Clinical experience using two nucleoside analogs plus Hydroxyurea for the treatment of HIV-Infected Children.
Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. MoOrB178)
Avila Figueroa C C. Avila Figueroa, HOSPITAL INFANTIL DE MEXICO, DR. Marquez 162 Col. Doctores, PO Box 06720, Mexico, Tel.: +52 5588 7149, Fax: +52 5588 7149, E-mail: avilaf@infosel.net.mx
Analysis is presented for 21 HIV-infected children treated for 9 months with an antiretroviral (ARV) combination including ddI+d4T plus Hydroxyurea (30mg/kg/day). The data is part of an ongoing open-label randomized trial to compare the efficacy and safety of this regimen versus HAART (ZDV+3TC+Ritonavir). HIV-infected children 2-8 years old with detectable viral load measured by quantitative plasma HIV-1 RNA PCR (Amplicor) were included. Mean age was 40 months and 12/21 children were nucleoside analog experienced. At baseline the mean viral load (Log10) and CD4 counts (%) were 128,907 copies (5.0) and 460 cells (15%) respectively. After 36 weeks of treatment, the levels of viral load declined 1.1 Log10. In contrast the CD4 cell count increased on the average 200 cells (5%). Monthly increase in weight and height were 216 grams and 0.6 cm respectively. All these improvements were greater in the naive as compared to the previously ARV experienced patients. The incidence of serious infections requiring hospital admission was 1.2 per person-year, which represent a reduction from the historical data collected before the ARV era of 3.6 infections per person-year. Adverse events were negligible; only one patient had transient neutropenia. Additionally, we observed than the regimen of hydroxyurea plus two nucleoside analogs was better tolerated and had lower cost ($287 Vs $445 USD) than HAART. Consistent with other reports, there is an apparent disconnection between the satisfactory clinical improvements in the well being of children receiving ARV combinations and the difficulty to achieve virologic targets. Few children achieved HIV-1 RNA below detection levels (>50 copies/mL); however, they showed a sustained increase in CD4 counts, lineal growth and weight gain, as well as a reduction in the incidence of severe infections and hospital admissions.
Keywords: AEGIS, HIV, HIV Infections, Stavudine, Didanosine, CD4 Lymphocyte Count, Hydroxyurea, Zidovudine, Lamivudine, Anti-HIV Agents, Antiretroviral Therapy, Highly Active, Viral Load, HIV Protease Inhibitors, Ritonavir, Drug Therapy, Combination, HIV Seropositivity, Child, Human, therapy, utilization, drug therapy
000709
MoOrB178
