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Ritonavir combination therapy restores intestinal function in children with advanced HIV disease
R B Canani1, M I Spagnuolo, P Cirillo
1Department of Pediatrics, University Federico II, Naples, Italy.
Insights
Combination therapy including ritonavir significantly improves intestinal function in children with HIV. This treatment restores nutrient absorption, reduces viral load, and promotes healthy weight gain.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Clinical Nutrition
Background:
- Children with advanced HIV infection often experience intestinal malabsorption.
- Impaired nutrient absorption can exacerbate disease progression and affect growth.
Purpose of the Study:
- To evaluate the impact of combination antiretroviral therapy (cART) including ritonavir on intestinal absorptive processes in children with HIV.
- To determine if cART improves carbohydrate and fat absorption and reduces protein loss.
Main Methods:
- Intestinal function tests (D-xylose, steatocrit, fecal alpha1-antitrypsin, serum iron) were performed in 10 children with HIV before and after 3 and 6 months of cART.
- HIV viral load, CD4 cell counts, and body weight were monitored throughout the study.
Main Results:
- Prior to treatment, significant malabsorption (carbohydrate, fat, protein) and iron deficiency were prevalent.
- Within 3 months of cART, most absorption tests normalized, with complete resolution of abnormalities by 6 months.
- Treatment led to significant improvements in all absorption tests, decreased viral load, increased CD4 counts, and catch-up growth.
Conclusions:
- Combination therapy including ritonavir effectively restores intestinal function in children with HIV.
- Improved intestinal function is linked to virologic and immunologic recovery and improved nutritional status.
- This therapy offers a promising approach to managing gastrointestinal complications in pediatric HIV.
Objectives:
To investigate the intestinal absorptive processes in children with HIV infection before and after treatment with combination therapy that includes ritonavir. To test the hypothesis that combination therapy improves intestinal function.
Design:
Intestinal function tests were performed in 10 children with advanced HIV disease at the enrollment and after 3 and 6 months of therapy with ritonavir combined with two HIV reverse transcriptase inhibitors. HIV viral load and CD4 cell counts were also determined; body weight was monitored.
Methods:
The D-xylose absorption test, the steatocrit and the determination of fecal alpha1-antitrypsin concentration were used to evaluate carbohydrate and fat absorption, as well as fecal protein loss. Serum iron levels were measured to indirectly evaluate iron absorption. HIV-1 RNA-polymerase chain reaction (PCR) and immunofluorescence imaging were used to evaluate virologic and immunologic responses.
Results:
In all, 9 children had carbohydrate malabsorption, 3 steatorrhea, 2 protein loss, and 7 iron deficiency. Most tests produced normal results after 3 months of therapy, and all abnormalities were abolished 6 months after institution of combination therapy. Mean results of each of four absorption tests were significantly changed on combination therapy. Viral load was progressively reduced and CD4 count was increased, with an inverse relationship. An evident shift of body weight pattern toward catch-up growth was observed in all children.
Conclusions:
Ritonavir combination therapy results in prompt and sustained restoration of intestinal function, which is associated with reduction in viral load, increase in CD4 counts, and gain in body weight.