title: Evaluation of multiple drug therapy in human immunodeficiency virus-infected pediatric patients.
abstract: BACKGROUND
  An aggressive therapeutic approach for treatment of HIV in adults consists of combining five or more concurrent antiretrovirals. The clinical benefits of this regimen are often accompanied by increased toxicities. We report the safety and tolerance of multiple drug therapy in HIV-infected children.
  
  
  METHODS
  A retrospective chart review was performed to identify HIV-infected children who received > or =5 concurrent antiretrovirals or 4 antiretrovirals plus hydroxyurea. Treatment success was defined as > or =1 log(10) decrease in plasma HIV RNA from baseline any time during multiple drug therapy. Toxicities were defined as a >Grade 2 change from baseline in laboratory values.
  
  
  RESULTS
  Twelve patients received multiple drug therapy for 6 months, and 42% of patients continued to receive therapy for at least 1 year. No Grade 3 or 4 toxicities or laboratory abnormalities were reported. Treatment success occurred in 8 (83%) of 12 patients. Adherence was a determining factor in treatment success or failure.
  
  
  CONCLUSIONS
  Treatment of HIV-infected children with multiple drug therapy was well-tolerated in this cohort. Treatment success occurred in most patients, with adherence affecting patients' likelihood of success. Larger controlled clinical trials in this patient population are necessary to determine whether the benefit of this therapeutic approach outweighs potential risks.
authors.affiliation: Division of Clinical Pharmacology, University of Alabama at Birmingham, 35294, USA.
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: King
authors.forename: Edward P
authors.initials: EP
authors.lastname: Acosta
authors.forename: Ellen
authors.initials: E
authors.lastname: Chadwick
authors.forename: Ram
authors.initials: R
authors.lastname: Yogev
authors.forename: Marilyn
authors.initials: M
authors.lastname: Crain
authors.forename: Robert
authors.initials: R
authors.lastname: Pass
authors.forename: David W
authors.initials: DW
authors.lastname: Kimberlin
authors.forename: Marsha S
authors.initials: MS
authors.lastname: Sturdevant
authors.forename: Grace M
authors.initials: GM
authors.lastname: Aldrovandi
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects* / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D007223:Infant; D008297:Male; D020714:Maximum Tolerated Dose; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D019380:Anti-HIV Agents