Effect of antiretroviral triple combinations including the protease inhibitor nelfinavir in heavily pretreated children with HIV-1 infection.

Abstract

BACKGROUND:

In this retrospective study the effect of antiretroviral triple therapy including the protease-inhibitor nelfinavir (NFV) on CD4-cells and viral load (VL) in heavily pretreated HIV-infected children was evaluated.

PATIENTS AND METHODS:

20 children (<18 years) were included. Median duration of antiretroviral pretreatment was 27 months (range, 7 65), median initial VL was 4.7 log subset 10 (3.2 6.1) and median relative CD4-cells was 17.5% (3 33). Patients were put on combinations with NFV because of treatment failure (increasing VL), intolerance to prior therapy with PIs or adherence problems with prior indinavir. Viral load (RT-PCR, detection limit 50 copies/ml) and CD4-cells were measured every 4-8 weeks.

RESULTS:

Median viral load decreased 1.2 log(10) (-1.3 2.5), 0.9 log(10) (-0.8 - 2.5) and 0.4 log(10) (-0.5 - 3.0) after 12, 24 and 36 weeks. The VL of 2 patients was below the detection limit (50 copies/ml) after 24 weeks. The relative CD4-cell count increased from a median of 17.5% to 22%, 23% and 25% after 12, 24 and 36 weeks, respectively. Side effects of NFV were usually mild. WHO grade 1 or 2 diarrhea occurred in 70% and moderate elevations of triglycerides in 40% of the patients. At 48 weeks 18/20 patients had to be switched to other combinations due to virological failure.

CONCLUSIONS:

In children with intensive prior antiretroviral therapy combination therapy including NFV lead to a modest short-term reduction of the VL and increase in CD4-cells. However, the long-term antiretroviral effect was poor.

• Authors: F Hoffmann, M Funk, R Linde, G Notheis, T Petropoulou, J Eberle, L Gürtler, B H Belohradsky, U Wintergerst
• Journal: European journal of medical research (Eur J Med Res) Vol. 7 Issue 7 Pg. 330-4 (Jul 24 2002) ISSN: 0949-2321 [Print] England
• PMID: 12176683 (Publication Type: Journal Article)

Chemical References

• Anti-HIV Agents
• HIV Protease Inhibitors
• RNA, Viral
• Nelfinavir

Topics

• Adolescent
• Anti-HIV Agents (administration & dosage, adverse effects, therapeutic use)
• CD4 Lymphocyte Count
• Child
• Child, Preschool
• Disease Progression
• Drug Resistance, Viral
• Drug Therapy, Combination
• Female
• HIV Infections (drug therapy, genetics, immunology, virology)
• HIV Protease Inhibitors (administration & dosage, adverse effects, therapeutic use)
• HIV-1 (genetics, isolation & purification)
• Humans
• Infant
• Male
• Nelfinavir (administration & dosage, adverse effects, therapeutic use)
• RNA, Viral (blood)
• Retrospective Studies
• Time Factors
• Treatment Refusal
• Viral Load
• Viremia (drug therapy, immunology, virology)