在感染HIV-1的儿童中用奈韦拉平替代蛋白酶抑制剂的结果。
Outcome of protease inhibitor substitution with nevirapine in HIV-1 infected children.
作者信息
Gonzalez-Tome M Isabel, Amador Jose Tomas Ramos, Peña M Jose Mellado, Gomez M Luisa Navarro, Conejo Pablo Rojo, Fontelos Pablo Martin
机构信息
Division of Immunodefiencies, Hospital 12 de Octubre, Madrid, Spain.
出版信息
BMC Infect Dis. 2008 Oct 22;8:144. doi: 10.1186/1471-2334-8-144.
BACKGROUND
Protease inhibitors (PIs) have been associated with metabolic complications. There is a trend to switch to simpler therapy to improve these disturbances. We report a case-series describing the effects in metabolic abnormalities in seven HIV-infected children, previously treated with protease inhibitor (PI) after switching to nevirapine.
METHODS
Seven children with stable PI-containing regimen and a long lasting HIV-1 RNA < 50 copies/ml were switched to nevirapine. All patients were naïve to non nucleoside reverse transcriptase inhibitor. PIs were switched to nevirapine. Preentry nucleoside reverse transcriptase inhibitors were maintained. The substitution of PIs with nevirapine was made when the patient showed hyperlipidemia or lipodystrophy or the physician and/or the patient's willingness to simplify. Clinical, laboratory data and anthropometric parameters were assessed every 3 months. Dual-energy X-Ray absorptiometry scans (DXA) was performed at baseline and at 12 months.
RESULTS
Seven HIV-infected children were enrolled. Median age: 130 months (99,177). Median baseline CD4%: 32%. All had HIV-1 RNA < 50 copies/ml. Median length of preentry PI-therapy was 47 months (28, 91). Median age at the beginning of nevirapine was 120 months (99,177). Median decrease in cholesterol in 7.2 mmol/L was observed (P = 0.09), from baseline to 12 months. HDL-cholesterol increased in 5.1 mmol/L (P = 0.03) throughout the study period. No significant changes were observed in DXA with regard to body fat, but changes in total body bone mineral content and lean body content were significant. CD4% remained stable. All patients but one maintained viral load < 50 copies/ml at 12 months. The patient with virologic failure referred bad adherence. Children referred to take medication more easily.
CONCLUSION
PI substitution with nevirapine improved lipid profile in our patients, although this strategy did not show significant changes in body fat or lipodystrophy.
背景
蛋白酶抑制剂（PIs）与代谢并发症有关。有一种趋势是转向更简单的治疗方法以改善这些紊乱情况。我们报告了一个病例系列，描述了7名感染HIV的儿童在从蛋白酶抑制剂（PI）转换为奈韦拉平后代谢异常的情况。
方法
7名接受含PI稳定方案且长期HIV-1 RNA＜50拷贝/ml的儿童转换为奈韦拉平。所有患者既往未使用过非核苷类逆转录酶抑制剂。将PI转换为奈韦拉平。维持原有的核苷类逆转录酶抑制剂。当患者出现高脂血症或脂肪营养不良，或医生和/或患者有简化治疗的意愿时，用奈韦拉平替代PI。每3个月评估临床、实验室数据和人体测量参数。在基线和12个月时进行双能X线吸收法扫描（DXA）。
结果
纳入7名感染HIV的儿童。中位年龄：130个月（99,177）。基线CD4%中位数：32%。所有患者HIV-1 RNA＜50拷贝/ml。PI治疗前的中位时长为47个月（28,91）。开始使用奈韦拉平的中位年龄为120个月（99,177）。从基线到12个月，观察到胆固醇中位数下降7.2 mmol/L（P = 0.09）。在整个研究期间，高密度脂蛋白胆固醇升高5.1 mmol/L（P = 0.03）。DXA在身体脂肪方面未观察到显著变化，但全身骨矿物质含量和瘦体重含量有显著变化。CD4%保持稳定。除1名患者外，所有患者在12个月时病毒载量维持＜50拷贝/ml。病毒学失败的患者依从性差。儿童表示服药更容易。
结论
用奈韦拉平替代PI改善了我们患者的血脂情况，尽管该策略在身体脂肪或脂肪营养不良方面未显示出显著变化。
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