Protease inhibitor therapy in children with perinatally acquired HIV infection.

Important note: Information in this article was accurate in 1998. The state of the art may have changed since the publication date.

Protease inhibitor therapy in children with perinatally acquired HIV infection.

AIDS. 1997 Oct;11(12):F107-11. Unique Identifier : AIDSLINE /MED98000109
Rutstein RM; Feingold A; Meislich D; Word B; Rudy B; Division of General Pediatrics, Children's Hospital of Philadelphia,; Pennsylvania 19104, USA.

Abstract: OBJECTIVE: To review the short-term response and safety of protease inhibitor therapy in HIV-infected children. DESIGN: Retrospective chart review of open-label protease inhibitor-containing combination therapy. SETTING: Two urban pediatric HIV centers. PATIENTS: Twenty-eight HIV-infected children were prescribed 30 protease inhibitor-containing antiretroviral therapy combinations. The median age at initiation of protease inhibitor antiretroviral therapy was 79 months. Patients had been on previous antiretroviral therapy for a mean of 45.5 months. RESULTS: Of the 28 children who completed at least 1 month of therapy, 26 experienced marked virologic and immunologic improvement (mean maximal decrease in viral load 1.90 log10 copies/ml; SD, 0.8; mean maximal rise in CD4+ lymphocytes of 279 x 10(6)/l; SD, 300 x 10(6)/l). Eleven patients achieved a viral nadir of < 400 copies/ml, and seven sustained this level of viral suppression for a mean of 6 months. Indinavir use was associated with a high incidence of renal side-effects, including two patients who developed interstitial nephritis. Two patients on ritonavir experienced a significant elevation of liver enzymes. CONCLUSIONS: Protease inhibitor therapy was associated with substantial short-term virologic and immunologic improvement in this primarily heavily pretreated cohort, with 25% maintaining a viral load of < 400 copies/ml after 6 months of therapy. There was a significant rate of adverse events. Pharmacokinetic and safety data are needed to guide aggressive antiretroviral therapy in HIV-infected children, and further treatment options are required for those failing or intolerant to the available protease inhibitors.

Keywords: *Anti-HIV Agents/THERAPEUTIC USE *HIV Infections/DRUG THERAPY *HIV-1 *Protease Inhibitors/THERAPEUTIC USE
980130
M9811081

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