Efficacy and Toxicity of Antiretroviral Therapy Using 4 or More Agents

Abstract

Treatment with 4 or 5 antiretroviral agents was well tolerated in HIV-1-infected children and resulted in a high degree of viral suppression, even in children with previous antiretroviral drug experience.

Immunological Response of Hiv-Infected Children to Highly Active Antiretoviral Therapy at Gondar University Hospital, North-Western Ethiopia

“…Therefore, starting HAART before clinical and/or immunological deterioration is important to get good CD4 response with the treatment. Similar findings were revealed in different studies ( 11 , 12 , and 13 ).…”

Induction maintenance concept for HAART as initial treatment in HIV infected infants

“…Melvin observed 36 children (range 0.2 to 16.0 years) with different previous drug combinations before changing to a four or even five drug regimen [10]. After initiation of the new regimen all children experienced a significant decrease in viral load.…”

“…In treatment naive infants Luzuriaga described adverse clinical or laboratory events in 8 of 52 patients receiving quadruple therapy (grade 2 (4 patients), grade 3 (1 patient), grade 4 (3 patients)), however these patients were receiving reverse-transcriptase inhibitors only (2 NRTI + 2 NNRTI); while no treatment-related adverse effect was reported among children receiving the regimen including a PI (2 NRTI + 1 NNRTI + 1 PI) [9]. In therapy-experienced children receiving a four drug regimen adverse reactions were limited to mild neutropenia and mild transient elevations in liver enzymes [10]. Starr observed severe effects, consisting of severe neutropenia, hepatic toxicity, diarrhea and rash with fever, in about 10% of the children treated with two NRTIs and two NNRTIs [12].…”

Hepatotoxicity in HIV-infected children and adolescents on antiretroviral therapy

“…2,16 Grade 1 hepatotoxicity, as assessed by AST levels, was found in three patients (8%) out of a group of 36 HIV-1 infected children who were treated with four or fi ve antiretroviral agents. 17 Another recent study 18 showed that 16% of 43 children on ART developed hepatotoxicity with elevated liver enzyme levels at least fi ve times the baselines values.…”