Dyslipidemia in HIV-Infected Children and Adolescents on Antiretroviral Therapy Receiving Care at Kilimanjaro Christian Medical Centre in Tanzania: A Cross-Sectional Study

Citation: 
Michael E Irira1,2, Rune N Philemon1,2, Joshua Y Mmbaga1, Venancia Komba1, John Bartlett2,3, Grace D Kinabo1,2and Blandina T Mmbaga1,2,3,4
Publication year: 
2020

BACKgRounD:

Worldwide prevalence of dyslipidemia in HIV-infected children on antiretroviral medications (ARVs) is rising due to exten-sive use of treatment during their entire lives. Dyslipidemia is the potential side effect of ARVs, especially in individuals taking protease inhibi-tors. The objective of this study was to determine the prevalence of dyslipidemia in HIV-infected children on ARVs receiving care at Kilimanjaro Christian Medical Centre (KCMC) in Tanzania.

MeTHoDS:

This was a cross-sectional hospital-based study conducted from September 2015 to May 2016 at KCMC. HIV-infected children and adolescents less than 17 years on ARVs for more than 6 months were enrolled. Blood samples were taken to determine levels of triglyc-erides (TGs), total cholesterol, lipoproteins (including low-density lipoprotein (LDL) and high-density lipoprotein (HDL)), CD4+ T cells, and viral load (VL). Anthropometric measurements were used to assess nutritional status. SPSS 20.0 was used for analysis. Logistic regression estimated odds ratio (OR) and 95% confidence interval (CI), and P value <.05 was considered significant. Written consent was obtained from parents/guardians on behalf of their children and assent for older children.

ReSulTS:

A total of 260 participants were included in the study; the median age at HIV diagnosis was 3 (interquartile range (IQR) = 1-6) years. The overall prevalence of dyslipidemia was 46.5% with hypercholesterolemia (200 mg/dl) of 11.2%, HDL (<35 mg/dl) of 22.7%, LDL (130 mg/dl) of 7.7%, and hyperglyceridemia (TG 150 mg/dl) of 12.3%. Children aged between 6 and 12 years at HIV diagnosis had 2.7 times higher odds of developing dyslipidemia compared with younger age at diagnosis (OR = 2.7; 95% CI = 1.1-6.6). Patients with advanced (OR = 6.4; 95% CI = 1.5-27.1) or severe (OR = 9.8; 95% CI = 1.2-76.5) HIV-associated immunodeficiency at diagnosis had higher odds of developing dyslipidemia. Protease inhibitor use was associated with higher odds of developing dyslipidemia (OR = 3.1; 95% CI = 1.4-7.1).

ConCluSIon:

Late diagnosis of HIV at 6 years of age or more, advanced, or severe immunosuppression, and the use of protease inhibi-tors were independent predictors of dyslipidemia in children on ARVs after 6 months of treatment, and with low HDL levels observed most commonly. Monitoring lipid profiles in children, especially those on protease inhibitors and with advanced/severe immunosuppression at diagnosis, may help in preventing future complications.