Initiation of HAART was defined as the first time the children took a PI with two or more additional antiretrovirals. Subsequent changes of HAART were ignored in the statistical analysis as long as the HAART regimen still included a PI. Height and weight were used to calculate the body mass index (BMI). For classification by BMI category, overweight and low weight were defined according to the World Health Organization (WHO) Expert Committee [19]. The degree of insulin resistance (IR) was estimated by the homeostatic model assessment method

(HOMA) from samples acquired from fasting patients via the formula: plasma glucose (mmol/L) × serum insulin (mU/L)/22.5. Lipodystrophy diagnoses were based on the clinical examination at the last visit according to Hartman et al. [20]. The degree of lipoatrophy or lipohypertrophy in every part of the body was measured as absent www.selleckchem.com/products/pd-166866.html (score of 0), mild (score of 1), moderate (score of 2), or severe (score of 3). Patients with scores ≥2 were classified in the lipodystrophy (LD) group and patients with scores <2 were classified find more in the nonlipodystrophy (NLD) group. Multiplex suspension bead array immunoassays were performed using the Luminex 100™ analyser (Luminex Corporation, Austin, TX, USA) and Multiplex kits (LINCOplex™; LINCO Research, St Charles, MO, USA) to determine protein levels in plasma according to the user manual. The statistical analysis

was performed with the Statistical Package for the Social Sciences (SPSS) (v.12) (SPSS, Chicago, IL, USA). All P-values were two-tailed. Statistical significance was defined as P<0.05. Continuous variables were compared longitudinally either within groups or against baseline data (Wilcoxon's test). Table 1 shows the demographic and clinical baseline characteristics of the 27 vertically HIV-infected children during 48 months on HAART. Most of the study population were female, Benzatropine were in Centers for Disease Control and Prevention (CDC) category C and had

previously been treated with combined therapy. Table 2 shows details of the ART received by the children. The most frequently prescribed HAART protocol at baseline was two NRTIs+one PI. The NRTI most frequently in use was lamivudine (3TC) and the most common PI was nelfinavir (NFV). After 2 years on HAART, 13 children remained on their initial HAART regimen, but by 4 years only seven children remained on their initial regimen. Figure 1 shows the medians for peripheral T-cell subset percentages, plasma viral load, and lipid and adipokine concentrations during follow-up of the study subjects. The median CD4 percentage increased to >25% at 12 months of HAART (Fig. 1a), and the median CD8 percentage was >30% at HAART initiation and throughout the entire follow-up period (Fig. 1b). The median viral load decreased during follow-up (Fig. 1c), but HAART reduced the viral load to ≤400 HIV-1 RNA copies/mL in <50% of children (37, 40.