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The study aims to evaluate the efficacy of different antiretroviral therapies in children who were given single-dose nevirapine. Results indicate that in the case of such children with nevirapine exposure, antiretroviral treatment consisting of zidovudine and lamivudine plus ritonavir-boosted lopinavir resulted in better outcomes.

Treatment failure and drug resistance create obstacles to long-term management of HIV-1 infection. Nearly 60% of infected persons fail their first highly active antiretroviral therapy (HAART) regimen, partially because of nonadherence, requiring a switch to a second regimen to prevent drug resistance. Among HIV-infected youth, a group with rising infection rates, treatment switch is often delayed; virologic and immunologic consequences of this delay are unknown. We conducted a retrospective, longitudinal study of drug resistance outcomes of initial HAART in U.S. youth enrolled between 1999-2001 in a multicenter, observational study and experiencing delayed switch in their first nonsuppressive treatment regimen for up to 3 years. HIV-1 genotyping was performed on plasma samples collected longitudinally, and changes in drug resistance mutations, CD[4.sup.+] T cell numbers and viral replication capacity were assessed. Forty-four percent (n = 18) of youth in the parent study experiencing virologic nonsuppression were maintained on their initial HAART regimen for a median of 144 weeks. Drug resistance was detected in 61% (11/18) of subjects during the study. Subjects on non-nucleoside reverse transcriptase inhibitor (NNRTI) regimens developed more (8/10) drug resistance mutations than those on protease-inhibitor (PI) regimens (2/7) (p = 0.058). Subjects developing NNRTI-resistance (NNRTI-R), showed a trend toward lower CD[4.sup.+] T cell gains (median: -6 cells/[mm.sup.3] per year) than those without detectable NNRTIR (median: +149 cells/[mm.sup.3] per year) (p = 0.16). HIV-1-infected youth maintained on initial nonsuppressive NNRTI-based HAART regimens are more likely to develop drug-resistant viremia than with PI-based HAART. This finding may have implications for initial treatment regimens and transmission risk in HIV-infected youth, a group with rising infection rates.

The level of HIV in the blood determines the progression of the disease in HIV-infected teenagers, according to a study of hemophiliacs who were infected by contaminated blood transfusions and teenagers who were sexually infected. This contradicts the belief that teenagers tolerate the infection better than older patients.

Stavudine may be safe in the treatment of HIV infection in young children. Researchers assigned 212 children 3 months to 6 years of age to treatment with stavudine or zidovudine. Children treated with stavudine had better weight gain, less reduction in CD4+ white cell levels, and less depression of neutrophilic white cell levels. Tolerance and safety of both drugs were similar. Stavudine may be appropriate as antiretroviral therapy for HIV disease in children., Objectives. To compare the safety and tolerance of stavudine (d4T) versus zidovudine (ZDV, AZT) in symptomatic human immunodeficiency virus-infected children 3 months to 6 years of age. Methods. In an initially double-blind trial, 212 evaluable human immunodeficiency virus-infected children who had received no more than 6 weeks of previous antiretroviral therapy were randomized to receive either d4T (1 mg/kg orally every 12 hours, maximum 40 mg orally every 12 hours) or zidovudine (180 mg/[m.sup.2] orally every 6 hours, maximum 200 mg orally every 6 hours). The study was unblinded after a median follow-up period of 6.3 months; median follow-up at study closure was 17.3 months. Tolerance, safety, disease progression, and immunologic responses were evaluated. Results. The patient population was young (median age, 1.2 years; range, 0.3 to 6.4 years), with a median baseline CD4+ lymphocyte count of 965 cells/[micro]L (range, 18 to 4238 cells/[micro]L). Neutropenia [is less than] 400/[micro]L occurred significantly more commonly among zidovudine recipients (1-year event rates of 20% both up to the time of unblinding and throughout the entire study) than among children receiving d4T (1-year event rates of 5% up to the time of unblinding and 6% throughout the entire study). In exploratory activity analyses using all data collected until study closure, children treated with d4T showed consistently greater positive changes from baseline in weight-for-age-and-gender z scores. As expected in this population of young children, median absolute CD4+ lymphocyte counts decreased in both treatment groups. Smaller changes from baseline were noted among d4T recipients. Conclusions. In children between the ages of 3 months and 6 years, d4T and zidovudine are largely comparable in terms of safety and tolerance. Neutropenia occurs significantly less commonly among children treated with d4T. There was evidence that weight gain and absolute CD4+ lymphocyte counts were better maintained in children receiving d4T. Pediatrics 1998,101:214-220; stavudine, zidovudine, HIV infection, infant or child., ABBREVIATIONS. HIV, human immunodeficiency virus; ZDV, zidovudine; d4T, stavudine; AIDS, acquired immunodeficiency syndrome; ALT, alanine aminotransferase. Antiretroviral therapy of human immunodeficiency virus (HIV)-infected children results in a variety of virologic, [...]

Objective. To examine beneficial or detrimental effects of protease inhibitor (PI)-containing antiretroviral regimens on height and weight growth in children with human immunodeficiency virus (HIV) infection. Methods. A prospective cohort study was conducted of 906 HIV-infected children, from pediatric research clinics in the United States, who were between 3 months and 18 years of age and who had height and weight assessed in 1995 (before introduction of PIs in this population) and at least once more through 1999. Changes in age- and gender-adjusted height and weight growth associated with PI use were assessed. Results. Compared with a healthy reference population, children were more affected in height (mean z score: -0.90 [18th percentile]) than in weight (mean z score: -0.42 [34th percentile]) at baseline (1995). Two thirds of children received at least 1 PI during 1996 to 1999. In the multivariate mixed effects regression models adjusted for baseline [log.sub.10] CD4 cell count, baseline age, gender, and race/ethnicity, the use of PIs was associated with per-year gains of 0.13 z scores in height and 0.05 z scores in weight relative to the expected growth with non-PI-containing regimens (eg, after 1 year of PI use, a representative 6-year-old boy in our study would be approximately 0.7 cm taller and 0.1 kg heavier than if he had not received PIs). No significant differential effects of PIs on height or weight growth according to specific agents or children's sociodemographic or clinical characteristics were found. Conclusions. Although the use of PI-containing regimens was not associated with growth retardation, it was associated with only small annual increments in height and weight growth in HIV-infected children. Pediatrics 2001;107(4). URL: http://www.pediatrics.org/cgi/content/ full/107/4/e72; HIV-1, protease inhibitor, growth, children.

OBJECTIVES. The purpose of this work was to examine the effects of HIV infection and the impact of highly active antiretroviral treatment with protease inhibitors on neuro-developmental functioning during the [...]

Health Science Research: A Handbook of Quantitative Methods. Jennifer PEAT. Thousand Oaks, CA: Sage Publications, 2002. ISBN 0-7619-7402-4. xiv + 313 pp. $80.00 (H). ISBN 0-7619-7403-2. $27.50 (P). This book [...]

Quick Results With the Output Delivery System. Sunil GUPTA. Cary, NC: SAS Publishing, 2003. ISBN 1-59047-163-6. viii + 102 pp. $24.95 (P). The Output Delivery System (ODS) in SAS is [...]