Adherence in pediatric anti-HIV-therapy often depends on side effects of therapy.and the age of the child.
Approximately one third of children and adolescents with perinatal HIV infection take their antiretroviral drugs irrregularly and enhance the risk of resistance development. For these patients is could be more useful to interrupt HIV-therapy with prior consultation under a clinical, immunological and virological control. In contrast to adults data of children under STI are not yet published.
In a pediatric HIV-practice in Berlin data of 10 children under STI have been evaluated. 10 perinatally HIV-infected children (10,2±2,4yrs) after antiretroviral long-term therapy interrupted 2- and 3-fold anti-HIV-therapy for 6-24 weeks. Changing of CD4- and CD8-cell count , viral load (log10 HIV-PCR) , geno- and phenotypical drug resistance and levels of serum Amylase, Lipase and γ-Glutamyl Transpeptidase have been measured at the time of STI, after 4 weeks, at the end of STI and after 6 weeks of newly started therapy. Clinical side effects and symptoms have been documented.
| Parameter |
At beginning STI |
4 wks after STI |
At end of STI |
after 6 wks therapy |
| CD4 (mm3) |
1188 ± 753 |
1061 ± 656 |
959 ± 503 |
1070 ± 601 |
| CD8 (mm3) |
1163 ± 633 |
1082 ± 257 |
1224 ± 387 |
1055 ± 351 |
| HIV-PCR (log) |
3,02 ± 0,52 |
3,46 ± 0,57 |
3,88 ± 0,65 |
2,21± 0,58 |
| IgG (mg/dl) |
1362 ± 710 |
1480 ± 762 |
1523 ± 742 |
1413± 735 |
| Γ-GT IU/l) |
12 ± 8,7 |
16 ± 17 |
12 ± 6,7 |
14 ± 10 |
| Amylase (IU/l) |
76 ± 38 |
68 ± 29 |
68 ± 45 |
76 ± 42 |
| Lipase (IU/l) |
52 ± 35 |
52 ± 35 |
31 ± 22 |
32 ± 27 |
| Phen. Resistance-Ratio |
16,4 ± 4,5 |
- |
- |
9,5 ± 3,5 |
Despite of reduction of the CD4 cell count no child developed clinical symptoms. Side effects of antiretroviral drugs could be avoided by STI. Especially after longer STI`s a reduction of drug resistance was found. All children, adolescents and their parents valued their STI`s positively. Therefore further studies about STI in children are necessary.
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