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Paediatric antiretroviral therapy audit in South London
K Doerholt1, M Sharland, C Ball
1Paediatric Infectious Diseases Unit, St George's Hospital, London, UK.
Insights
Combination antiretroviral therapy significantly improved clinical outcomes and viral load markers in HIV-infected children. Regimens were updated rapidly, primarily due to virological failure, demonstrating therapy
Area of Science:
- Pediatric HIV/AIDS research
- Clinical pharmacology of antiretroviral drugs
- Immunology of HIV infection
Background:
- Combination antiretroviral therapy (cART) has transformed HIV management.
- Auditing treatment outcomes in pediatric populations is crucial for optimizing care.
- South London has a significant cohort of HIV-infected children requiring specialized care.
Purpose of the Study:
- To evaluate the clinical and surrogate marker outcomes of cART in HIV-infected children.
- To assess the impact of cART on viral load and CD4 counts.
- To identify reasons for antiretroviral therapy regimen changes in this pediatric cohort.
Main Methods:
- Retrospective cohort study of 110 HIV-infected children in South London (1996-1999).
- Analysis of antiretroviral therapy regimens, duration, toxicity, viral load, CD4 counts, and clinical progression.
- Data collected from the Paediatric HIV in South London Network (PHILS-NET).
Main Results:
- 83% of children received 166 cART regimens, predominantly triple therapy (NRTI-based).
- Mean duration of first-line therapy was 46 weeks; changes were driven by virological failure (60%) or toxicity (10%).
- Significant viral load reduction (<400 HIV-1 RNA copies/mL) observed in 46% on first-line and 37% on second-line therapy; clinical progression decreased substantially with highly active antiretroviral therapy (HAART).
Conclusions:
- cART demonstrated clear clinical benefits in children with moderately advanced HIV disease.
- Surrogate marker outcomes (viral load, CD4 count) align with clinical trial data.
- Rapid regimen sequencing, mainly due to virological failure, highlights the dynamic nature of pediatric HIV treatment.
Objectives:
To audit clinical and surrogate marker outcome data following the introduction of combination antiretroviral therapy to HIV-infected children in South London.
Methods:
We performed a retrospective cohort study of 110 HIV-infected children under the care of the Paediatric HIV in South London Network (PHILS-NET) from January 1996 to September 1999. The following were identified: type of antiretroviral therapy used; duration of therapy; toxicity; impact on viral load and CD4 count; reasons for changing therapy; and clinical progression.
Results:
Ninety-one (83%) of the 110 children (55 females; median age 6.3 years) received 166 antiretroviral therapy regimens. Sixty per cent of the regimens were triple therapy: either two nucleoside reverse transcriptase inhibitors (NRTIs) and one protease inhibitor (58; 34.9%) or two NRTIs and one non-nucleoside reverse transcriptase inhibitor (39; 23.5%). The mean duration of completed therapy was 46 weeks for first line therapy with a standard deviation (SD) of 38 weeks and 40 weeks in third line therapy with an SD of 22 weeks. Changes in antiretroviral regimens were owing to virological failure in 60% and toxicity in 10%. Overall, 46% of children on first line and 37% on second line antiretroviral therapy achieved an undetectable viral load of < 400 HIV-1 RNA copies/mL. Clinical progression for the whole cohort fell from 3.7% per year for children on dual therapy to 0.7% per year for children on highly active antiretroviral therapy.
Conclusions:
This audit shows the clinical benefit of antiretroviral therapy use in a cohort of children with moderately advanced HIV disease. The surrogate outcome data seen for the viral load and CD4 count are similar to those of reports from clinical trials. Antiretroviral therapy regimens were sequenced rapidly, mainly owing to virological failure.