Metabolic Effects of Initiating Lopinavir/Ritonavir Treatment in Children

Lopinavir/ritonavir-based treatment may be associated with higher total cholesterol in young children.

Lopinavir/ritonavir (LPV/r)-based treatment may be associated with higher total cholesterol in young children, according to a study published in AIDS. Researchers performed a prospective cohort study to illuminate on the metabolic effects of LPV/r-based treatments in young children.

Participants included 449 children aged 2 to 36 months, from 6 African countries and India—part of the International Maternal Pediatric Adolescent AIDS Clinical Trials. Researchers randomly assigned participants (n=222) and (n=227) to initiate LPV/r- and nevirapine (NVP)-based regimens, respectively. Data was obtained from participants to ascertain the long-term efficacy and safety of LPV/r compared with NVP treatment when initiated at an early age.

Demographic and clinical characteristics were comparable between LPV/r and NVP groups at baseline, but median total cholesterol and triglyceride values were higher in the LPV/r group than in the NVP group (cholesterol: 108 compared with 100.5 mg/dL, respectively; triglycerides: 154.6 compared with 150.6 mg/dL, respectively).

Of those enrolled in follow-up, the relative risks for borderline/elevated cholesterol, when comparing LPV/r to NVP, ranged from a 60% increased risk at 5 years (95% CI, 0.9, 2.8) to a more than four-fold increased risk at 7 years (95% CI, 1.2, 15.3) for LPV/r participants. Weighted relative risks for high triglycerides at follow-up, comparing the LPV/r group with the NVP group, ranged from a 20% to a 2.9-fold increased risk for LPV/r participants.

Researchers indicated that LPV/r has virologic superiority despite the risk of high cholesterol, and recommended “continual assessment of total cholesterol among young children initiating a LPV/r-based regimen to monitor cardiometabolic health.”

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This study was supported by the National Institute of Allergy and Infectious Diseases, the National Institutes of Health, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the National Institute of Mental Health.


Patel K, Lindsey J, Angelidou K, Aldrovandi G, Palumbo P. Metabolic effects of initiating lopinavir/ritonavir-based regimens among young children: 7- year follow-up of the IMPAACT P1060 trial [published August 18, 2018]. AIDS. doi:10.1097/QAD.0000000000001980.