Longitudinal Lipid Trajectories and Age-Specific Correlates of Dyslipidemia Among Kenyan Children with Perinatally Acquired HIV Initiating Antiretroviral Therapy During Infancy

Abstract

Introduction Few longitudinal studies from sub-Saharan Africa have characterized lipid trajectories throughout childhood or evaluated age-specific correlates of dyslipidemia among children with perinatal HIV infection (CPHIV) who initiated ART during infancy. Methods This study was a secondary analysis of the Optimizing Pediatric HIV (OPH) cohort in Kenya. Longitudinal lipid trajectories were described among children with repeated lipid measurements assessed 6-monthly from infancy through approximately 10 years of age. Age-specific analyses were conducted among children at approximately 2 years and 10 years. Lipid abnormalities were classified according to established pediatric clinical thresholds. Modified Poisson regression with robust standard errors was used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) for the associations with abnormal total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides. Results Among 158 children followed from the first year of life with 494 lipid measurements, lipid concentrations demonstrated distinct dynamic trajectories throughout childhood. Abnormalities in triglycerides were the most common across follow-up, total cholesterol and LDL cholesterol increased during early childhood before stabilizing, and HDL cholesterol remained relatively stable. At 2 years of age, cumulative protease inhibitor (PI) exposure was associated with a higher prevalence of abnormal triglycerides (adjusted PR [aPR] 1.15, 95% CI 1.01–1.31) and stunting was associated with a lower prevalence of abnormal LDL (aPR 0.30, 95% CI 0.10–0.91). In contrast, no statistically significant associations between early-life clinical characteristics and lipid abnormalities were identified at 10 years of age. There was no evidence of effect modification by sex or timing of ART initiation. Conclusions Lipid profiles among CPHIV evolved throughout childhood, with persistent hypertriglyceridemia representing the predominant long-term metabolic abnormality. While early-life PI exposure was associated with elevated triglycerides during early childhood, early-life characteristics did not predict dyslipidemia by 8-12 years of age. These findings provide longitudinal evidence to inform age-appropriate metabolic lipid monitoring strategies for children receiving lifelong ART. Key words: Perinatally acquired HIV; antiretroviral therapy; dyslipidemia; lipid trajectories; hypertriglyceridemia; protease inhibitors; pediatric HIV; Kenya