Improvement in lipids after switch to boosted atazanavir or darunavir in children/adolescents with perinatally acquired HIV on older protease inhibitors: results from the Pediatric HIV / AIDS Cohort Study

Objectives Dyslipidaemia is common in perinatally HIV ‐infected ( PHIV ) youth receiving protease inhibitors ( PI s). Few studies have evaluated longitudinal lipid changes in PHIV youth after switch to newer PI s. Methods We compared longitudinal changes in fasting lipids [total cholesterol ( TC ), triglycerides ( TG ), low‐density lipoprotein cholesterol ( LDL ‐C), high‐density lipoprotein cholesterol ( HDL ‐C), and TC : HDL ‐C ratio] in PHIV youth enrolled in the Pediatric HIV / AIDS Cohort Study ( PHACS ) Adolescent Master Protocol ( AMP ) study who switched to atazanavir/ritonavir ( ATV /r)‐ or darunavir/ritonavir ( DRV /r)‐based antiretroviral therapy ( ART ) from an older PI ‐based ART and those remaining on an older PI . Generalized estimating equation models were fitted to assess the association of a switch to ATV /r‐ or DRV /r‐based ART with the rate of change in lipids, adjusted for potential confounders. Results From 2007 to 2014, 47 PHIV children/adolescents switched to ATV /r or DRV /r, while 120 remained on an older PI [primarily lopinavir/r (72%) and nelfinavir (24%)]. Baseline age ranged from 7 to 21 years. After adjustment for age, Tanner stage, race/ethnicity, and HIV RNA level, a switch to ATV /r or DRV /r was associated with a more rapid annual rate of decline in the ratio of TC : HDL ‐C. ( β = −0.12; P = 0.039) than remaining on an older PI . On average, TC declined by 4.57 mg/ dL /year ( P = 0.057) more in the switch group. A switch to ATV /r or DRV /r was not associated with the rate of HDL ‐C, LDL ‐C, or TG change. Conclusions A switch to ATV /r or DRV /r may result in more rapid reduction in TC and the TC : HDL ‐C ratio in PHIV youth, potentially impacting long‐term cardiovascular disease risk.