2009, Number 4
<< Back Next >>
Bol Med Hosp Infant Mex 2009; 66 (4)
Discordant response to highly active antiretroviral therapy in Mexican pediatric patients infected with HIV/AIDS
Romano-Mazzotti L, Sifuentes-Vela C, Villalobos-Acosta P, Santos-Preciado JI, Pavía-Ruz N
Language: Spanish
References: 28
Page: 335-342
PDF size: 150.20 Kb.
ABSTRACT
Introduction. The goal of antiretroviral (ART) therapy is to control human immunodeficiency virus replication and to increase CD4 T-cell count. Discordant response to ART occurs when only one of these two objectives is achieved.
Methods. Pediatric patients who attended the Clínica de Inmunodeficiencias at Hospital Infantil de Mexico Federico Gomez were studied retrospectively. Response to a PI-based highly active antiretroviral therapy (HAART) was classified as optimal, failure, discordant response with viral failure and discordant response with viral success. Demographic data, viral load and CD4 T-cell count (baseline, 6-month and 12-month follow-up determinations) were analyzed.
Results. Fifty six patients were included. Mean age of patients was 30.5 months. Discordant response was seen in 45 and 53.5% at 6- and 12-months follow-up, respectively.
Conclusions. Discordant response was seen in ›50% of our study population and is a common scenario; clinical implications are still unknown. Discordant response should not be interpreted, especially during the first 12 months of therapy, as a failure of HAART.
REFERENCES
Starr SE, Fletcher CV, Spector SA, et al. Combination therapy with efavirenz, nelfinavir, and nucleoside reverse-transcriptase inhibitors in children infected with human immunodeficiency virus type 1. Pediatric AIDS Clinical Trials Group 382 Team. N Engl J Med. 1999; 341: 1874-81.
Staszewski S, Morales-Ramírez J, Tashima KT, et al. Efavirenz plus zidovudine and lamivudine, efavirenz plus indinavir, and indinavir plus zidovudine and lamivudine in the treatment of HIV-1 infection in adults. Study 006 Team. N Engl J Med. 1999; 341: 1865-73.
Working Group on Antiretroviral Therapy and Medical Management of HIV-infected children, United States. Health Resources and Services Administration. National Institutes of Health (U.S.). Guidelines for the use of antiretroviral agents in pediatric HIV infection. 2008 Junio 28; Bethesda, MD: National Institutes of Health; 2008.
Mellors JW, Muñoz A, Giorgi JV, et al. Plasma viral load and CD4+ lymphocytes as prognostic markers of HIV-1 infection. Ann Intern Med. 1997; 126: 946-54.
O’Brien WA, Hartigan PM, Daar ES, Simberkoff MS, Hamilton JD. Changes in plasma HIV RNA levels and CD4+ lymphocyte counts predict both response to antiretroviral therapy and therapeutic failure. VA Cooperative Study Group on AIDS. Ann Intern Med. 1997; 126: 939-45.
Mehta SH, Lucas G, Astemborski J, Kirk GD, Vlahov D, Galai N. Early immunologic and virologic responses to highly active antiretroviral therapy and subsequent disease progression among HIV-infected injection drug users. AIDS Care. 2007; 19: 637-45.
Nicastri E, Chiesi A, Angeletti C, et al. Clinical outcome after 4 years follow-up of HIV-seropositive subjects with incomplete virologic or immunologic response to HAART. J Med Virol. 2005; 76: 153-60.
Ghaffari G, Passalacqua DJ, Caicedo JL, Goodenow MM, Sleasman JW. Two-year clinical and immune outcomes in human immunodeficiency virus-infected children who reconstitute CD4 T cells without control of viral replication after combination antiretroviral therapy. Pediatrics. 2004; 114: e604-11.
Flynn PM, Rudy BJ, Douglas SD, et al. Virologic and immunologic outcomes after 24 weeks in HIV type 1-infected adolescents receiving highly active antiretroviral therapy. J Infect Dis. 2004; 190: 271-9.
