The prevalence of dyslipidemia in hiv infected children receiving highly active antiretroviral therapy at the Kenyatta National Hospital

Abstract

Implementation of highly active antiretroviral therapy (HAART) has resulted in decline in morbidity and mortality in HIV-infected children, with more children living into adulthood. However, the long term adverse effects, including dyslipidemia, have raised concern on increased cardiovascular risk in this population. Objective: To determine the prevalence of dyslipidemia in HIV-infected children receiving HAART at the Kenyatta National Hospital. Study design: Hospital based Cross sectional study Study methods: HIV-infected children on HAART aged between 18 months and 15 years were recruited. Demographic, clinical and immunologic data were recorded. The United States National Cholesterol Education Programme III guidelines in children were used to define dyslipidemia (Total cholesterol ≥ 5.17 mmol/l, triglycerides ≥ 1.69 mmol/l, low density lipoprotein cholesterol ≥ 3.36 mmol/l and high density lipoprotein cholesterol < 0.9 mmol/l). The prevalence of dyslipidemia was determined and associated factors were explored. Results: For a total of 170 patients analyzed, the prevalence of dyslipidemia was 40% (95% CI, 18-36). The prevalence of hypercholesterolemia was 27.1% and prevalence of hypertriglyceridemia 11.8%. High low density lipoprotein (LDL) cholesterol was observed in 19.4% of the patients and low high density lipoprotein (HDL) cholesterol in 5.3%. The prevalence of dyslipidemia among patients on non-nucleoside reverse transcriptase inhibitor based regimens was 37% compared to 90% in patients on protease inhibitor based therapy. Factors found to be associated with the presence of dyslipidemia were age 10 years and below (OR 3.2; 95% CI: 1.3 – 7.7, p = 0.009) and protease inhibitor therapy (OR 7.5; 95% CI: 1.5 – 38.5, p = 0.015). Conclusion: There is a high prevalence of dyslipidemia in HIV-infected children taking HAART at the Kenyatta National Hospital Comprehensive Care Centre. There is need to perform baseline lipid profiles in patients starting HAART and there after reassessment at least every six months.