HIV-positive children treated with a triple-combination antiretroviral regimen have a significant survival advantage, compared with children receiving less effective drug regimens or no antiretrovirals, according to the authors of a new study published in the February 15 issue of Clinical Infectious Diseases.
These results, while perhaps not unexpected, are important because unlike with adults, there have been very few large, well-controlled studies measuring the impact of combination antiretroviral therapy in HIV-positive children.
Kunjal Patel, PhD, of the department of epidemiology at Harvard School of Public Health in Cambridge, Massachusetts, and her colleagues evaluated the medical files of 1,236 HIV-positive children enrolled in two Pediatric AIDS Clinical Trials Group (PACTG) studies, PACTG 219 and PACTG 219C. All of the children were infected with HIV before or during birth. At baseline—the first study visit—80 percent of the children were at least 4 years old. Roughly half were female, 56 percent were black and 28 percent entered the study with an AIDS diagnosis.
During the course of the study, 70 percent of the children began a triple-combination antiretroviral regimen that included at least two different classes of drugs. The majority were given a regimen including a protease inhibitor (PI) plus two nucleoside reverse transcriptase inhibitors (NRTI).
Over the ten years of the study, five percent of the children who received triple combination therapy died, compared with ten percent of the children who either started a less effective antiretroviral regimen or who did not take antiretrovirals at all.
When Patel’s team accounted for a variety of factors, including age and immune status, they found that the children who initiated combination therapy were 76 percent less likely to die than children who did not initiate combination therapy.
The authors write that this study offers strong proof of the effectiveness of combination antiretroviral therapy in children. They did not, however, publish information on side effects experienced by the children in the study.
