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Background: A frequent side-effect of antiretroviral therapy is elevation of plasma lipids and cholesterol. Atazanavir has been shown in adults to have a smaller elevation in plasma lipids in relation to other protease inhibitors. The purpose of this study was to determine the efficacy of Atazanavir in pediatric patients switching to Atazanavir from other HAART regimens and to compare the lipid levels after the switch. Methods: Ten HIV infected pediatric patients with virologic suppression on HAART and elevated lipid levels were enrolled. Subjects were switched to boosted Atazanavir and followed for 24 weeks. CD4 + cell counts, viral loads and lipid levels were monitored at each study visit. Changes in lipid levels were analyzed with the non-parametric Friedman’s test. Results: Subjects were perinatally infected, not on lipid lowering medications, aged 6-18 years. Eight were male and 2 were female. Triglycerides trended from a mean of 288.5 at baseline to a mean of 193.3 at follow-up but the decrease was not statistically significant. Cholesterol trended from a mean of 214.3 at baseline to as low as 178.5 at 12 weeks post switch with a significant Friedman’s Test (χ2(3) = 12.6, p = 0.006). Across all visits mean preand postswitch viral loads remained < 200 and CD4 + cell counts were not significantly different. Conclusions: All patients maintained viral suppression and stable CD4 + cell counts after switching to Atazanavir. There was a statistically significant improvement in cholesterol levels with a trend to improvement in elevated triglyceride levels. Switch to Atazanavir is safe, efficacious and potentially beneficial in pediatric patients with elevated lipid levels.

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Equivalence of Boosted Atazanavir Based Regimens and Currently Effective HAART Regimens with Other PI's/NNRTI's in HIV + Children and Adolescents with Elevated Lipid Levels