Etravirine-based highly active antiretroviral therapy in HIV-1-infected paediatric patients |
| |
Authors: | Briz V Palladino C Navarro Ml Jiménez de Ory S González-Tomé Mi León Ja Núñez-Cuadros E de José Mi Ramos Jt Muñoz-Fernández Ma |
| |
Institution: | 1. Sección de Enfermedades Infecciosas, Servicio de Pediatría, Hospital General Universitario ‘Gregorio Mara?ón’, Madrid, Spain;2. Laboratory of Immunomolecular Biology, Hospital General Universitario ‘Gregorio Mara?ón’, Madrid, Spain;3. Servicio de Infecciosas Pediátricas, Hospital Universitario ‘Doce de Octubre’, Madrid, Spain;4. Unidad de Infectología/Medicina Interna Pediátrica, Hospital Infantil Universitario ‘Virgen del Rocío’, Sevilla, Spain;5. Unidad de Infectología e Inmunodeficiencias, Servicio de Pediatría, Hospital Regional Universitario ‘Carlos Haya’, Málaga, Spain;6. Servicio Infecciosas Infantil, Hospital Universitario ‘La Paz’, Madrid, Spain;7. Servicio de Pediatría, Hospital Universitario de Getafe, Madrid, Spain |
| |
Abstract: | Background We evaluated the efficacy, safety and tolerability of etravirine in paediatric patients vertically infected with HIV‐1. Methods A multicentre retrospective study of 23 multidrug‐resistant paediatric patients (five children and 18 adolescents) enrolled in the study from 1 September 2007 to 28 February 2010 was carried out. We performed a longitudinal analysis of immunological, virological and clinical data. Results The median age of the patients was 14.2 years interquartile range (IQR) 12.5–15.8 years]. At baseline, the median HIV‐1 RNA was 29 000 (4.5 log10) HIV‐1 RNA copies/mL (range 4300‐83 000 copies/mL), the median CD4 T‐cell count was 445 cells/μL (range 221–655 cells/μL) and the median CD4 percentage was 19.6% (IQR 13.0‐31.0). Remarkably, 16 of 23 patients (70%) harboured one or more etravirine‐associated resistance mutations. The backbone regimen included at least two fully active drugs in 91% of patients. After etravirine‐based therapy, 20 patients (87%) achieved HIV‐1 RNA<400 copies/mL and 18 of 23 (78%) achieved HIV‐1 RNA<50 copies/mL: three (13%) within the first month, seven (30%) within the first 4 months, and six (26%) between the 5th and 8th months. CD4 T‐cell recovery was observed in 19 patients (83%). The median follow‐up time was 48.4 weeks (IQR 35.7–63.4 weeks); four patients (17%) were exposed to etravirine for >120 weeks. Three mild/short‐term and two moderate skin rashes were observed in the adolescents. Laboratory abnormalities included hypercholesterolaemia (11 of 23 patients), hypertriglyceridaemia (eight of 23 patients), and reduced high‐density lipoprotein cholesterol (10 of 23 patients). Adherence was complete in seven patients (30%). No patients showed complete resistance to etravirine after follow‐up. However, three of 21 patients (14%) who initially showed intermediate resistance interrupted etravirine treatment because of virological failure. Conclusions We observed a sustained antiviral response and improved immunological parameters in multidrug‐resistant paediatric patients, most of whom had received etravirine as part of salvage regimens with at least two fully active drugs. |
| |
Keywords: | adolescents children etravirine highly active antiretroviral therapy HIV |
本文献已被 PubMed 等数据库收录! |
|