Association of hypercholesterolemia incidence with antiretroviral treatment, including protease inhibitors, among perinatally HIV-infected children

J Acquir Immune Defic Syndr. 2008 Apr 15;47(5):607-14. doi: 10.1097/QAI.0b013e3181648e16.


Context: Antiretroviral therapy has been associated with hypercholesterolemia in HIV-infected children. Few longitudinal studies have been conducted to examine this association, however.

Objective: To evaluate the incidence of and risk factors for development of hypercholesterolemia in a large pediatric study.

Design: Prospective cohort study (Pediatric AIDS Clinical Trials Group 219C).

Participants: A total of 2122 perinatally HIV-infected children free of hypercholesterolemia at entry.

Outcome: Development of hypercholesterolemia (total cholesterol >or=220 mg/dL at 2 consecutive visits). Cox proportional hazards models were used to evaluate risk factors.

Results: Thirteen percent of children had hypercholesterolemia at entry, and an additional 13% developed hypercholesterolemia during follow-up for an incidence rate of 3.4 cases per 100 person-years (95% confidence interval [CI]: 3.0 to 3.9). After adjustment for age, boosted protease inhibitor (PI) use (hazard ratio [HR] = 13.9, 95% CI: 6.73 to 28.6), nonboosted PI use (HR = 8.65, 95% CI: 4.19 to 17.9), and nonnucleoside reverse transcriptase inhibitor use (HR = 1.33, 95% CI: 1.04 to 1.71) were associated with increased risk of hypercholesterolemia, and higher viral load was protective (>50,000 vs. <or=400 copies/mL; HR = 0.59, 95% CI: 0.39 to 0.90). Self-reported adherent subjects had higher risk.

Conclusions: PIs were significant risk factors for hypercholesterolemia. Higher viral load was protective and may reflect nonadherence. Further follow-up is critical to evaluate long-term consequences of chronic PI exposure and hypercholesterolemia.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Antiretroviral Therapy, Highly Active / adverse effects*
  • Child
  • Child, Preschool
  • Cholesterol / blood*
  • Cohort Studies
  • Female
  • HIV / drug effects
  • HIV / isolation & purification
  • HIV Infections / drug therapy*
  • HIV Infections / virology
  • HIV Protease Inhibitors / adverse effects*
  • HIV Protease Inhibitors / therapeutic use
  • Humans
  • Hypercholesterolemia / chemically induced*
  • Hypercholesterolemia / epidemiology
  • Incidence
  • Male
  • Proportional Hazards Models
  • Prospective Studies
  • Risk Factors
  • Viral Load


  • HIV Protease Inhibitors
  • Cholesterol