title: Response to two consecutive protease inhibitor combination therapy regimens in a cohort of HIV-1-infected children.
abstract: The response to 2 consecutive protease inhibitor (P1) combination regimens was evaluated in a cohort of HIV-1-infected children. Twelve children, most of whom had been heavily treated, received a 3-drug treatment: saquinavir in hard gelatin capsules (SQVhgc) + zidovudine (ZDV) + didanosine. When this treatment failed it was replaced by a 4-drug regimen: ritonavir + SQVhgc + ZDV + lamivudine. A mild and temporary decrease in viral load (VL) was observed with the initial regimen (p = 0.22). Therapy failure occurred in 7 patients (58%) within 9 months and in another 3 (25%) within 9-18 months. The 7 children who failed within 9 months received the subsequent boosted regimen, leading to a significant and lasting reduction in VL (p = 0.001). None of the patients failed on the boosted regimen: 5/7 achieved a VL of < 400 copies/ml and 3/7 achieved a VL of < 50 copies/ml. Our results suggest that a 4-drug regimen including 2 PIs produces a better and more sustained response than a 3-drug regimen including only 1 PI, and that a good, sustained response is possible with subsequent boosted regimens even in heavily treated children.
authors.affiliation: Unidad de Investigacion Medica en Epidemiologia Clinica Hospital de Pediatria, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City. palsaugc@terra.com.mx
authors.forename: Gerardo C
authors.initials: GC
authors.lastname: Palacios
authors.forename: Veronica L
authors.initials: VL
authors.lastname: Palafox
authors.forename: Maria T
authors.initials: MT
authors.lastname: Alvarez-Muñoz
authors.forename: Guillermo
authors.initials: G
authors.lastname: Vazquez
authors.forename: Guadalupe
authors.initials: G
authors.lastname: Miranda
authors.forename: Onofre
authors.initials: O
authors.lastname: Muñoz
authors.forename: Fortino
authors.initials: F
authors.lastname: Solorzano
mesh_terms: D000293:Adolescent; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D017320:HIV Protease Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D015497:HIV-1 / Q000502:physiology*; D006801:Humans; D007223:Infant; D012367:RNA, Viral / Q000097:blood; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents; D017320:HIV Protease Inhibitors; D012367:RNA, Viral; D018894:Reverse Transcriptase Inhibitors