Clinical, virologic and immunologic responses of children with advanced human immunodeficiency virus type 1 disease treated with protease inhibitors.
OBJECTIVE
To determine the effects of combination antiretroviral therapy including a protease inhibitor (PI combination therapy) in children with advanced HIV-1 disease.


METHODS
An observational study of HIV-1 plasma RNA, lymphocyte subsets, delayed type hypersensitivity and physical growth after initiation of PI combination therapy.


RESULTS
In nine children the median HIV-1 plasma RNA decreased 1.7 log10 (mean, 1.57; range, 0.7 to 2.2) following PI combination therapy and CD4 cells increased a median of 499 (mean, 528; range, 9 to 1088) cells/microl. A rebound of RNA, associated with the development of resistance to the PI, occurred in three subjects. Three of six children were no longer anergic and all nine achieved normal weight-growth velocities. Ritonavir was well-tolerated, despite its bitter taste; however, four of five children treated with indinavir developed renal complications.


CONCLUSIONS
PI combination therapy in children with advanced HIV-1 disease was associated with a decrease in HIV-1 RNA, improved immunologic measures and normal or better weight gain. Of concern was the rebound in plasma HIV-1 associated with resistance to the PI observed in one-third of patients. This emphasizes the need for larger studies to define optimal PI containing regimens with long term efficacy in children.
Melvin
A J
AJ
Department of Pediatrics, University of Washington, Children's Hospital and Medical Center, Seattle 98105, USA. ajmelvin@u.washington.edu
Mohan
K M
KM
Arcuino
L A
LA
Edelstein
R E
RE
Frenkel
L M
LM
D000293:Adolescent; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D002648:Child; D002675:Child, Preschool; D004352:Drug Resistance, Microbial / Q000235:genetics; D004359:Drug Therapy, Combination; D006128:Growth; D015658:HIV Infections / Q000188:drug therapy* / Q000503:physiopathology; D017320:HIV Protease Inhibitors / Q000627:therapeutic use*; D015497:HIV-1 / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D006968:Hypersensitivity, Delayed; D007223:Infant; D019562:Viral Load
D019380:Anti-HIV Agents; D017320:HIV Protease Inhibitors