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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, Klara / Siegrist, Claire-Anne
Published in The 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)
Recherche en infectiologie pédiatrique et en 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: The Pediatric infectious disease journal, 2008, vol. 27, n° 5, p. 431-437. doi: 10.1097/INF.0b013e3181646d5a https://archive-ouverte.unige.ch/unige:2145

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Deposited on : 2009-06-24

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