Children's HIV Drugs May Cause High Cholesterol

Strategies are needed to protect infected kids from long-term cardiovascular harm, researchers say

Children with HIV who receive antiretroviral treatments have persistently high cholesterol and other blood fat (lipid) levels, and would benefit from guidelines aimed at reducing their long-term heart risks, researchers say.

"Formal guidelines are the first crucial step in minimizing cardiovascular disease complications and maximizing quality of life in this vulnerable population," the authors of an editorial said in a journal news release. The most effective strategy probably consists of a "lipid-friendly" drug regimen -- meaning medications that don't affect blood fats -- along with lifestyle changes, such as diet and exercise, they said.

The editorial accompanies two studies in the Aug. 15 issue that examined blood fats in children treated for HIV.

In one study, led by Denise L. Jacobson of Harvard School of Public Health, the researchers followed 240 HIV-infected children with high cholesterol for two years. During this time, the children had persistently high lipid levels. Cholesterol levels dropped to normal in only about one-third of the children.

Cholesterol levels were more likely to decline when changes were made to their antiretroviral treatment, the researchers found. In most cases, medication changes were related to the HIV, not lipid levels. Only 15 of the children were given drugs specifically to manage their cholesterol.

In a separate study, researchers at the Imperial College School of Medicine, London, compared the effect of different HIV drugs on 449 HIV-infected children's lipid levels. They found all of the drugs caused a surge in cholesterol. The class of HIV drugs known as protease inhibitors, in particular, triggered the biggest increase.

Within five years, 10 percent of children developed low-density lipoprotein ("bad") cholesterol levels above the 95th percentile. But based on those numbers, only three patients needed to take cholesterol medication.

Because HIV-infected children are likely to live well into adulthood, the researchers said treatment strategies need to be developed that will protect them against heart disease later in life.

"Clinical trials are required to develop and test intervention strategies to protect against cardiovascular disease in children born with HIV, growing into adult life," Dr. Margaret P. Rhoads of Imperial College and co-authors wrote in the news release.