Affecting factors to effectiveness of starting therapy in children with hiv infection

Abstract

The purpose of the research – to characterize of the factors that influence the effectiveness of the starting highly activе antiretroviral therapy in children with HIV infection.Materials and methods. A total of 67 children with HIV infectionat the age from 24 to 36 months who have not received antiretroviral treatment. Patients received highly activе antiretroviral therapy on clinical, immunological and laboratory indications. Regimen consisted of two HIV nucleoside reverse transcriptase inhibitors (zidovudine and lamivudine) in combination with a nonnucleoside reverse transcriptase inhibitor or viral protease inhibitor. Аs the third component of the scheme in 22 patients (32,8%) used nevirapine, in 24 (35,8%) – lopinavir/ritonavir, in 21 children (31,3%) – nelfinavir. In the future, the effectiveness of treatment was assessed by clinical parameters, the number of CD4 lymphocytes in the blood and HIV blood viral load. Data on the duration of the effectiveness of conservation regimens examined using Cox proportional hazard model.Results. Duration of highly activу antiretroviral therapy was 12–79 months (median 28 months, interquartile range 13–60 months). In 55,2% patients, achieved sustained viral suppression (viral load levels below the level of test system sensitivity), improving the immune status (increase number of CD4 lymphocytes), the positive dynamics of clinical symptoms. In 37,3% patients, initial regimen was modified because of its inefficiency, which is often due to the inability to completely suppress viral replication (37,5%) and improve immune status (8,9%). Side effects occurred in 28,4% children, but only in 7,5% patients they were the cause of change therapies. When testing the clinical and laboratory parameters prior to treatment in the Cox model revealed that an independent factor increasing the duration of the effectivenessof homepage conservation regimen was the appointment of lopinavir/ritonavir.Conclusion. The results will contribute to the effectiveness of highly activе antiretroviral therapy of HIV infection in children with her long-term use.

Keywords

• hiv
• children
• highly activе antiretroviral therapy
• lopinavir/ritonavir
• nelfinavir
• nevirapine