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Trends in Antiretroviral Therapy Use and Survival Rates for a Large Cohort of HIV-Infected Children and Adolescents in the United States, 1989-2001.
McConnell MS, Byers RH, Frederick T, Peters VB, Dominguez KL, Sukalac T, Greenberg AE, Hsu HW, Rakusan TA, Ortiz IR, Melville SK, Fowler MG, for the Pediatric Spectrum of HIV Disease Consortium.
J Acquir Immune Defic Syndr
2005 Apr 1;38(4):488-494.
Abstract
BACKGROUND:: In the United States, HIV-infected children and adolescents are aging and using antiretroviral (ARV) therapy for extended periods of time. OBJECTIVE:: To assess trends in ARV use and long-term survival in an observational cohort of HIV-infected children and adolescents in the United States. METHODS:: The Pediatric Spectrum of HIV Disease Study (PSD) is a prospective chart review of more than 2000 HIV-infected children and adolescents. Patients were included in the analysis from enrollment until last follow-up. RESULTS:: Triple-ARV therapy use (for 6 months or more) increased from 27% to 66% during 1997 to 2001 (P < 0.0001, chi for trend). The proportion of patients receiving 3 or more sequential triple-therapy regimens also increased from 4% to 17% during 1997 to 2001 (P < 0.0001, chi for trend), however, and the durability of triple-therapy regimens decreased from 13 to 7 months from the first to third regimen. Survival rates for the 1997 to 2001 birth cohorts were significantly better than for the 1989 to 1993 and 1994 to 1996 cohorts (P < 0.0001). CONCLUSIONS:: Survival rates in the PSD cohort have increased in association with triple-ARV therapy use. With continued changes in ARV regimens, effective modifications in ARV therapy and the sustainability of gains in survival need to be determined.
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Reviewed by
Arthur Ammann, MD
Comment
Several studies confirm that the use of combination antiretroviral treatment (ART) in children results in marked clinical, virologic, and immunologic improvements equivalent to those found in adults receiving treatment.(1,2,3) Similar results have been observed in resource-poor countries where ART has been made available for treatment of HIV-infected children. For example, a study in Côte d'Ivoire that evaluated 159 children receiving ART between 2000 and 2002 found that after 756 days of treatment >50% of them had undetectable viral loads with a median CD4 percentage of 23%.(4) In addition to changes in laboratory results, the children had increased height and weight Z scores. The mean duration of follow-up was 21 months. Treatment survival in children with CD4 percentages of <5% was 73% compared with 98% in children with CD4 percentages >5%.
The study reported by McConnell et al followed a cohort of approximately 2,040 children between 1989 and 2001. It found that survival was significantly better in those who received a 3-drug regimen that included either a protease inhibitor or a nonnucleoside reverse transcriptase inhibitor (NNRTI). By 2001, 94% of children in the cohort were taking nucleoside reverse transcriptase inhibitors, 70% were taking protease inhibitors, and 35% were taking NNRTIs.
This study and others confirm that ART works as well in children as in adults and underscore the need to increase treatment access for children.
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