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Effectiveness and safety of protease inhibitor‐based regimens in HIV ‐infected T hai children failing first‐line treatment
Author(s) -
Wattanutchariya N,
Sirisanthana V,
Oberdorfer P
Publication year - 2013
Publication title -
hiv medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.53
H-Index - 79
eISSN - 1468-1293
pISSN - 1464-2662
DOI - 10.1111/j.1468-1293.2012.01061.x
Subject(s) - interquartile range , medicine , viral load , adverse effect , gastroenterology , reverse transcriptase inhibitor , protease inhibitor (pharmacology) , human immunodeficiency virus (hiv) , antiretroviral therapy , immunology , virology
Objectives Virological failure on first‐line nonnucleoside reverse transcriptase inhibitor ( NNRTI )‐based treatment regimens has become a problem in HIV ‐infected children on long‐term antiretroviral therapy ( ART ). Protease inhibitor ( PI )‐based regimens are therefore often given to children failing NNRTI ‐based regimens. The aim of the study was to assess the 48‐week effectiveness, safety and predictive factors for viral suppression of PI ‐based regimens in HIV ‐infected Thai children who had failed NNRTI ‐based regimens. Methods This study assessed 41 HIV ‐infected children who had failed first‐line NNRTI ‐based regimens and were switched to PI ‐based regimens for at least 48 weeks. We assessed their CD 4 cell counts, plasma HIV RNA levels, weight‐for‐age and height‐for‐age z ‐scores, and adverse events. Results The children's median age was 9.5 years (range 1.5–15.8 years). At baseline, their median CD 4 cell count was 276 cells / μ L [interquartile range ( IQR ) 160–749 cells/μ L ], and their median plasma HIV RNA level was 4.5 log 10 HIV ‐1 RNA copies/mL ( IQR 3.9–4.8 log 10 copies/ mL ). After 48 weeks of PI ‐based therapy, their CD 4 cell counts increased to a median of 572 cells/μ L ( IQR 343–845 cells/μ L ) and in 73.2% plasma HIV RNA levels decreased to < 50 copies/ mL . Their median weight‐for‐age and height‐for‐age z ‐scores were stable over the period of the study. Diarrhoea occurred in 29.3% of patients. Triglyceride levels were significantly higher at weeks 24 and 48 in comparison to baseline measurements. Conclusions PI ‐based regimens are safe and effective for HIV ‐infected Thai children who have failed first‐line NNRTI ‐based regimens. However, long‐term follow‐up is warranted in order to ascertain the feasibility and sustainability of these new regimens.