Studies Highlight Need for Specific Guidelines on Cardiovascular Risks in HIV-Infected Children
Newswise — Philadelphia, Pa. (August 3, 2011) – Children with HIV have persistently high levels of cholesterol and other lipids during treatment with antiretroviral medications, according to a pair of studies in JAIDS: Journal of Acquired Immune Deficiency Syndromes. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.
The new research highlights the "urgent need" for specific guidelines to manage lipid levels and control long-term cardiovascular risks in children with HIV, according to an editorial by Dr. Allison C. Ross of Emory University, Atlanta, and Dr. Grace A. McComsey of Case Western Reserve University, Cleveland. They write, "Formal guidelines are the first crucial step in minimizing cardiovascular disease complications and maximizing quality of life in this vulnerable population." Lipid Levels Are Persistently High—Changes in Treatment May Have EffectsAdults with HIV are at increased risk of cardiovascular disease, including myocardial infarction (heart attack). Since development of atherosclerosis ("hardening of the arteries") begins early in childhood, children with HIV probably have accelerated development of cardiovascular disease.
In one of the two new studies, Denise L. Jacobson, Ph.D., M.P.H., of Harvard School of Public Health and colleagues monitored trends in cholesterol and lipid levels in 240 HIV-infected children with hypercholesterolemia (high cholesterol). During two years' follow-up, the children had persistently elevated lipid levels—cholesterol levels decreased to normal in only about one-third of patients.
Cholesterol was more likely to go down in children whose antiretroviral drug therapy (ART) was changed during follow-up. Although the study didn't include information on why treatment was changed, in most cases it was probably to control HIV levels—not in response to high cholesterol levels. Just 15 of the children were started on cholesterol-lowering statin drugs. In the other study, Dr. Margaret P. Rhoads of Imperial College School of Medicine, London, and colleagues compared the effects of different types of ART drugs on lipid levels in 449 HIV-infected children. All classes of ART drugs were associated with increased cholesterol—although the increases were most significant for children receiving one specific class of ART drugs (protease inhibitors).
During the five-year follow-up period, ten percent of the children developed low-density lipoprotein ("bad") cholesterol levels above the 95th percentile. However, just three patients had cholesterol levels high enough to call for drug treatment. "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. Rhoads and coauthors conclude.
With the availability of ART, HIV-infected children are expected to live well into adulthood. This makes it critically important to understand how the HIV-associated increase in cardiovascular risk develops—and whether treatment during childhood can decrease cardiovascular risk later in life.
However, there are currently no specific, evidence-based recommendations for managing lipid levels in children with HIV. Further complicating matters, increased lipid levels aren't the only factor contributing to increased cardiovascular risk in patients with HIV. For example, ART reduces HIV-related inflammation, which may "overshadow" the risk associated with high lipid levels.
The new studies "emphasize the urgent need to develop guidelines specifically for HIV-infected children, where there is an opportunity to minimize CVD risk early, well before the onset of established disease," Drs. Ross and McComsey write. They believe the best strategy is likely to be a combined approach consisting of a "lipid-friendly" drug regimen along with nondrug treatments (such as diet and exercise). More research is needed to evaluate these and other strategies—including the role of cholesterol-lowering medications.
###About JAIDSJAIDS: Journal of Acquired Immune Deficiency Syndromes (www.JAIDS.com) is the trusted, interdisciplinary resource for HIV- and AIDS-related information with a strong focus on basic science, clinical science, and epidemiology. Co-edited by the foremost leaders in clinical virology, molecular biology, and epidemiology, JAIDS publishes vital information on the advances in diagnosis and treatment of HIV infections, as well as the latest research in the development of therapeutics and vaccine approaches. This ground-breaking journal brings together rigorously peer-reviewed articles, reviews of current research, results of clinical trials, and epidemiologic reports from around the world.
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