Tudor-Williams G, Head S, Weigel R, Valerius NH, Riddell A, Lyall EG; International Conference on AIDS.

Int Conf AIDS. 2002 Jul 7-12; 14: abstract no. MoOrB1129.

St. Mary's Hospital / Imperial College, London, United Kingdom

BACKGROUND: Triple drug regimens fail to suppress HIV in more than 50% of sick infants. Protease inhibitors for children have problems with adherence, pharmacodynamics, and long term toxicities. We have designed a protease-sparing combination with 4 palatable suspensions that require no food restrictions. METHODS: The regimen is given in divided doses twice daily: zidovudine (360 mg/m2/day), lamivudine (8mg/kg/day), abacavir (16mg/kg/day) and nevirapine [NVP] (120 mg/m2/day, then 300mg/m2/day from Day 14 if no rash). Data on 17 infants treated for up to 108 weeks (median 48 weeks) are presented. RESULTS: Median age at diagnosis = 3 months (range 0.5-39 months). Presentations: 9 PCP, 6 cytomegalovirus disease (4 had PCP also), 2 failure to thrive, 2 non-PCP pneumonia, 1 erosive tracheitis and 1 asymptomatic. Baseline median viral load = >750,000 copies/ml (>5.8 log, range 4.6 to at least 6.8 log), median CD4 count z score = -3.2 (range -0.6 to -4.4), and median weight z score = -2.46 (range -1.0 to -4.4). 2 children developed hepatitis due to NVP after 1 and 10 weeks (data excluded, on Kaletra). 3 children developed rash, but continued treatment. No cases of abacavir hypersensitivity. 1 child stopped abacavir at 14 weeks and 1 child stopped zidovudine at week 24, each due to GI intolerance (data included, on 3 drugs). The 15 children achieved undetectable VL (<400 copies) by a median of 16 weeks, and all were consistently undetectable from week 48 including 2 children with rebound at weeks 24 and 36 due to transient illness/non-adherence. CD4 counts were slower to reach normal (median = week 48). Weight z scores mirrored CD4 counts but with greater variability, the median time to reach normal weight for age = 48 weeks. CONCLUSION: in a cohort of predominantly sick infants, 15 of 17 children achieved sustained viral suppression and subsequent normalisation of CD4 counts and weight for age on a twice-daily, protease-sparing 4 drug combination.

Publication Types:

• Meeting Abstracts

Keywords:

• Acquired Immunodeficiency Syndrome
• CD4 Lymphocyte Count
• Child
• Dideoxynucleosides
• Drug Combinations
• Endopeptidases
• HIV Infections
• Humans
• Infant
• Infant, Newborn
• Lamivudine
• Nevirapine
• Viral Load
• Zidovudine
• abacavir

Other ID:

• GWAIDS0019147

UI: 102256645

From Meeting Abstracts