Combo HIV drug therapy safe, effective in children

Treatment with combination anti-HIV drug therapy that includes a drug from the class known as protease inhibitors is safe and effective for the long-term treatment of previously treated HIV-infected children, according to a report in The Pediatric Infectious Disease Journal.

Our experience shows that the therapeutic effects achieved in clinical trials "also hold true in a real world situation," Dr. Christoph Rudin told Reuters Health. "One can also endorse the view that adherence is probably the most important issue" when a patient first begins treatment because the first regimen appears to achieve better patient outcomes than treatments that follow.

Rudin from University Children's Hospital, Basel, Switzerland and colleagues evaluated the safety, tolerability, and effectiveness of a combination drugs that included one or more protease inhibitors - ritonavir, nelfinavir, and a lopinavir/ritonavir compound - in 133 HIV-infected children previously exposed to anti-HIV drug therapy. The children were also given at least one agent from the drug class called nucleoside reverse transcriptase inhibitors, such as zidovudine or lamivudine.

Significant reductions in average blood levels of the virus and increases in average blood levels of CD4 T cells, white blood cells that decrease as HIV infection advances, were seen within 4 weeks after the initiation of treatment with ritonavir, nelfinavir, or lopinavir/ritonavir, the authors report. These improvements persisted through week 96.

In a combined analysis of patients who had never been treated with protease inhibitors and those who had, 66 percent of children receiving ritonavir-based regimens, 55.0 percent of those receiving nelfinavir-based regimens, and 68.8 percent of those receiving lopinavir/ritonavir-based regimens achieved a decline in virus levels by week 48.

Only one hospitalization (pancreatitis during the first 180 days of ritonavir use) was considered related to protease inhibitor treatment, the investigators say, and other side effects were similar for the three treatment combinations.

This is our first experience with protease-based anti-HIV drug regimens in Switzerland, Rudin said. "We think that this piece of evidence is still relevant, especially with regard to safety issues, as today most children will be treated with ritonavir-boosted newer protease inhibitors."

SOURCE: The Pediatric Infectious Disease Journal, May 2008.