Effect of nutritional status and antiretroviral treatment on serum lipids in Ugandan children living with HIV

The negative impact of antiretroviral (ART) treatment on lipid metabolism, characterised by lipid disturbances, is well documented in adults. However, similar data on children is scarce, particularly in the setting of malnutrition. The aim of our study is to investigate the impact of ART and nutritional status on blood cholesterol level and the genes involved in cholesterol transport, in Ugandan children living with HIV. The children ( n = 156) were classified based on ART status into naive (no ART) and experienced (> 6 months on ART) and based on nutritional status into well-nourished (WN), moderately malnourished (MAM) and severely malnourished (SAM). Total cholesterol (TC), high-density lipoproteins (HDL), low-density lipoproteins (LDL) and triglycerides (TG) were measured in the serum. Also, the expression of genes involved in cholesterol transport was quantified in the peripheral blood mononuclear cells. Abnormally low HDL level was the most prominent characteristic in all patient groups, and this disturbance was more pronounced in ART naïve children. Regarding the effect of nutritional status, HDL was significantly lower in SAM relative to WN ( p < 0.05), suggesting an association between nutritional status and HDL abnormalities in children living with HIV. The gene expression analysis showed a trend towards higher ABCG1 expression in well-nourished compared to malnourished children ( p = 0.0534). Low serum HDL was common in children living with HIV prior to ART initiation and was most pronounced in those with severe malnutrition. HDL levels partially normalised following ART. Together, these findings suggest that severe malnutrition is associated with greater disturbances in lipid homeostasis among children living with HIV before ART initiation.