Effect of combination antiretroviral therapy on cerebrospinal fluid HIV RNA, HIV resistance, and clinical manifestations of encephalopathy.
OBJECTIVE
This study evaluated the effect of treatment with abacavir/lamivudine/zidovudine versus lamivudine/zidovudine on cerebrospinal fluid (CSF) human immunodeficiency virus (HIV) RNA and clinical manifestations of HIV encephalopathy in children.


METHODS
HIV-infected children 7 months to 10 years of age (n = 23) were studied. CSF and plasma were obtained at baseline and weeks 8, 16, and 48. Genotype analysis of HIV was attempted at baseline and week 48. Neurologic evaluations were performed at baseline and weeks 16, 32, and 48.


RESULTS
At baseline, 83% of children had >2.00 log(10) copies/mL HIV RNA in CSF, but only 10% had HIV RNA measurable at week 48. Among children in whom paired genotyping of HIV was possible, 8 of 11 had identical patterns in both CSF and plasma at baseline, whereas at week 48, only 1 of 9 children had similar patterns. Neurologic abnormalities were observed in 83% of children at baseline but only 35% of children at week 48 (P =.004), suggesting a benefit of treatment.


CONCLUSIONS
Antiretroviral therapy was associated with a decline in CSF HIV RNA and an improvement in neurologic status. The development of genotypic mutations was different in CSF and plasma, suggesting discordant viral evolution. These results suggest that antiretroviral treatment in children should include agents with activity in the CNS.
McCoig
Cynthia
C
Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas 75390-9063, USA.
Castrejón
Maria Mercedes
MM
Castaño
Elizabeth
E
De Suman
Onix
O
Báez
Carmen
C
Redondo
Wilfrido
W
McClernon
Daniel
D
Danehower
Susan
S
Lanier
E Randall
ER
Richardson
Carol
C
Keller
Amy
A
Hetherington
Seth
S
Sáez-Llorens
Xavier
X
Ramilo
Octavio
O
D015526:AIDS Dementia Complex / Q000145:classification / Q000175:diagnosis / Q000188:drug therapy*; D019380:Anti-HIV Agents / Q000494:pharmacology / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D015224:Dideoxynucleosides / Q000494:pharmacology / Q000627:therapeutic use*; D024882:Drug Resistance, Viral; D004359:Drug Therapy, Combination; D015497:HIV-1 / Q000187:drug effects / Q000235:genetics; D006801:Humans; D007223:Infant; D019259:Lamivudine / Q000494:pharmacology / Q000627:therapeutic use*; D012367:RNA, Viral / Q000097:blood / Q000134:cerebrospinal fluid; D018709:Statistics, Nonparametric; D019562:Viral Load; D015215:Zidovudine / Q000494:pharmacology / Q000627:therapeutic use*; D000099227:Abacavir
D019380:Anti-HIV Agents; D015224:Dideoxynucleosides; D019259:Lamivudine; D012367:RNA, Viral; D015215:Zidovudine; D000099227:Abacavir