Predictive factors of virological success to salvage regimens containing protease inhibitors in HIV-1 infected children

Larrú, Beatriz; Mendoza, Carmen de; Bellón, José M.; José, Ma Isabel De; Mellado, M José; Soriano, Vincent; Ma, Mai‐Juan; Ramos, José Tomás

doi:10.1186/1471-2334-7-55

Cited by 3 publications

(2 citation statements)

References 16 publications

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“…Larru et al [50] recently assessed the utility of virtual phenotype resistance testing by performing a retrospective analysis of heavily experienced children with median age 15 years who had at least 6 months follow-up after initiating salvage therapy. The patients with virological response had a mean number of susceptible drugs according to the lower clinical cut-off of 1.7 vs 0.8 ( P = 0.03) in those who did not have a response; for the upper clinical cut-off, the predicted mean number of susceptible drugs was 2.7 vs 1.3 ( P = 0.01).…”

Section: Resistance Testingmentioning

confidence: 99%

Management of paediatric HIV-1 resistance

Gibb²,

Pillay³

2009

Current Opinion in Infectious Diseases

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Common goals in paediatric HIV for both resource-rich and resource-limited settings are to limit vertical transmission, minimize emergence of resistant viruses in both mother and child where prevention of mother-to-child transmission fails, and limit resistance in children starting HAART. Optimal sequencing of regimens in the absence of resistance testing is a priority research area. Paediatric studies using newer classes of agents are of paramount importance, as well as expanding access to existing antiretrovirals.

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Section: Resistance Testingmentioning

confidence: 99%

Management of paediatric HIV-1 resistance

Gibb²,

Pillay³

2009

Current Opinion in Infectious Diseases

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“…Hal tersebut sesuai dengan penelitian lain yang menemukan bahwa sesudah diberikan obat ARV lini kedua dengan kombinasi lopinavir/ritonavir, proporsi pasien dengan jumlah virus tidak terdeteksi terdapat pada 47% pasien pada minggu ke-24 dan 69% pada minggu ke-96. 17,18 Subyek yang masih teratur kontrol ke RS Cipto Mangunkusumo semuanya masih dalam keadaan hidup. Dua pasien meninggal dengan penyebab limfoma malignum dan setelah putus obat.…”

Section: Metodeunclassified

Terapi Antiretroviral Lini Kedua pada HIV Anak di RS. Cipto Mangunkusumo

Muktiarti¹,

Akib²,

Munasir³

et al. 2016

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Latar belakang. Akses terhadap terapi antiretroviral (ARV) semakin mudah saat ini dan membuat angka harapan hidup anak terinfeksi HIV semakin panjang. Dalam penanganan jangka panjang anak terinfeksi HIV, salah satu masalah baru yang timbul adalah gagal terapi dan resistensi obat. Tujuan. Menilai karakteristik pasien anak terinfeksi di RS. Cipto Mangunkusumo yang menggunakan terapi ARV lini kedua dan indikasi penggantian ke terapi ARV lini kedua.Metode. Penelitian kohort pasien anak terinfeksi HIV di RS Cipto Mangunkusumo sejak tahun 2002. Kriteria inklusi adalah pasien anak terinfeksi HIV yang berobat di RS Cipto Mangunkusumo sejak tahun 2002 sampai April 2012 dan menggunakan salah satu obat antiretroviral lini kedua. Data yang diambil adalah data demografis, kada CD4, jumlah virus, stadium klinis, dan kombinasi terapi ARV.Hasil. Empatratus empat pasien anak terinfeksi HIV dan 44 (10,9%) menggunakan terapi antiretroviral lini kedua. Sebagian besar (59,1%) gagal terapi adalah kombinasi antara kegagalan virologi, imunologis, dan klinis. Median usia saat memulai terapi ARV lini kedua 69 (26-177) bulan. Median lama subyek menggunakan terapi ARV lini pertama 9 (13-176) bulan. Seluruh subyek penelitian menggunakan lopinavir/ritonavir sebagai salah satu obat ARV lini kedua dengan kombinasi terbanyak adalah didanosin, lamivudin, dan lopinavir/ritonavir (40,9%). Efek samping didapatkan pada 2 pasien akibat abacavir. Sebagian besar subyek (19/25) yang diperiksa jumlah virus pada 6-12 sesudah menggunakan ARV lini kedua mempunyai hasil tidak terdeteksi.Kesimpulan. Jumlah pasien yang menggunakan terapi ARV lini kedua tidak terlalu banyak karena deteksi kegagalan terapi masih lebih banyak berdasarkan kegagalan klinis dan imunologis.

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Genotype-guided antiretroviral regimens in children with multidrug-resistant HIV-1 infection

et al. 2016

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Background: Genotyping tests were developed to attenuate the impact of viral resistance. Information about the efficacy in genotype base antiretroviral therapy in children is rare and even more in low-and middle-income countries. Methods: Sixteen children with antiretroviral therapy (ART) failure and triple-class drug-resistant viruses were included in this study. Protease and retrotranscriptase genotypes were available for all patients. Switch of ART regimen was guided by genotyping data. The primary end point was virological suppression (<50 copies/ml) and immunological improvement after 48 wk of treatment with the new ART regimen. results: The median age of the patients was 14.5 y (interquartile range (IQR) 11-16.5). Median HIV-1 RNA viral load was 4.2 log 10 (IQR: 3.4-4.8). The primary end point was found in 11 children (69%), and 13 children (81%) had an HIV-1 RNA viral load <200 copies/ml. Median (IQR) for the baseline CD4 + cell count was 382 cells/μl (281-686 cells/μl), whereas after 48 wk of treatment with the new ART regimen, it was 640 cells/μl (361-936 cells/μl) (P < 0.001). conclusion: Darunavir/ritonavir, raltegravir, and etravirine were well tolerated in the present pediatric population. These drugs provide good options for children exposed to extensive ART. Regimens guided by genotyping data were effective for children who had ART failure and multidrug-resistant HIV-1 infection.i nfants and children who were infected perinatally are now surviving to adulthood with lifelong HIV infection and longterm exposure to combined antiretroviral therapy (ART) (1). Data from the United Kingdom Collaborative HIV Pediatric Study cohort demonstrated that over one-third of children had experienced virological treatment failure and were on a second or subsequent line of therapy at the time of their transition to adult care (2). In the pediatric setting, virological treatment failure occurs most frequently because of poor adherence to ART, and whenever viral replication is inefficiently controlled, virological treatment failure occurs more quickly, allowing the selection of HIV-1 quasispecies resistant to antiretroviral (ARV) drugs (3).Many innate and external factors have been associated with HIV drug resistance mutations in children, such as being infected perinatally, and extremely high viral load during the first steps of the infection, which can take longer to suppress than that in older children or adults, even when they are on fully active ART regimens (4).Interpretation of resistance tests in this context can be complex, particularly in the presence of expanding options for ARV drugs, and treatment decisions should be made with the support of pharmacists and clinicians who have expertise in the field (5).Currently, more than 20 different ARV drugs with six different classes of action have been approved for use in children or adolescents with HIV infection worldwide; most of them are used in Mexico (6).A good level of adherence is particularly difficult during adolescence, especially with a complex regimen ...

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Predictive factors of virological success to salvage regimens containing protease inhibitors in HIV-1 infected children

Cited by 3 publications

References 16 publications

Management of paediatric HIV-1 resistance

Management of paediatric HIV-1 resistance

Terapi Antiretroviral Lini Kedua pada HIV Anak di RS. Cipto Mangunkusumo

Genotype-guided antiretroviral regimens in children with multidrug-resistant HIV-1 infection

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