Dyslipidemia and lifestyle in children in anti-retroviral treatment

Objectives Dyslipidemia is common in HIV-infected children, due to the infection itself and the anti-retroviral drugs, particularly protease-inhibitors. We aimed to study the prevalence of dyslipidemia and its association with diet and physical activity in children in anti-retroviral treatment in El Salvador. Materials and Methods We surveyed 270 children aged 5-18 years in anti-retroviral therapy at a reference centre of El Salvador. Anthropometric measures were obtained and information gathered on socio-demographic characteristics, type and length of therapy, diet and physical activity. Triglycerides, total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), viral load, and CD4 concentration were measured. Abnormal lipid concentrations were defined as triglycerides ≥130 mg/dl in children aged 10-19 years and ≥100 mg/dl in < 10 years; total cholesterol ≥200 mg/dl, LDL ≥130 mg/dl and HDL ≤35 mg/dl. Dietary patterns were identified by principal component analysis and the “high fat/sugar diet” pattern was used as a proxy of unhealthy diet. We performed a descriptive analysis by sex, and adjusted four logistic multivariate models to assess the association of each type of dyslipidemia with diet and physical exercise. Results Of the 270 children – 80 of whom taking protease-inhibitors - 128 (47.4%) had high triglycerides and 36 (13.3%) high total cholesterol concentrations. High LDL were observed in 17/176 children (9.7%) and low HDL in 39/183 (21.3%). No difference by sex were found in the lipids profile nor in the adherence to the unhealthy diet, but significantly more boys than girls were doing exercise at least three times a week (81.4% versus 59.2%, p<0.001). Treatment with protease-inhibitors was associated with high triglycerides (Odds Ratio (OR) 10.9 95%CI 5.1-23.4) and cholesterol (OR 7.3 95% CI 2.9-18.5). After adjustment for the rest of variables, children in the highest tertile for “unhealthy diet” showed a 1.8 increased odds (95% CI 1.1-2.8) for high cholesterol and a 1.9 increased odds for high LDL (95% CI 1.0-3.6) with respect to those in the two lowest tertiles. Compared with those exercising less than three times a week, children exercising more often were less likely to have low HDL (OR=0.34 95%CI 0.11-1.1 for 3-6 times a week and OR=0.23 95%CI 0.08-0.67 for more than seven times) Key findings These results suggest that a healthy diet and exercise habits could be helpful in controlling some aspects of the lipid profile in this population. Girls should be encouraged to exercise more, due to the low frequency of regular physical activity in this group.