Efficacy and tolerability of multiple drug therapy in HIV-infected children.
OBJECTIVE
To characterize the efficacy and tolerability of multiple drug therapy (MDT) among heavily pre-treated HIV-infected children.


METHODS
An observational study of seven children treated with 4-7 antiretroviral agents. MDT regimens were chosen with regard to past antiretroviral exposure and genotypic resistance data. Five children received MDT once, one child twice and one child four times. All patients had AIDS and severe CD4+ depletion and failed >2 PI-based HAART regimens.


RESULTS
Virologic response, defined as a > or =log10 decrease in plasma HIV-1 RNA at week 24, was achieved in 7/11 MDT. Successful MDT kept a sustained viral suppression (<50 copies/ml) at longest follow-up (72-96 weeks). Successful MDT obtained a great immune recovery: the median rise in absolute and percentage of CD4+ cells was 261 and 4 at week 24 and it reached 480 and 16 at 72-96 weeks. Adverse events were common but generally manageable. Mild/moderate gastrointestinal complaints and laboratory abnormalities were detected in 5/11 and 8/11 MDT. Grade 2 severity pancreatitis occurred in one case with chronic active hepatitis C. Pancreatitis resolved within 30 days of MDT interruption.


CONCLUSIONS
MDT may be a therapeutic option in children who failed to respond to most standard HAART regimens.
Viganò
Alessandra
A
Clinica Pediatrica, L. Sacco Hospital, University of Milan, Via G.B. Grassi 74, 20153 Milano, Italy. alessandra.vigano@unimi.it
Schneider
Laura
L
Giacomet
Vania
V
Bianchi
Roberta
R
Cicero
Mirko Lo
ML
Soster
Francesca
F
Bulgheroni
Elisabetta
E
Rusconi
Stefano
S
D000163:Acquired Immunodeficiency Syndrome / Q000209:etiology; D000293:Adolescent; D044966:Anti-Retroviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D002648:Child; D004359:Drug Therapy, Combination; D005260:Female; D005767:Gastrointestinal Diseases / Q000139:chemically induced; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D015497:HIV-1 / Q000235:genetics; D006801:Humans; D008297:Male; D010195:Pancreatitis / Q000139:chemically induced; D012367:RNA, Viral / Q000032:analysis; D016896:Treatment Outcome; D019562:Viral Load
D044966:Anti-Retroviral Agents; D012367:RNA, Viral