Retrovir therapy in hemophilic children with symptomatic human immunodeficiency virus infection: efficacy and toxicity.
In desperation, we have used retrovir in five hemophilic children (10-16 years old) over the past 22 months. All had presented with various clinical manifestations of acquired-immune-deficiency-syndrome (AIDS)-related complex or AIDS. Our decision to treat with retrovir was based on clinical manifestations and very low numbers of CD4 cells (less than 200). The most common clinical presentation was recurrent oral moniliasis. Other significant findings included recurrent herpes zoster, thrombocytopenia, growth failure, and biliary tract infection. Initially, all five children received the full adult dosage of retrovir (200 mg q 4 h x 6 doses/day). This dosage had to be reduced in four children because of toxicity. The most commonly observed toxic side effects were anemia and neutropenia. Alanine aminotransferase (ALT) levels rose to 4-10 times the upper limit of normal in four of five children. One was on concomitant ketokonazole prior to the rise in ALT level. Myalgia and headache were reported by two patients. Improvement in clinical and immunological status was observed in all children initially. After 12-18 months of retrovir therapy, infectious complications secondary to prolonged neutropenia were seen in these immunocompromized children. However, compared to historic controls, these children have had fairly stable disease. We feel that all hemophilic children with symptomatic human immunodeficiency virus infection should be offered this drug, even though the optimal dosage for children is not yet established.
Warrier
I
I
Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit 48201.
Lusher
J M
JM
D000386:AIDS-Related Complex / Q000150:complications / Q000188:drug therapy*; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000188:drug therapy*; D000293:Adolescent; D000740:Anemia / Q000139:chemically induced; D002648:Child; D004341:Drug Evaluation; D006467:Hemophilia A / Q000150:complications*; D006801:Humans; D009503:Neutropenia / Q000139:chemically induced; D009894:Opportunistic Infections / Q000517:prevention & control; D015215:Zidovudine / Q000009:adverse effects / Q000627:therapeutic use*
D015215:Zidovudine