Combination Treatment with Zidovudine, Didanosine, and Nevirapine in Infants with Human Immunodeficiency Virus Type 1 Infection

Abstract

, "Combination treatment with zidovudine, didanosine, and nevirapine in infants with human immunodeficiency virus type 1 infection" (1997). Open Access Articles. 1686.

Guidelines for the use of antiretroviral agents in pediatric HIV infection

“…Combination therapy with nevirapine, ZDV and ddI in a small number of young, antiretroviral therapy-naïve infants was associated with substantial and sustained viral suppression in some of the infants [94,104]. Treatment of therapy-naïve adults with nevirapine plus dual NRTI regimen demonstrated comparable results to triple therapy with the protease inhibitor indinavir [136], but no similar comparative studies have been performed in children.…”

“…Analyses from a large prospective study of 360 HIV-infected U.S. children (Perinatal AIDS Collaborative Transmission Study, PACTS) showed that infants who received early treatment with HAART were significantly less likely to progress to AIDS or death compared with those who received no therapy, adjusting for year of birth and maternal disease factors [103]. Several small studies have demonstrated that despite the very high levels of viral replication in perinatally-infected infants, early initiation of HAART can result in durable viral suppression and normalization of immunologic responses to non-HIV antigens in some infants; the proportion of children in these studies with viral levels remaining below quantification after 24 months of therapy ranged from 18% to 62% [94,[104][105][106][107][108]. In those infants who have had sustained control of plasma viremia, there has also been lack of detection of extra-chromosomal replication intermediates, suggesting near complete control of viral replication.…”

“…Subsequent pediatric clinical trials in symptomatic, antiretroviral-naïve children have demonstrated that combination therapy with either ZDV and 3TC or ZDV and ddI is clinically, immunologically, and virologically superior to monotherapy with ddI or ZDV as initial therapy [48,91,92]. In clinical trials in antiretroviral-experienced children, combination therapy that included a protease inhibitor was shown to be virologically and immunologically superior to dual nucleoside combination therapy [93][94][95].…”

Infections in AIDS

“…However, a larger problem is the emergence of drug-resistant mutants. During acute infection it is estimated that c. 10 9 HIV particles are produced per day and c. 10 6 of these are mutants [12,13]. Thus it is clear that application of selective pressure such as antiviral chemotherapy will drive the development of resistant mutants as happened, for example, with zidovudine monotherapy [14].…”

National Institutes of Health (NIH)

“…The NNRTI class of drugs rapidly reduces viral load; however, drug resistance develops quickly after initiation of monotherapy or with combination therapy that does not fully suppress viral replication, and cross-resistance between drugs in this class is common. Sustained suppression of viral load has been observed in some patients who have been treated with regimens combining an NNRTI with two NRTIs or with an NRTI and a protease inhibitor (63,(91)(92)(93).…”