Management of antiretroviral therapy in neonates, children, and adolescents

Neely, Michael; Kovács, Andrea

doi:10.1007/s11904-004-0014-y

Cited by 5 publications

(2 citation statements)

References 47 publications

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“…1 , 41 This contrasts with the results of the International Maternal Pediatric Adolescent AIDS Clinical Trials Group (IMPAACT) 1060 trial (see Development of efavirenz resistance in children section) that found a significantly higher rate of virological failure, treatment discontinuation, or death at 24 weeks in children aged <3 years on nevirapine-regimens compared with lopinavir/ritonavir. 4 , 42 , 43 Switching from protease inhibitor-based regimens to NNRTI in order to simplify ART after virologic suppression can result in improvements in total cholesterol, low-density lipoprotein cholesterol, triglycerides, and the cholesterol/high-density lipoprotein cholesterol ratio, while maintaining virologic suppression and immunologic benefits. 5 , 44 …”

Section: Nnrti-based Versus Protease Inhibitor-based Arv Regimens In mentioning

confidence: 99%

“…The pathogenesis of HIV-1 and HIV-2 infection and the general virological and immunological principles underlying the use of ART are similar for all HIV-infected patients, but unique considerations exist for infected children. 4 Mother-to-child transmission represents the most common cause of pediatric HIV infection, the majority of cases occurring in the peripartum period. Postpartum infection of infants occurs primarily through breastfeeding, which globally accounts for roughly one third of all cases of perinatal HIV.…”

Section: Introductionmentioning

confidence: 99%

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Antiretroviral treatment in HIV-1 infected pediatric patients: focus on efavirenz

Larrú

Eby

Lowenthal

2014

PHMT

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Efavirenz is a non-nucleoside reverse transcriptase inhibitor (NNRTI), used for the treatment of human immunodeficiency virus (HIV)-1 infection. Approved by the US Food and Drug Administration in 1998, its indication was recently extended to include children as young as 3 months of age. The World Health Organization and many national guidelines consider efavirenz to be the preferred NNRTI for first-line treatment of children over the age of 3 years. Clinical outcomes of patients on three-drug antiretroviral regimens which include efavirenz are as good as or better than those for patients on all other currently approved HIV medications. Efavirenz is dosed once daily and has pediatric-friendly formulations. It is usually well tolerated, with central nervous system side effects being of greatest concern. Efavirenz increases the risk of neural tube defects in nonhuman primates and therefore its use during the first trimester of pregnancy is limited in some settings. With minimal interactions with antituberculous drugs, efavirenz is preferred for use among patients with HIV/tuberculosis coinfection. Efavirenz can be rendered inactive by a single point mutation in the reverse transcriptase enzyme. Newer NNRTI drugs such as etravirine, not yet approved for use in children under the age of 6 years, may maintain their activity following development of efavirenz resistance. This review highlights key points from the existing literature regarding the use of efavirenz in children and suggests directions for future investigation.

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Section: Nnrti-based Versus Protease Inhibitor-based Arv Regimens In mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Antiretroviral treatment in HIV-1 infected pediatric patients: focus on efavirenz

Larrú

Eby

Lowenthal

2014

PHMT

View full text Add to dashboard Cite

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Characteristics of HIV-infected children recently diagnosed in Paris, France

et al. 2006

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Pediatric HIV-1 infections are still being diagnosed in France, despite the efficacy of prophylactic treatment to prevent mother-to-child transmission. To describe the characteristics and mode of infection of these children, we retrospectively analysed data of 59 children diagnosed with the HIV-1 infection between January 2000 and June 2005 in a Parisian university hospital. Twenty of these children had been born in France, and none had received appropriate prophylaxis (insufficient, not taken or given too late). Six received no preventive treatment due to failures in screening: three mothers were HIV-seronegative at the start of pregnancy and no test was carried out for the other three. At diagnosis, four had a severe immune deficiency (CD4 cells <15%). The 39 children born abroad were diagnosed at a median age of 3 years (range: 3 months-16 years), sometimes several years after their arrival in France. The clinical, virological and immunological status of these children was poorer than that of the children born in France: 18 had less than 15% CD4 cells. In contrast, the response to treatment of the children born in France was not as good as that of the children born abroad. The HIV-1 screening and prevention programme for pregnant women could be improved. Some children infected following the failure of prevention are at high risk of subsequent treatment failure. HIV-1 infection should be taken into consideration in children born in countries with a high prevalence of HIV, even if they have been living in France for several years and present no symptoms.

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