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Variable use of therapeutic interventions for children with human immunodeficiency virus type 1 infection in Europe
S Bernardi1, C Thorne, M L Newell
1Bambino Gesù Children's Hospital, Rome, Italy.
Insights
Pediatric human immunodeficiency virus (HIV) management varies across Europe. A survey revealed differing approaches to antiretroviral therapy initiation, prophylaxis, and regimen modifications in children, highlighting the need for unified European guidelines.
Area of Science:
- Pediatric infectious diseases
- Clinical pharmacology
- Public health
Background:
- Antiretroviral drug availability for children is increasing, but optimal treatment regimens remain undefined.
- Current therapeutic management of pediatric human immunodeficiency virus (HIV) infection shows significant variation across European centers.
Purpose of the Study:
- To investigate current policies and practices in the therapeutic management of children with HIV across Europe.
- To identify variations in prophylaxis, antiretroviral therapy initiation, and regimen modification strategies.
Main Methods:
- A postal questionnaire was distributed to named pediatricians in 70 major HIV centers across 13 European countries.
- A response rate of 91% (64 pediatricians) was achieved, providing data on clinical practices in early 1998.
Main Results:
- Pneumocystis pneumonia prophylaxis was standard, but timing varied. Fungal and bacterial infection prophylaxis were common; CMV prophylaxis was less frequent.
- While nucleoside analogues were widely used, protease inhibitor availability varied. Most clinicians delayed antiretroviral therapy initiation until disease progression was evident.
- Regimen modification policies differed, with initial prescriptions varying between double and triple therapy. Clinical practice relied on various guidelines, with a consensus for European guidelines.
Conclusions:
- Significant disparities exist in the therapeutic management of pediatric HIV infection throughout Europe.
- The study underscores the need for harmonized European guidelines to standardize care for children with HIV.
Unlabelled:
Although a range of antiretroviral drugs are available for use in children, the appropriate paediatric regimen remains unclear. In a survey to investigate policies and practices relating to the therapeutic management of children infected by the human immunodeficiency virus (HIV), a postal questionnaire was sent to a named paediatrician in 70 major HIV centres in 13 European countries in early 1998. A total of 64 paediatricians (91%) responded. Pneumocystis carinii pneumonia prophylaxis was found to be routine in all centres, although considerable variation existed regarding the time of starting and stopping therapy. Prophylaxis for fungal infections and recurrent bacterial infections was common, with cytomegalovirus prophylaxis being less frequent. Although most centres (89%) used all five currently available nucleoside analogues (ziduvodine, lamivudine, stavudine, didanosine, zalcitabine), there was considerable variability regarding the availability of protease inhibitors. Most respondents delayed initiation of antiretroviral therapy until evidence of disease progression was apparent. The initial prescription of 38% of clinicians was triple therapy and that of 57% prescribed double therapy. Policies varied regarding the modification to regimens in response to disease progression and emergence of side effects and drug resistance. Clinical practice was informed by a number of sources, including centre-specific and national guidelines. Most respondents affirmed the need for European guidelines.
Conclusion:
Approaches to the therapeutic management of paediatric human immunodeficiency virus infection differ across Europe.