Allen Upton D, Lapointe Normand, Read Stanley E, Forbes Jack C, King Susan M, Wasfy Samia
The Division of Infectious Diseases, Department of Pediatrics,Hospital for Sick Children, Toronto, Ontario.
Can J Infect Dis. 2003 Mar;14(2):89-93. doi: 10.1155/2003/891968.
The number of antiretroviral agents available for children who are failing existing therapy is limited. Data are lacking on the use of various combination regimens and the resulting viral load dynamics in such children.
Between March 1998 and March 2000, HIV-infected children younger than 18 years of age were studied in an open trial. The study regimen included ritonavir, with at least two drugs to which the virus was known or presumed to be sensitive. Subjects were ritonavir-naive and were included if they had high viral loads while receiving antiretroviral therapy. Patients had clinical assessments, CD4 counts and viral load monitoring.
Fifteen antiretroviral-experienced HIV-infected children were enrolled. Approximately 87% (13 of 15) had perinatally-acquired HIV; median age was 7.9 years (range 1.6 to 14.8). At enrolment, the median CD4 count was 557 cells/mm(3) (range 57 to 1702) and the median viral load was 72,600 copies/mL (range 3626 to 796,440). The majority of children (73.3%) had increases in CD4 counts within 12 weeks. During this period, the median increase in CD4 counts over baseline was 30.0%. Approximately 73% (eight of 11) of subjects with initial improvements in CD4 counts had sustained increases at 32 to 48 weeks. Over the first 12 weeks, 60% (nine of 15) had greater than 0.5 log(10) decreases in viral load. The improvement was sustained in 88.9% (eight of nine) of these patients at 32 to 48 weeks. Three patients discontinued therapy due to taste aversion.
Among pediatric patients with high viral loads while on existing therapy, the ritonavir-containing regimen was generally well tolerated. In a significant proportion of patients, modification of therapy was associated with sustained improvements in viral loads and CD4 counts over 32 to 48 weeks.
对于现有治疗方案失败的儿童，可用的抗逆转录病毒药物数量有限。目前缺乏关于此类儿童使用各种联合治疗方案及其病毒载量动态变化的数据。
在1998年3月至2000年3月期间，对18岁以下感染HIV的儿童进行了一项开放试验研究。研究方案包括利托那韦，以及至少两种已知或推测病毒对其敏感的药物。研究对象此前未使用过利托那韦，若在接受抗逆转录病毒治疗时病毒载量较高则纳入研究。患者接受临床评估、CD4细胞计数和病毒载量监测。
共纳入15名有抗逆转录病毒治疗经验的HIV感染儿童。约87%（15例中的13例）为围生期感染HIV；中位年龄为7.9岁（范围1.6至14.8岁）。入组时，CD4细胞计数中位数为557个/立方毫米（范围57至1702），病毒载量中位数为72,600拷贝/毫升（范围3626至796,440）。大多数儿童（73.3%）在12周内CD4细胞计数增加。在此期间，CD4细胞计数相对于基线的中位数增加为30.0%。约73%（11例中的8例）CD4细胞计数最初有所改善的受试者在32至48周时保持增加。在最初的12周内，60%（15例中的9例）的患者病毒载量下降超过0.5个对数（10）。在32至48周时，这些患者中有88.9%（9例中的8例）持续改善。3例患者因味觉厌恶而停止治疗。
在接受现有治疗但病毒载量较高的儿科患者中，含利托那韦的治疗方案总体耐受性良好。在相当比例的患者中，调整治疗与32至48周内病毒载量和CD4细胞计数的持续改善相关。
