AIDSWEEKLY Plus; Monday, July 24, 2000
Prepared by AIDS Weekly editors from staff and other reports

NewsRx -- Antiretroviral combination therapy reduces the risk of death in human immunodeficiency virus-type 1 (HIV-1) perinatally (occurring around the time of birth) infected children, according to an article in the July 12 issue of The Journal of the American Medical Association.

The study was presented by co-author Patrizio Pezzotti, D.Stat., at a JAMA HIV/AIDS media briefing at the 13th International AIDS Conference in Durban, South Africa. Pezzotti is a senior researcher at the AIDS Surveillance Unit, Istituto Superiore di Sanita, Rome.

Lead author Maurizio de Martino, MD, of the University of Florence, Italy, and colleagues conducted a study to assess the effectiveness of antiretroviral therapy on survival of HIV-1 perinatally infected children. The study included 1,142 HIV-1 perinatally infected children born between November 1980 and December 1997. The data were collected by the Italian Register for HIV Infection in Children.

According to background information cited in the study, clinical trials conducted among limited numbers of perinatally HIV-1 infected children have shown that combined antiretroviral therapy reduces viral load and increases CD4-positive lymphocyte counts, yet among children there is a lack of studies that have evaluated the effectiveness of combination therapy on survival in settings other than clinical trials. As the authors noted, trials with adults have found that combination therapies are more efficacious than monotherapy in reducing the risk of AIDS and death.

In this study, the authors found that the probability of survival was significantly higher for the 1996-1997 birth cohort compared with the 1980-1989 and 1990-1995 birth cohorts, with similar findings for calendar periods. These periods of times are grouped to coincide with the distribution of the predominant type of antiretroviral therapy given over time. When the effects of birth cohort, calendar period, and type of antiretroviral therapy were assessed simultaneously (in the same model), the risk of death was not significantly different from one for the 1996-1997 birth cohort and calendar period 1996-1998. The risk of death in children when receiving monotherapy, double, or triple combination therapy was 23%, 30%, and 71% lower, respectively, compared to no antiretroviral therapy.

"Our study shows that although the survival of HIV infected children in Italy remained unchanged up to 1995, it has significantly improved since 1996, with a more than 30% reduction in the adjusted risk of death for children at risk in the period 1996-1998 versus those at risk in the period 1980-1989," the authors wrote. "This can be explained by the fact that in 1996 the use of double combination therapy became widespread and triple combination therapy was introduced in the care of HIV infected children.

"The incremental protective effect of therapy was also evident, in that the risk of death decreased by 30% for double combination therapy (although statistically non-significant) and by approximately 70% for triple combination therapy. Finally, the estimated decrease in the risk of death since 1996 disappeared after adjusting for type of therapy, suggesting a causal relationship between decreased risk of death and use of combination therapy. Thus, overall, our results indicate that antiretroviral combination therapy reduced, at the population level, the risk of death in perinatally infected children."

De Martino et al. continued: "Notwithstanding the biologic characteristics of perinatal HIV infection and difficulties in treating infants and children, our study shows the effectiveness at a population level of triple combination therapies in the pediatric age group. The effectiveness in infants and children is at least similar, or even greater, than that observed in adults" JAMA 2000 Jul 12;284(2):190-7.

This work was supported by the Ministero della Sanit Istituto Superiore di Sanit Progretto AIDS 1998.

This article was prepared by AIDS Weekly editors from staff and other reports.

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