Evaluation of response to protease inhibitor based first line anti-retroviral therapy (ART) regimens in human immunodeficiency virus infected children compared to standard first line non-protease inhibitor ART regimens

An Indian experience

Sowmya Shashidhara, Sangita Trivedi, Jayesh Kosambiya, Aditya Gaur

Research output: Contribution to journalArticle

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 nonprotease 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<0.001). Fewer children remained in stages 3 and 4 at the end of the study in the PI group. The mean height, weight and CD4 counts of children in the PI group were significantly higher than those in NPI group after 6 months of ART therapy. Total white blood cell counts and cholesterol levels were considerably higher in the PI group (p<0.001). 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.

Original languageEnglish
Pages (from-to)160-164
Number of pages5
JournalSri Lanka Journalof Child Health
Volume46
Issue number2
DOIs
Publication statusPublished - 01-01-2017
Externally publishedYes

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Protease Inhibitors
HIV
Nevirapine
Therapeutics
Tertiary Healthcare
CD4 Lymphocyte Count
Growth
Hypercholesterolemia
Leukocyte Count
Tertiary Care Centers
India
Acquired Immunodeficiency Syndrome
Cohort Studies
Cholesterol
Parturition
Organizations
Prospective Studies
Weights and Measures

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health

Cite this

@article{829a6cd779fe481ea9866781119d619d,
title = "Evaluation of response to protease inhibitor based first line anti-retroviral therapy (ART) regimens in human immunodeficiency virus infected children compared to standard first line non-protease inhibitor ART regimens: An Indian experience",
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 nonprotease 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<0.001). Fewer children remained in stages 3 and 4 at the end of the study in the PI group. The mean height, weight and CD4 counts of children in the PI group were significantly higher than those in NPI group after 6 months of ART therapy. Total white blood cell counts and cholesterol levels were considerably higher in the PI group (p<0.001). 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.",
author = "Sowmya Shashidhara and Sangita Trivedi and Jayesh Kosambiya and Aditya Gaur",
year = "2017",
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doi = "10.4038/sljch.v46i2.8274",
language = "English",
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pages = "160--164",
journal = "Sri Lanka Journalof Child Health",
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T1 - Evaluation of response to protease inhibitor based first line anti-retroviral therapy (ART) regimens in human immunodeficiency virus infected children compared to standard first line non-protease inhibitor ART regimens

T2 - An Indian experience

AU - Shashidhara, Sowmya

AU - Trivedi, Sangita

AU - Kosambiya, Jayesh

AU - Gaur, Aditya

PY - 2017/1/1

Y1 - 2017/1/1

N2 - 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 nonprotease 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<0.001). Fewer children remained in stages 3 and 4 at the end of the study in the PI group. The mean height, weight and CD4 counts of children in the PI group were significantly higher than those in NPI group after 6 months of ART therapy. Total white blood cell counts and cholesterol levels were considerably higher in the PI group (p<0.001). 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.

AB - 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 nonprotease 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<0.001). Fewer children remained in stages 3 and 4 at the end of the study in the PI group. The mean height, weight and CD4 counts of children in the PI group were significantly higher than those in NPI group after 6 months of ART therapy. Total white blood cell counts and cholesterol levels were considerably higher in the PI group (p<0.001). 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.

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