title: Use of nucleoside reverse transcriptase inhibitor-only regimens in HIV-infected children and adolescents.
abstract: OBJECTIVE
  In adults, nucleoside reverse transcriptase inhibitor-only antiretroviral regimens (NOARs) with ≥3 nucleoside reverse transcriptase inhibitors are less potent than highly active antiretroviral therapy (HAART). Published pediatric experience with NOARs is limited; thus, we wished to better define the virological, immunological and toxicological effects of NOARs in children and adolescents.
  
  
  METHODS
  We analyzed data from NOAR-treated participants in LEGACY, a multicenter observational cohort study of HIV-infected children and adolescents. NOAR-treated case-participants were matched to participants without prior NOAR who initiated HAART during the same year for comparison.
  
  
  RESULTS
  Of 575 participants with data from time of HIV diagnosis through 2006, 67 (12%) received NOARs for at least 24 weeks; most (46%) received the fixed dose combination of zidovudine/lamivudine/abacavir. NOAR use peaked in 2001 to 2002. NOAR-treated participants were significantly older and more treatment experienced than HAART-treated participants. Virologic outcomes, including the percentage of participants with a plasma HIV RNA viral load <400 copies/mL at week 24 (47% versus 34%) and the mean 24-week change in log10 plasma HIV RNA viral load from baseline (-0.63 versus -1.02), were similar between NOAR- and HAART-treated participants, but virologic rebound was more likely in NOAR-treated participants (77% versus 54%, P = 0.02). Increase in CD4 percentage points from baseline to 24 weeks was negligible in NOAR-treated participants compared with HAART-treated participants (0.95% versus 10.1%, P < 0.001). Anemia and leukopenia were more commonly reported with NOARs than HAART.
  
  
  CONCLUSIONS
  Week 24 virologic outcomes were similar between NOAR- and HAART-treated participants, but NOAR durability was poorer and their use was associated with less immunologic reconstitution. NOARs should play a limited role in pediatric and adolescent antiretroviral therapy.
authors.affiliation: From the *Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA; †Children's Hospital of Philadelphia, Philadelphia, PA; ‡University Texas Health Science Center at Houston, Houston, TX; §University Texas-Southwestern Medical Center, Dallas, TX; ¶Jacobi Medical Center, Bronx, NY; ‖Centers for Disease Control and Prevention; and **Northrop Grumman, Atlanta, GA.
authors.forename: Michael
authors.initials: M
authors.lastname: Neely
authors.forename: Richard
authors.initials: R
authors.lastname: Rutstein
authors.forename: Gabriela
authors.initials: G
authors.lastname: Del Bianco
authors.forename: Gloria
authors.initials: G
authors.lastname: Heresi
authors.forename: Theresa
authors.initials: T
authors.lastname: Barton
authors.forename: Andrew
authors.initials: A
authors.lastname: Wiznia
authors.forename: Ryan
authors.initials: R
authors.lastname: Wiegand
authors.forename: Travis
authors.initials: T
authors.lastname: Wheeling
authors.forename: Beverly
authors.initials: B
authors.lastname: Bohannon
authors.forename: Kenneth
authors.initials: K
authors.lastname: Dominguez
mesh_terms: D000293:Adolescent; D019380:Anti-HIV Agents / Q000009:adverse effects / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004359:Drug Therapy, Combination / Q000009:adverse effects / Q000379:methods; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology / Q000473:pathology; D005260:Female; D006678:HIV / Q000302:isolation & purification; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000453:epidemiology / Q000473:pathology; D007223:Infant; D009705:Nucleosides / Q000009:adverse effects / Q000627:therapeutic use*; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood; D018894:Reverse Transcriptase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome; D019562:Viral Load; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D009705:Nucleosides; D012367:RNA, Viral; D018894:Reverse Transcriptase Inhibitors