Long-Term Responses to Treatment Including Ritonavir or Nelfinavir in HIV-1-Infected Children

Nadal, David; Steiner, Felicitas; Cheseaux, Jean‐Jacques; Lazarevitch, C. A. Wyler; Aebi, Christoph; Kind, Christian; Rudin, Christoph

doi:10.1007/s150100070021

Cited by 24 publications

(22 citation statements)

References 31 publications

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“…Preliminary evidence in pediatric HIV-1 research suggests that combination antiretroviral therapies have a positive effect on mean weight, height, growth velocity, appetite, and well-being 21,23,45,46 . Studies on the tolerability and efficacy of PI containing regimens have mentioned alterations in serum lipids ranging from dyslipidemia in 20% to 50% of children on single PI to > 90% on dual PI containing regimens 45,[47][48][49] . The present data showed a lower proportion of hyperlipidemia compared to the study by Taylor et al 50 , who reported 58.3% and the study by Werner et al, who verified 88.3% 51 .…”

Section: Discussionmentioning

confidence: 99%

Nutritional assessment and lipid profile in HIV-infected children and adolescents treated with highly active antiretroviral therapy

Tremeschin

Sartorelli

Cervi

et al. 2011

Rev. Soc. Bras. Med. Trop.

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Introduction: HIV-infected children and adolescents treated with highly active antiretroviral therapy (HAART) regimens that include a protease inhibitor (PI) can show significant improvements in clinical outcomes, nutritional status and quality of life. The study aimed to report nutritional and metabolic alterations for pediatric patients continuously exposed to HAART and for healthy controls for up to 1 year. Methods: Clinical, anthropometric, lipid profile and food intake data were collected prospectively over approximately 12-months for each patient. Results: Fifty-one individuals were studied, of these, 16 were healthy. After 12 months followup, HIV-positive individuals remained below the healthy control group parameters. No change was observed concerning food intake. Triglyceride serum levels were higher in patients using protease inhibitor at the onset of the study , and 136 (63 -271) versus control group: 54.5 (20 -162); p = 0.003], but after twelve months follow-up, only the group using protease inhibitor for up to two months presented higher values [140 (73 -273)

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Section: Discussionmentioning

confidence: 99%

Nutritional assessment and lipid profile in HIV-infected children and adolescents treated with highly active antiretroviral therapy

Tremeschin

Sartorelli

Cervi

et al. 2011

Rev. Soc. Bras. Med. Trop.

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“…5,6,24 Therefore, PI-containing therapy may have to be continued for a long period. However, in adults, serum lipid abnormalities vanished with discontinuation of PIs.…”

Section: Discussionmentioning

confidence: 99%

“…19,20 Studies on the tolerability and efficacy of PI-containing regimens have mentioned alterations of serum lipids ranging from dyslipidemia in 20% to 50% of children on single PI to Ͼ90% on dual PIcontaining regimens. 4,[23][24][25] However, the determination of the precise role of PI on metabolic side effects has been difficult to examine as all of these studies In this study, we investigated the effects of PIcontaining antiretroviral therapy on metabolic disturbances in children by comparing serologic parameters in patients with and without PI treatment. We found significant alterations of lipid metabolism in the majority of children on PI-containing regimens, whereas the lipid metabolism in children on dual-NRTI regimens remained largely unchanged.…”

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confidence: 99%

Marked Dyslipidemia in Human Immunodeficiency Virus-Infected Children on Protease Inhibitor-Containing Antiretroviral Therapy

et al. 2002

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ABSTRACT. Objective. To assess the effects of antiretroviral combination therapy that contains protease inhibitor (PI) on carbohydrate and lipid metabolism in human immunodeficiency virus (HIV)-infected children.Methods. A cross-sectional, descriptive clinical study was conducted in an outpatient clinic. Thirty-seven HIVinfected children who ranged from 1 to 17 years of age received nucleoside reverse transcriptase inhibitor treatment together with PI (PI group, n ‫؍‬ 25) or without PI (non-PI group, n ‫؍‬ 12). Age, gender, weight, length, CD4 cell count, and viral load did not differ between groups. Nonfasting total cholesterol, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein (LDL) cholesterol, glucose, lactate, and blood gases were determined. In addition, c-peptide, insulin, hemoglobin A1c, free fatty acids, lipoprotein a, and apolipoproteins A1 and B were evaluated after fasting. PI and non-PI group values were compared with normal values taken from healthy children.Results. In nonfasting and fasting conditions, children of the PI group had higher total cholesterol (fasting PI group: 235 ؎ 71 mg/dL; non-PI group: 176 ؎ 25 mg/dL, mean ؎ standard deviation), triglycerides (156 ؎ 89 vs 87 ؎ 31 mg/dL), and LDL cholesterol levels (159 ؎ 58 vs 113 ؎ 23 mg/dL) compared with the non-PI group. Highdensity lipoprotein cholesterol and apolipoprotein A1 levels did not differ in both groups; there was a trend toward higher apolipoprotein B levels in the PI group. After fasting, 8 (47%) of 17 patients in the PI group presented with hypercholesterolemia as a result of an increase of LDL cholesterol and 11 (65%) had hypertriglyceridemia. It is interesting that the non-PI group showed no pathologic deviations. Compared with normal values, lipoprotein a and free fatty acids were increased in the PI and non-PI groups. Glucose, lactate, blood gases, c-peptide, insulin, and hemoglobin A1c were normal in both groups.Conclusion. PI-containing antiretroviral treatment of HIV-infected children was associated with hypercholesterolemia, hypertriglyceridemia, and an increase of LDL cholesterol. The long-term complications of dyslipidemia are of major concern in the growing HIV-infected child. Pediatrics 2002;110(5). URL: http://www.pediatrics. org/cgi/content/full/110/5/e56; antiretroviral therapy, HIV infection, dyslipidemia, carbohydrate metabolism.ABBREVIATIONS. HAART, highly active antiretroviral therapy; PI, protease inhibitor; NNRTI, nonnucleoside reverse transcriptase inhibitor; NRTI, nucleoside reverse transcriptase inhibitor; HIV, human immunodeficiency virus; 3TC, lamivudine; AZT, zidovudine; NFV, nelfinavir; DDI, didanosine; d4T, stavadine; RTV, nitonavir, ABC, abacavir; DDC, zalcitabine; SAQ, saquinavir; HDL, high-density lipoprotein; LDL, low-density lipoprotein; Lp(a), lipoprotein a; HbA1c, hemoglobin A1c. H ighly active antiretroviral therapy (HAART) that consists of protease inhibitors (PIs) or nonnucleoside reverse transcriptase inhibitors (NNRTIs) in combination with nucleoside reverse tran...

