Аdverse events underlying antiretroviral therapy in children with HIV infection

Abstract

Introduction. Human immunodeficiency virus infection can alter properties of blood vessels in children and increase the risk of development of cardiovascular diseases in the future. Today the actual contribution of the effects of both HIV infection and antiretroviral therapy into such changes remains unknown. Objective. We seek to assess adverse events, including metabolic disorders (dyslipidemias), underlying antiretroviral therapy, and to determine the relation between metabolic disorders and intima injury in children receiving antiretroviral therapy (ART).Materials and methods. The adverse events were investigated within the framework of a prospective and retrospective study. The study included evaluation of biochemical parameters in relation to the therapeutic regimen; calculation of atherogenic index of plasma; and determination of incidence of dyslipidemia in children. In addition to standard tests, children on ART were evaluated for insulin resistance (using HOMA-IR) and submitted to diagnostic imaging including Doppler ultrasonography of brachiocephalic arteries and veins.Results. Children on protease inhibitor-based ART have higher total cholesterol, LDL and triglyceride levels in comparison to both children on NNRTI-based ART and children who do not receive ART. LDL levels in children on long-term ART remained within the tolerance range and were clearly higher than those in children who did not receive ART. Carotid IMT was higher in children on NNRTI-based ART in comparison to those who received protease inhibitor-based therapy; and the correlation analysis conducted revealed positive correlation between the age and carotid IMT: The later ART was prescribed, the greater IMT was, which most likely was attributable to HIV effects.Conclusion. Prescription of antiretroviral therapy at an older age results in changes in the intima-media complex, which may give evidence to vasoprotective effects of the therapy. Since HIV is directly involved in causing injury to the intima, it is advisable to start managing HIV infection in children as soon as they are diagnosed with the infection; and children to whom ART is prescribed at an older age and who develop dyslipidemia should be additionally evaluated by medical imaging with Doppler ultrasonography with carotid IMT measurement.