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Long-term safety and effectiveness of ritonavir, nelfinavir, and lopinavir/ritonavir in antiretroviral-experienced HIV-infected children

Rudin, Christoph
Burri, Marcus
Shen, Yang
Rode, Richard
Nadal, David
CollaborationWith : Gervaix, Alain / Myers, Catherine Jayne / Posfay Barbe, Clara / Siegrist, Claire-Anne
Published in Pediatric Infectious Disease Journal. 2008, vol. 27, no. 5, p. 431-437
Abstract AIM: To evaluate the long-term safety and effectiveness of ritonavir, nelfinavir, and lopinavir/ritonavir in antiretroviral-experienced, initially protease inhibitor (PI)-naive, human immunodeficiency virus (HIV)-1-infected children. METHODS: HIV-1-infected children enrolled in the Swiss Mother and Child HIV Cohort Study were eligible for this observational cohort study if they received at least 1 PI of interest between March 1996 and October 2003: ritonavir, nelfinavir, or lopinavir/ritonavir. Data regarding demographics, clinical disease and antiretroviral treatment history, HIV-1 RNA copies/mL, CD4 T-cell counts [absolute (cells/microL) and percentages (%)], adverse events, clinical laboratory values, reasons for discontinuation of PIs, and concomitant medications were extracted from the database for PI-naive (first-line) and PI-experienced (second- or higher-line) PI use. RESULTS: The total duration of ritonavir, nelfinavir, and lopinavir/ritonavir use for 133 HIV-1-infected children was 163.8, 235.0, and 46.1 patient-years, respectively. In an on-treatment analysis, first-line therapy with any of the PIs significantly reduced HIV-1 concentrations and increased CD4 T-cell counts and percentages from baseline throughout the 288-week study (P <or= 0.05) for ritonavir and nelfinavir and throughout 84 weeks of use for lopinavir/ritonavir, which was introduced into treatment more recently. All PIs investigated were most effective in PI-naive children. Thirteen PI-associated toxicities occurred requiring treatment changes or interruptions (neurologic symptoms, n = 2; pancreatitis, n = 1; allergic reactions, n = 4; visual symptoms, n = 3; and hyperlipidemia, n = 3). CONCLUSIONS: Long-term PI-based therapy seems to be safe and to result in durable virologic and immunologic effectiveness in HIV-1-infected antiretroviral-experienced children.
Keywords AdolescentCD4 Lymphocyte CountChildChild, PreschoolCohort StudiesFemaleHIV Infections/drug therapy/immunology/virologyHIV Protease Inhibitors/adverse effects/therapeutic useHIV-1HumansInfantInfant, NewbornLongitudinal StudiesMaleNelfinavir/adverse effects/therapeutic usePregnancyPyrimidinones/adverse effects/therapeutic useRitonavir/adverse effects/therapeutic useSwitzerlandTreatment OutcomeViral LoadWithholding Treatment
PMID: 18382386
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Research groups Centre de Vaccinologie et d'Immunologie néonatale (177)
Etiologie des pneumonies et marqueurs inflammatoires chez l'enfant fébrile (183)
Groupe Posfay-Barbe Clara (pédiatrie générale) (853)
(ISO format)
RUDIN, Christoph et al. Long-term safety and effectiveness of ritonavir, nelfinavir, and lopinavir/ritonavir in antiretroviral-experienced HIV-infected children. In: Pediatric Infectious Disease Journal, 2008, vol. 27, n° 5, p. 431-437. https://archive-ouverte.unige.ch/unige:2145

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Deposited on : 2009-06-24

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