Skip Navigation LinksHome > November 30, 2007 - Volume 21 - Issue 18 > Successful simplification of protease inhibitor-based HAART...
doi: 10.1097/QAD.0b013e3282f1560b
Clinical Science

Successful simplification of protease inhibitor-based HAART with triple nucleoside regimens in children vertically infected with HIV

Palma, Paoloa,c; Romiti, Maria Luisaa; Cancrini, Caterinaa,c; Pensieroso, Simonea; Montesano, Carlab; Santucci, Marilina Bb; Bernardi, Stefaniac; Martino, Alessandra Mc; Rossi, Paoloa,c; Castelli-Gattinara, Guidoc

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Objective: To assess the virological, immunological and metabolic effects of switching from an efficacious first-line protease inhibitor (PI)-based HAART to a simplified triple nucleoside reverse transcriptase inhibitor (NRTI) regimen in children vertically infected with HIV.

Design: Prospective, open-label, before–after study of 20 vertically infected children with at least 12 consecutive months of undetectable viral load under a PI-based HAART and no previous history of NRTI treatment.

Methods: At study entry, HAART was shifted to a triple-NRTI combination.

Results: The children were aged 2 to 18 years (median, 7.9) and were followed for 96 weeks. All were receiving a PI-based regimen for an average duration of 4 years before enrollment. At study entry, 12 patients (60%) switched to abacavir, 5 (25%) to lamivudine; 2 (10%) to zidovudine and 2 to didanosine (10%). All but one patient maintained plasma HIV RNA < 50 copies/ml during the entire follow-up. No immunological failure was observed at week 96. A trend of normalization (P < 0.001) of T cell receptor Vβ families of the CD8 cell subset was detected in 19/20 (95%), with an increased HIV-specific CD8 T cell response (P < 0.01) in 17/20 (85%). Dyslipidaemia significantly improved during the follow up (P < 0.001). No new cases of lipodystrophy were detected.

Conclusions: Switching to triple-NRTI regimens in selected HIV-infected children with an extremely low likelihood of harbouring nucleoside-associated mutations maintains viral suppression and immunological function, improving metabolic abnormalities and the effort to take medication for up to 96 weeks.

© 2007 Lippincott Williams & Wilkins, Inc.


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