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

HIV Med. 2018 Mar;19(3):175-183. doi: 10.1111/hiv.12566. Epub 2017 Nov 21.


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.

Keywords: atazanavir; children; darunavir; lipids; longitudinal; perinatally HIV-infected.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Atazanavir Sulfate / therapeutic use*
  • Child
  • Cohort Studies
  • Darunavir / therapeutic use*
  • Drug Therapy, Combination
  • Dyslipidemias / chemically induced
  • Dyslipidemias / metabolism*
  • Female
  • HIV Infections / drug therapy*
  • HIV Protease Inhibitors / therapeutic use*
  • HIV-1 / drug effects
  • Humans
  • Lipids / analysis*
  • Longitudinal Studies
  • Male
  • Ritonavir / therapeutic use*
  • Viral Load / drug effects
  • Young Adult


  • HIV Protease Inhibitors
  • Lipids
  • Atazanavir Sulfate
  • Ritonavir
  • Darunavir