Farley John, Gona Philimon, Crain Marilyn, Cervia Joseph, Oleske James, Seage George, Lindsey Jane
Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
J Acquir Immune Defic Syndr. 2005 Apr 1;38(4):480-7. doi: 10.1097/01.qai.0000139397.30612.96.
HIV protease inhibitors (PIs) are known to disturb lipid metabolism in adults, leading to hypercholesterolemia. A number of cross-sectional studies have also reported this phenomenon in perinatally HIV-infected children but differ greatly with respect to prevalence and/or methodology.
The Pediatric AIDS Clinical Trials Group 219C (PACTG 219C) is a prospective cohort study designed to examine long-term outcomes in children born to HIV-infected women. The outcome of interest in this analysis was total cholesterol, and patients were classified as hypercholesterolemic if their total cholesterol was above the 95th percentile of US Third National Health and Nutrition Survey (NHANES III) standards for gender, race/ethnicity, and age. We hypothesized that hypercholesterolemia would be more common among older children receiving PI therapy who demonstrated excellent adherence and might be associated with hypertension and obesity. Information regarding treatment, adherence, and laboratory values was obtained using the date closest to the cholesterol measurement. Crude and adjusted effect measures were estimated using exposure odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) from univariate and multivariate logistic regression models.
Among 1812 HIV-infected participants between 4 and 19 years of age, 229 children had hypercholesterolemia (prevalence = 13.0%, 95% CI: 11.1-14.3) compared with 9 of 187 HIV-uninfected children (prevalence = 4.8%, 95% CI: 2.2-8.8). After adjusting for confounders, current PI use (OR = 5.3, 95% CI: 3.1-9.2), age from 4 to <6 years (OR = 2.9, 95% CI: 1.7-4.9), HIV-1 RNA <400 copies/mL (OR = 2.3, 95% CI: 1.7-3.2), self-report of no missed doses in the past 3 days (OR = 2.2, 95% CI: 1.3-3.8), white race (OR = 2.2, 95% CI: 1.4-3.3), age from 6 to <12 years (OR = 1.9, 95% CI: 1.3-2.9), Hispanic ethnicity (OR = 1.8, 95% CI: 1.2-2.5), and current nonnucleoside reverse transcriptase inhibitor use (OR = 1.7, 95% CI: 1.2-2.3) were independently associated with the presence of hypercholesterolemia among the HIV-infected children. There was a positive association with elevated systolic blood pressure in univariate but not multivariate analysis, and no association was present with body mass index.
Among the HIV-infected children, the overall prevalence of hypercholesterolemia was 13.0% and the strongest associated risk factor for hypercholesterolemia was current use of a PI in the antiretroviral regimen. Continued follow-up is needed to assess the long-term effects of hypercholesterolemia in children.
已知HIV蛋白酶抑制剂（PIs）会扰乱成人的脂质代谢，导致高胆固醇血症。一些横断面研究也报告了围产期感染HIV的儿童中存在这种现象，但在患病率和/或方法上差异很大。
儿科艾滋病临床试验组219C（PACTG 219C）是一项前瞻性队列研究，旨在研究感染HIV的妇女所生儿童的长期结局。该分析中感兴趣的结局是总胆固醇，如果患者的总胆固醇高于美国第三次全国健康和营养调查（NHANES III）按性别、种族/族裔和年龄划分的标准的第95百分位数，则被归类为高胆固醇血症。我们假设，在接受PI治疗且依从性良好的大龄儿童中，高胆固醇血症更为常见，并且可能与高血压和肥胖有关。使用最接近胆固醇测量日期的信息来获取有关治疗、依从性和实验室值的信息。使用单变量和多变量逻辑回归模型的暴露比值比（OR）及其相应的95%置信区间（CI）来估计粗效应量和调整后的效应量。
在1812名4至19岁的感染HIV的参与者中，229名儿童患有高胆固醇血症（患病率=13.0%，95%CI：11.1-14.3），而187名未感染HIV的儿童中有9名（患病率=4.8%，95%CI：2.2-8.8）。在对混杂因素进行调整后，目前使用PI（OR=5.3，95%CI：3.1-9.2）、4至<6岁（OR=2.9，95%CI：1.7-4.9）、HIV-1 RNA<400拷贝/mL（OR=2.3，95%CI：1.7-3.2）、自我报告在过去3天内无漏服剂量（OR=2.2，95%CI：1.3-3.8）、白人种族（OR=2.2，95%CI：1.4-3.3）、6至<12岁（OR=1.9，95%CI：1.3-2.9）、西班牙裔族裔（OR=1.8，95%CI：1.2-2.5）以及目前使用非核苷类逆转录酶抑制剂（OR=1.7，95%CI：1.2-2.3）与感染HIV儿童中高胆固醇血症的存在独立相关。在单变量分析中与收缩压升高呈正相关，但在多变量分析中无此关联，且与体重指数无关。
在感染HIV的儿童中，高胆固醇血症的总体患病率为13.0%，高胆固醇血症最强的相关危险因素是目前在抗逆转录病毒治疗方案中使用PI。需要持续随访以评估儿童高胆固醇血症的长期影响。
