EFFECT OF ANTIRETROVIRAL COMBINATION THERAPY (ZIDOVUDINE DIDANOSINE OR ZIDOVUDINE/LAMIVUDINE) ON QUANTITATIVE PLASMA HUMAN-IMMUNODEFICIENCY-VIRUS RIBONUCLEIC-ACID IN CHILDREN AND ADOLESCENTS INFECTED WITH HUMAN-IMMUNODEFICIENCY-VIRUS/

Objective: To assess human immunodeficiency virus (HIV) ribonucleic ac id load in children and adolescents with HIV infection who are being t reated with antiretroviral combination therapy. Study design: Five pat ients whose disease progressed with their prior antiretroviral therapy had treatment regimens changed to zidovudine (ZDV)/didanosine (DDI) ( group A), and the regimens of six patients were changed to ZDV/lamivud ine (3TC) (group B). Patients were followed every 4 to 8 weeks for an average period of 8.6 months. Serial determinations of viral copy numb ers and CD4 cells were performed. Results: In group A patients' mean r elative changes in CD4 cells showed a 20% increase after 4 months (dif ference not significant (NS)) and a return to baseline after 8 months; in group 8 patients' mean relative increases of CD4 cells were 72% (p = 0.046) and 50% (NS), respectively. In group A mean relative viral l oad increased 21% (0.08 log(10), NS) and 71% (0.23(10) log, NS), where as in group B viral load decreased 22% (0.1 log(10) NS) and 74% (0.58 log(10), p = 0.03) after 4 and 8 months, respectively. After starting antiretroviral combination therapy in group A, there was a slight tren d of a decreasing ratio of viral load per number of CD4 cells, whereas in group B this ratio significantly decreased, indicating a marked su ppression of viral turnover with ZDV/3TC treatment. Conclusion: In a s mall cohort of pediatric patients, combination therapy with ZDV/3TC wa s well tolerated and had a strong and sustained effect on the decrease of viral load similar to results obtained in adults. In patients with ZDV/DDI therapy the reduction of viral load was less pronounced, but treatment groups A and B were not comparable for statistic evaluation.