Combination antiretroviral therapy including ritonavir in children infected with human immunodeficiency

Objective: To assess the efficacy of combination therapy that includes rito navir in HIV-1 infected children. Design: A monocentric retrospective study. Patients and Methods: Twenty two children with a minimum follow-up of 6 mon ths under triple therapy including ritonavir were analysed for treatment ef ficacy. At entry, all the patients were protease inhibitor naive and all bu t two had received previous antiretroviral therapy during a median period o f 5 years. Their initial median CD4+ lymphocyte count and viral load were 1 21 x 10(6)/l and 5.08 log(10) copies/ml, respectively. Clinical and biologi cal evaluation included clinical assessment every 6 weeks and determination of CD4 cell count and HIV-RNA concentration every 3 months. Results: Median length of follow-up on triple therapy was 15 months (range: 7-21 months). Neither progression in the CDC classification nor death occu rred. No significant change in mean weight SD scores was noted when baselin e values were compared with values obtained after 1 year of triple therapy. Median CD4 count increases were of 210 x10(6)/l, 415 x10(6)/l, and 472 x10 (6)/l cells at 6, 12, and 18 months, respectively. Among the patients basel ine characteristics, neither age nor initial CD4 cells count influenced the magnitude of immunologic improvement. There were median decreases of 1.14, 0.95, and 1.5 log(10) per ml of plasma in the concentration of viral RNA a t 6, 12, and 18 months respectively. Seven patients maintained an undetecta ble viral load when under treatment. The introduction of at least one new r everse transcriptase inhibitor at the initiation of triple therapy correlat ed significantly with a greater viral suppression. Conclusion: Despite variable viral response, antiretroviral-experienced HIV -infected children demonstrated a substantial CD4 cell increase during a me dian period of 15 months of ritonavir containing combination therapy. (C) 1 999 Lippincott Williams & Wilkins.