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“…1,2 Clinical trials have demonstrated the effectiveness of PI combination therapy (PI therapy) in decreasing plasma HIV RNA levels, although the proportion of children with virologic suppression to undetectable levels is generally smaller than the corresponding proportion of adults. [3][4][5][6] Antiretroviral regimens including PIs have been shown to increase CD4 ϩ cell counts, even for children with advanced disease, [4][5][6][7][8][9] and studies are now beginning to document their effects on clinical outcomes. Baseline and treatment-mediated changes in immunologic and virologic markers were independent predictors of survival in a meta-analysis of pediatric antiretroviral clinical trials, and virologic markers predicted weight growth and cognitive failure among children Ͼ1 year of age.…”

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Protease Inhibitor Combination Therapy, Severity of Illness, and Quality of Life Among Children With Perinatally Acquired HIV-1 Infection

Storm¹,

Boland²,

Gortmaker

et al. 2005

Pediatrics

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ABSTRACT.Objectives. This study examines quality of life (QOL) among school-aged children with perinatally acquired HIV infection and compares QOL outcomes between treatment groups that differ according to the use of protease inhibitor (PI) combination therapy (PI therapy). To gain insights into how PI therapy might influence QOL, associations between severity of illness and QOL were also investigated.Methods. Cross-sectional data for 940 children, 5 to 18 years of age, who were enrolled in Pediatric AIDS Clinical Trials Group Late Outcomes Protocol 219 were used to examine domains of caregiver-reported QOL, as assessed with the General Health Assessment for Children, during 1999. The General Health Assessment for Children is an age-specific, modular, QOL assessment that was developed for the study with previously validated measures. QOL differences between treatment groups were estimated with linear and logistic regressions that controlled for sociodemographic characteristics (age, gender, race/ethnicity, maternal/caregiver education, and respondent) and severity-of-illness indicators related to receipt of PI therapy (AIDS status, log 10 CD4 ؉ cell counts, and height-for-age z scores).Results. The mean age of participants was 9.7 years. Most children were non-Hispanic black (54%) or Hispanic (31%), and 49% of the participants were female. At the 1999 study visit, ϳ14% of children had severe immune suppression (<15% CD4 ؉ cells), whereas 62% of children had >25% CD4 ؉ cells, ie, no immune suppression. Participants did exhibit some lag in growth, with mean height and weight z scores of ؊0.70 and ؊0.20, respectively. Twenty-eight percent of the children were reported to have met criteria for AIDS at study entry (1993)(1994)(1995)(1996)(1997)(1998)(1999). When treatment groups were compared, children receiving PI therapy (72%) were older, had lower CD4 ؉ cell percentages, and had lower height and weight z scores than did those receiving non-PI therapies. They were also more likely to have met criteria for AIDS at study entry. The most commonly used PIs were ritonavir (46%) and nelfinavir (63%). Health perceptions ratings for most children were at the upper end of the scale, whereas ratings for 25% of the children ranged over the lower 70% of scale scores. Almost one half of the children had at least some limitations in physical functioning, with more frequent limitations in energydemanding activities (46%) than in basic activities of daily living (32%). The Behavior Problems Index was used to assess psychologic functioning. The mean total Behavior Problems Index score (9.34) and the proportion of children with extreme scores (23%) were consistent with values reported for chronically ill children and those at social and economic risk. One or more limitations in social/school functioning were reported for 58% of children. More than one third of the children (38%) experienced >1 physical symptoms that were at least moderately distressing. Health perceptions, physical functioning, psychologic functioning, social/school...

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Long-Term Responses to Treatment Including Ritonavir or Nelfinavir in HIV-1-Infected Children

Abstract: The antiretroviral and immunologic benefits of protease inhibitors are more profound in ART-naive than in non-naive children.

Cited by 24 publications

References 31 publications

Nutritional assessment and lipid profile in HIV-infected children and adolescents treated with highly active antiretroviral therapy

Nutritional assessment and lipid profile in HIV-infected children and adolescents treated with highly active antiretroviral therapy

Marked Dyslipidemia in Human Immunodeficiency Virus-Infected Children on Protease Inhibitor-Containing Antiretroviral Therapy

Protease Inhibitor Combination Therapy, Severity of Illness, and Quality of Life Among Children With Perinatally Acquired HIV-1 Infection

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