, Sanders, Ann, Malee, Kathleen, Hunter, Scott, Shearer, William, Paul, Mary, Cooper, Norma, Harris, Lynnette, Purswani, Murli, Baig, Mahboobullah, Cintron, Anna, Puga, Ana, Navarro, Sandra, Garvie, Patricia A., Blood, James, Burchett, Sandra K., Karthas, Nancy, Kammerer, Betsy, Wiznia, Andrew, Burey, Marlene, Nozyce, Molly, Dieudonne, Arry, Bettica, Linda, Bulkley, Garcia, Ivey, Latreaca, Grant, Mitzie, Knapp, Katherine, Allison, Kim, Wilkins, Megan, Acevedo‐Flores, Midnela, Rios, Heida, Olivera, Vivian, Gabriel, Medea, Sirois, Patricia, Spector, Stephen A., Norris, Kim, Nichols, Sharon, McFarland, Elizabeth, Darrow, Juliana, Barr, Emily, Harding, Paul, Scott, Gwendolyn, Alvarez, Grace, Cuadra, Anai
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-03-2018
• Subjects: Acquired immune deficiency syndrome; Adolescent; Adolescents; AIDS; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; atazanavir; Atazanavir Sulfate - therapeutic use; Cardiovascular diseases; Child; Children; Cholesterol; Cohort analysis; Cohort Studies; darunavir; Darunavir - therapeutic use; Drug Therapy, Combination; Dyslipidemia; Dyslipidemias - chemically induced; Dyslipidemias - metabolism; Female; Health risks; High density lipoprotein; HIV; HIV Infections - drug therapy; HIV Protease Inhibitors - therapeutic use; HIV-1 - drug effects; Human immunodeficiency virus; Humans; Lipids; Lipids - analysis; longitudinal; Longitudinal Studies; Lopinavir; Low density lipoprotein; Male; Minority & ethnic groups; Nelfinavir; perinatally HIV‐infected; Protease; Protease inhibitors; Proteinase inhibitors; Ribonucleic acid; Ritonavir; Ritonavir - therapeutic use; RNA; Triglycerides; Viral Load - drug effects; Young Adult; Youth; lipids; darunavir; longitudinal; atazanavir; children; perinatally HIV-infected
• ISSN: 1464-2662; 1468-1293
• DOI: 10.1111/hiv.12566

Objectives
Dyslipidaemia is common in perinatally HIV‐infected (PHIV) youth receiving protease inhibitors (PIs). Few studies have evaluated longitudinal lipid changes in PHIV youth after switch to newer PIs.
Methods
We compared longitudinal changes in fasting lipids [total cholesterol (TC), triglycerides (TG), low‐density lipoprotein cholesterol (LDL‐C), high‐density lipoprotein cholesterol (HDL‐C), and TC:HDL‐C ratio] in PHIV youth enrolled in the Pediatric HIV/AIDS Cohort Study (PHACS) Adolescent Master Protocol (AMP) study who switched to atazanavir/ritonavir (ATV/r)‐ or darunavir/ritonavir (DRV/r)‐based antiretroviral therapy (ART) from an older PI‐based ART and those remaining on an older PI. Generalized estimating equation models were fitted to assess the association of a switch to ATV/r‐ or DRV/r‐based ART with the rate of change in lipids, adjusted for potential confounders.
Results
From 2007 to 2014, 47 PHIV children/adolescents switched to ATV/r or DRV/r, while 120 remained on an older PI [primarily lopinavir/r (72%) and nelfinavir (24%)]. Baseline age ranged from 7 to 21 years. After adjustment for age, Tanner stage, race/ethnicity, and HIV RNA level, a switch to ATV/r or DRV/r was associated with a more rapid annual rate of decline in the ratio of TC:HDL‐C. (β = −0.12; P = 0.039) than remaining on an older PI. On average, TC declined by 4.57 mg/dL/year (P = 0.057) more in the switch group. A switch to ATV/r or DRV/r was not associated with the rate of HDL‐C, LDL‐C, or TG change.
Conclusions
A switch to ATV/r or DRV/r may result in more rapid reduction in TC and the TC:HDL‐C ratio in PHIV youth, potentially impacting long‐term cardiovascular disease risk.