Induction maintenance concept for HAART as initial treatment in HIV infected infants
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June 21, 2011 Eur J Med Res (2011) 16: 243-248
243 © I. Holzapfel Publishers 2011
InductIon MaIntEnancE concEPt foR HaaRt as InItIal tREatMEnt In HIV InfEctEd Infants s. Ghosh1*, J. neubert1*, t. niehues2, o. adams3, n. Morali-Karzei1, a. Borkhardt1, H. J. laws1 1department
of Pediatric oncology, Hematology and clinical Immunology, Heinrich-Heine universität düsseldorf, Medical faculty, duesseldorf, Germany 2department of Pediatrics, Helios Hospital Krefeld, Krefeld, Germany 3Institute of Virology, Heinrich-Heine universität düsseldorf, düsseldorf, Germany
Abstract Background: Early initiated antiretroviral therapy (aRt) in HIV infected infants leads to improved longterm viral suppression and survival. Guidelines recommend initiating therapy with a triple aRt consisting of two nucleoside reverse transcriptase inhibitors (nRtIs) and either one additional non-nucleoside reverse transcriptase inhibitor (nnRtI) or a protease inhibitor (PI). compared to older children and adults, viral relapse is seen more frequently in infants receiving triple aRt. We now address the possibility of a more potent aRt with a quadruple induction and triple maintenance therapy. Methods: We examine the longitudinal course in four HIV infected infants, who were referred from other centers and could not be recruited to multicentre trials. We introduced aRt initially consisting of two nRtIs, one nnRtI and one PI and later discontinued the PI at the age of 12 months maintaining a triple regime consisting of two nRtIs and one nnRtI. Results: Provided that therapy adherence was maintained we observed an effective sustained decline of viral load and significant cd4 cell reconstitution even after switching to a triple regime. no drug associated toxicity was seen. Conclusion: We suggest that a four drug therapy might be a possible initial therapy option in HIV infected infants, at least in those with a high viral load, followed by a maintenance triple regime after 12 months of therapy. Key words: HIV, HaaRt, anti HIV agents, infants, viral load
BacKGRound European [1] and us guidelines [2] recommend to start with aRt in all HIV infected infants below the age of 12 months irrespective of clinical or immunological stage. In particular, in infants infected despite attempted mother to child transmission prophylaxis, aRt should be commenced as soon as the diagnosis is confirmed. Evidence that early therapy in all infected infants leads to a significant reduction of morbidity * Both authors contributed equally to this work.
and mortality compared to deferring treatment came from cHER trial conducted in south africa [3] and from the European Infant collaboration group [4]. In the cHER trial early HIV diagnosis and early treatment reduced early infant mortality by 76%. Virological failure continues to be a major challenge after initiating early aRt in infants. PEnPact-1 showed recently that in children following the recommended initial regimen with two nucleoside reverse transcriptase inhibitors (nRtI) and one protease inhibitor (PI) or non-nucleoside
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