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Protease inhibitor therapy in HIV-infected children
A R Feingold1, R M Rutstein, D Meislich
1The Children's Regional Hospital, Camden, New Jersey 08103, USA. Feingold-Anat@Cooperhealth.edu
Insights
Protease inhibitor (PI) therapy significantly improved immune function and reduced viral load in HIV-infected children. Good compliance correlated with better treatment response, though side effects were noted.
Area of Science:
- Pediatric Infectious Diseases
- Virology
- Immunology
Background:
- Human Immunodeficiency Virus (HIV) infection remains a significant health concern in children.
- Antiretroviral therapy (ART) is crucial for managing pediatric HIV.
- Protease inhibitors (PIs) are a key component of ART regimens.
Purpose of the Study:
- To evaluate the short-term efficacy and safety of protease inhibitor (PI)-containing antiretroviral therapy (ART) in HIV-infected children.
- To assess the impact of PI therapy on immunological and virological markers.
- To examine the relationship between patient compliance and treatment outcomes.
Main Methods:
- Retrospective chart review of 70 HIV-infected children receiving PI-containing ART at two urban pediatric centers.
- Analysis of follow-up CD4 counts and viral loads as primary outcome measures.
- Inclusion of patient or caregiver-reported compliance data.
Main Results:
- PI-containing ART was associated with a mean maximal increase in CD4+ lymphocyte count of 454 x 10(6)/L.
- A mean maximal decrease in viral load of 1.76 log units was observed.
- 87.5% of patients achieving undetectable viral loads maintained this status for a mean of 8.9 months.
- Good compliance was linked to a higher response rate (92.6%) compared to poor compliance (61.5%).
- 11 out of 14 patients (78.6%) responded positively to a second PI regimen after treatment failure.
- Significant side effects occurred in 19 of 101 PI therapy courses, with renal complications noted in 8 of 21 patients on indinavir.
Conclusions:
- PI-containing ART demonstrated substantial short-term improvements in immunological and virological parameters in a heavily pretreated pediatric HIV cohort.
- Approximately 40% of patients maintained undetectable viral loads after 9 months of PI therapy.
- Patients experiencing treatment failure with one PI regimen often responded well to a second PI regimen.
- A notable incidence of side effects associated with PI treatment was observed.
Abstract:
We reviewed the short-term response to and safety of protease inhibitor (PI) therapy in HIV-infected children by performing a retrospective chart review of open-label PI containing combination therapy at two urban pediatric HIV centers. Seventy HIV-infected children received 101 PI containing antiretroviral therapy (ART) combinations. Main outcome measures were follow-up CD4 counts, viral loads, and patient or caregiver reported compliance. During follow-up, treatment with PI ART was associated with a mean maximal increase in CD4+ lymphocyte count of 454 x 10(6)/L and a mean maximal decrease in viral load of 1.76 log units. Of the 32 patients who achieved undetectable viral loads, 28 (87.5%) remained undetectable through a mean follow-up of 8.9 months. Patients who reported good compliance achieved a higher rate of response (92.6%) than those who reported poor compliance (61.5%). Of 14 changes made to a second PI because of treatment failure, 11 (78.6%) resulted in a positive response to the second regimen. Nineteen of 101 courses of PI therapy resulted in significant side effects, including renal complications in 8 of 21 patients treated with indinavir. PI ART was associated with substantial short-term improvement in immunological and virological parameters in this heavily pretreated cohort, with 40% of patients maintaining an undetectable viral load after 9 months of therapy. Patients who failed one PI regimen usually responded to a second regimen. There was a significant rate of side effects from PI treatment.