@article{e2a703b399ea47b9a9a5199a2bbd8714,
title = "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",
abstract = "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",
author = "{the Pediatric HIV/AIDS Cohort Study (PHACS) Adolescent Master Protocol (AMP) study} and J. Jao and W. Yu and K. Patel and Miller, {T. L.} and B. Karalius and Geffner, {M. E.} and DiMeglio, {L. A.} and A. Mirza and Chen, {J. S.} and M. Silio and McFarland, {E. J.} and {Van Dyke}, {R. B.} and D. Jacobson and Ram Yogev and Ann Sanders and Kathleen Malee and Scott Hunter and William Shearer and Mary Paul and Norma Cooper and Lynnette Harris and Murli Purswani and Mahboobullah Baig and Anna Cintron and Ana Puga and Sandra Navarro and Garvie, {Patricia A.} and James Blood and Burchett, {Sandra K.} and Nancy Karthas and Betsy Kammerer and Andrew Wiznia and Marlene Burey and Molly Nozyce and Arry Dieudonne and Linda Bettica and Garcia Bulkley and Latreaca Ivey and Mitzie Grant and Katherine Knapp and Kim Allison and Megan Wilkins and Midnela Acevedo-Flores and Heida Rios and Vivian Olivera and Medea Gabriel and Patricia Sirois and Spector, {Stephen A.} and Gwendolyn Scott and Anai Cuadra",
note = "Funding Information: We thank the children and families for their participation in PHACS and the individuals and institutions involved in the conduct of PHACS. PHACS is supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development with co-funding from the National Institute on Drug Abuse, the National Institute of Allergy and Infectious Diseases (NIAID), the Office of AIDS Research, the National Institute of Mental Health (NIMH), the National Institute of Neurological Disorders and Stroke, the National Institute on Deafness and Other Communication Disorders, the National Heart Lung and Blood Institute, the National Institute of Dental and Craniofacial Research, and the National Institute on Alcohol Abuse and Alcoholism, through cooperative agreements with the Harvard T. H. Chan School of Public Health (HD052102) (Principal Investigator: George Seage; Project Director: Julie Alperen) and the Tulane University School of Medicine (HD052104) (Principal Investigator: Russell Van Dyke; Co-Principal Investigators: Kenneth Rich and Ellen Chadwick; Project Director: Patrick Davis) and the Tulane University School of Medicine (HD052104). Data management services were provided by Frontier Science and Technology Research Foundation [principal investigator (PI): Suzanne Siminski], and regulatory services and logistical support were provided by Westat, Inc. (PI: Julie Davidson). Funding Information: Conflicts of interest and funding sources: JJ is supported by NICHD K23HD070760. PHACS is supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development with co-funding from the National Institute on Drug Abuse, the National Institute of Allergy and Infectious Diseases (NIAID), the Office of AIDS Research, the National Institute of Mental Health (NIMH), the National Institute of Neurological Disorders and Stroke, the National Institute on Deafness and Other Communication Disorders, the National Heart Lung and Blood Institute, the National Institute of Dental and Craniofacial Research, and the National Institute on Alcohol Abuse and Alcoholism, through cooperative agreements with the Harvard T. H. Chan School of Public Health (HD052102) and the Tulane University School of Medicine (HD052104). MEG is a consultant to Daiichi-Sankyo and receives royalties from McGraw-Hill and UpToDate. LAD has or had research contracts from Medtronic, Merck, Lexicon, Novo Nordisk, and Sanofi; serves on a data safety monitoring board for Janssen; has served on an advisory board for Merck; and receives royalties from Wolters Kluwer. EJM has research contracts from Gilead, Inc. JSC has research contracts from Gilead Sciences, Inc. For the remaining authors, no conflicts of interest are declared. The conclusions and opinions expressed in this article are those of the authors and do not necessarily reflect those of the NIH or US Department of Health and Human Services. Funding Information: We thank the children and families for their participation in PHACS and the individuals and institutions involved in the conduct of PHACS. PHACS is supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development with co-funding from the National Institute on Drug Abuse, the National Institute of Allergy and Infectious Diseases (NIAID), the Office of AIDS Research, the National Institute of Mental Health (NIMH), the National Institute of Neurological Disorders and Stroke, the National Institute on Deafness and Other Communication Disorders, the National Heart Lung and Blood Institute, the National Institute of Dental and Craniofacial Research, and the National Institute on Alcohol Abuse and Alcoholism, through cooperative agreements with the Harvard T. H. Chan School of Public Health (HD052102) (Principal Investigator: George Seage; Project Director: Julie Alperen) and the Tulane University School of Medicine (HD052104) (Principal Investigator: Russell Van Dyke; Co-Principal Investigators: Kenneth Rich and Ellen Chadwick; Project Director: Patrick Davis) and the Tulane University School of Medicine (HD052104). Data management services were provided by Frontier Science and Technology Research Foundation [principal investigator (PI): Suzanne Siminski], and regulatory services and logistical support were provided by Westat, Inc. (PI: Julie Davidson). Conflicts of interest and funding sources: JJ is supported by NICHD K23HD070760. PHACS is supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development with co-funding from the National Institute on Drug Abuse, the National Institute of Allergy and Infectious Diseases (NIAID), the Office of AIDS Research, the National Institute of Mental Health (NIMH), the National Institute of Neurological Disorders and Stroke, the National Institute on Deafness and Other Communication Disorders, the National Heart Lung and Blood Institute, the National Institute of Dental and Craniofacial Research, and the National Institute on Alcohol Abuse and Alcoholism, through cooperative agreements with the Harvard T. H. Chan School of Public Health (HD052102) and the Tulane University School of Medicine (HD052104). MEG is a consultant to Daiichi-Sankyo and receives royalties from McGraw-Hill and UpToDate. LAD has or had research contracts from Medtronic, Merck, Lexicon, Novo Nordisk, and Sanofi; serves on a data safety monitoring board for Janssen; has served on an advisory board for Merck; and receives royalties from Wolters Kluwer. EJM has research contracts from Gilead, Inc. JSC has research contracts from Gilead Sciences, Inc. The conclusions and opinions expressed in this article are those of the authors and do not necessarily reflect those of the NIH or US Department of Health and Human Services. Publisher Copyright: {\textcopyright} 2017 British HIV Association",
year = "2018",
month = mar,
doi = "10.1111/hiv.12566",
language = "English (US)",
volume = "19",
pages = "175--183",
journal = "HIV Medicine",
issn = "1464-2662",
publisher = "Wiley-Blackwell",
number = "3",
}