Abstract
Background: Children exposed to single dose nevirapine at birth, if tested human immunodeficiency virus (HIV) positive, cannot be given nevirapine based anti-retroviral therapy (ART). Therefore protease inhibitor (PI) based combinations are being used as first line therapy in such children. However, experience is limited regarding their efficacy and adverse effects in the Indian population. Objectives: To document clinical and immunological responses to PI based regimens as first line therapy in HIV infected children less than 5 years old compared to responses to standard non-protease inhibitor (NPI) first line regimens recommended by National AIDS Control Organisation and World Health Organisation. Method: An observational prospective cohort study was conducted in a tertiary care hospital in Surat, India, from December 2011 to June 2013 on children less than 5 years of age with confirmed HIV status. At diagnosis, clinical staging, growth parameters and CD4 levels were assessed and the children were allotted to NPI and PI groups depending on prior nevirapine exposure. Clinical, immunological and biochemical alterations after ART initiation were assessed and compared after 6 months of therapy. Results: During the study period, there were 43 children less than 5 years of age with confirmed HIV status. Children in both NPI and PI groups showed significant improvement in clinical stage of the disease after 6 months of therapy (P Conclusions: PI based regimens were effective as first line therapy in HIV infected children less than 5 years old. Both PI and NPI regimens were equally effective at 6 months of therapy but PI based regimens achieved significantly better growth parameters and CD4 levels. Elevated total cholesterol levels were observed after therapy with PI regimens. (Key words: HIV, children, protease inhibitors) Sri Lanka Journal of Child Health, 2017; 46 (2): 160-164
Highlights
In India, first line antiretroviral therapy (ART) regimens extensively used for children and adults with human immunodeficiency virus (HIV) comprise 3 drugs viz. stavudine or zidovudine, lamivudine and nevirapine[1,2,3]
protease inhibitor (PI) based regimens were effective as first line therapy in HIV infected children less than 5 years old
Both PI and nonprotease inhibitor (NPI) regimens were effective at 6 months of therapy but PI based regimens achieved significantly better growth parameters and CD4 levels
Summary
In India, first line antiretroviral therapy (ART) regimens extensively used for children and adults with human immunodeficiency virus (HIV) comprise 3 drugs viz. stavudine or zidovudine, lamivudine and nevirapine[1,2,3]. In India, first line antiretroviral therapy (ART) regimens extensively used for children and adults with human immunodeficiency virus (HIV) comprise 3 drugs viz. Children given single dose nevirapine at birth for prevention of parent to child transmission cannot receive nevirapine based ART regimens according to the National AIDS Control Organisation (NACO) policy[3,4] and are prescribed protease inhibitor (PI) based combinations containing lopinavir / ritonavir[5,6]. Experience is limited regarding clinical and immunological responses of PI regimens as first line therapy in children in the Indian population. Children exposed to single dose nevirapine at birth, if tested human immunodeficiency virus (HIV) positive, cannot be given nevirapine based anti-retroviral therapy (ART). Protease inhibitor (PI) based combinations are being used as first line therapy in such children. Experience is limited regarding their efficacy and adverse effects in the Indian population
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