New research highlights urgent need to develop specific guidelines for HIV-infected children

June 08, 2017

During the five-year follow-up period, ten percent of the children developed low-density lipoprotein ("bad") cholesterol levels above the 95th percentile. However, just three patients had cholesterol levels high enough to call for drug treatment. "Clinical trials are required to develop and test intervention strategies to protect against cardiovascular disease in children born with HIV, growing into adult life," Dr. Rhoads and coauthors conclude.

With the availability of ART, HIV-infected children are expected to live well into adulthood. This makes it critically important to understand how the HIV-associated increase in cardiovascular risk develops??”and whether treatment during childhood can decrease cardiovascular risk later in life.

However, there are currently no specific, evidence-based recommendations for managing lipid levels in children with HIV. Further complicating matters, increased lipid levels aren't the only factor contributing to increased cardiovascular risk in patients with HIV. For example, ART reduces HIV-related inflammation, which may "overshadow" the risk associated with high lipid levels.

The new studies "emphasize the urgent need to develop guidelines specifically for HIV-infected children, where there is an opportunity to minimize CVD risk early, well before the onset of established disease," Drs. Ross and McComsey write. They believe the best strategy is likely to be a combined approach consisting of a "lipid-friendly" drug regimen along with nondrug treatments (such as diet and exercise). More research is needed to evaluate these and other strategies??”including the role of cholesterol-lowering medications.

Source: JAIDS: Journal of Acquired Immune Deficiency Syndromes