Sufka SA, Ferrari G, Gryszowka VE, et al. Prolonged CD4+ cell/virus load discordance during treatment with protease inhibitor-based highly active antiretroviral therapy: immune response and viral control. J Infect Dis. 2003; 187: 1027-37.
Dronda F, Moreno S, Moreno A, Casado JL, Pérez-Elías MJ, Antela A. Long-term outcomes among antiretroviral-naive human immunodeficiency virus-infected patients with small increases in CD4+ cell counts after successful virologic suppression. Clin Infect Dis. 2002; 35: 1005-9.
D’Ettorre G, Forcina G, Andreotti M, et al. Discordant response to antiretroviral therapy: HIV isolation, genotypic mutations, T-cell proliferation and cytokine production. AIDS. 2002; 16: 1877-85.
Tan R, Westfall AO, Willig JH, et al. Clinical outcome of HIV-infected antiretroviral-naive patients with discordant immunologic and virologic responses to highly active antiretroviral therapy. J Acquir Immune Defic Syndr. 2008; 47: 553-8.
Rodríguez C, Koch S, Goodenow M, Sleasman J. Clinical implications of discordant viral and immune outcomes following protease inhibitor containing antiretroviral therapy for HIV-infected children. Immunol Res. 2008; 40: 271-86.
Tuboi SH, Brinkhof MW, Egger M, et al. Discordant responses to potent antiretroviral treatment in previously naive HIV-1-infected adults initiating treatment in resource-constrained countries: the antiretroviral therapy in low-income countries (ART-LINC) collaboration. J Acquir Immune Defic Syndr. 2007; 45: 52-9.
Mehta S, Lucas G, Astemborski J, Kirk G, Vlahov D, Galai N. Early immunologic and virologic responses to highly active antiretroviral therapy and subsequent disease progression among HIV-infected injection drug users. CAIC. 2007; 19: 637-45.
Schechter M. Discordant immunological and virological responses to antiretroviral therapy. J Antimicrob Chemother. 2006; 58: 506-10.
Grabar S, Le Moing V, Goujard C, et al. Clinical outcome of patients with HIV-1 infection according to immunologic and virologic response after 6 months of highly active antiretroviral therapy. Ann Intern Med. 2000; 133: 401-10.
Moore DM, Hogg RS, Yip B, et al. Discordant immunologic and virologic responses to highly active antiretroviral therapy are associated with increased mortality and poor adherence to therapy. J Acquir Immune Defic Syndr. 2005; 40: 288-93.
Piketty C, Weiss L, Thomas F, Mohamed AS, Belec L, Kazatchkine MD. Long-term clinical outcome of human immunodeficiency virus-infected patients with discordant immunologic and virologic responses to a protease inhibitor-containing regimen. J Infect Dis. 2001; 183: 1328-35.
Wu H, Lathey J, Ruan P, et al. Relationship of plasma HIV-1 RNA dynamics to baseline factors and virological responses to highly active antiretroviral therapy in adolescents (aged 12-22 years) infected through high-risk behavior. J Infect Dis 2004; 189: 593-601.
Jankelevich S, Mueller BU, Mackall CL, et al. Long-term virologic and immunologic responses in human immunodeficiency virus type 1-infected children treated with indinavir, zidovudine, and lamivudine. J Infect Dis. 2001; 183: 1116-20.
Malhotra A, Gaur S, Whitley-Williams P, Loomis C, Petrova A. Protease inhibitor associated mutations compromise the efficacy of therapy in human immunodeficiency virus-1 (HIV-1) infected pediatric patients: a cross-sectional study. AIDS Res Ther. 2007; 4: 15.
Molinapinelo S, Leal M, Sorianosarabia N, et al. Prevalence and factors involved in discordant responses to highly active antiretroviral treatment in a closely followed cohort of treatment-naïve HIV-infected patients. J Clin Virol. 2005; 33: 110-5.
National Institutes of Health (U.S.). Office of AIDS Research. Advisory Council, United States. Public Health Service. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents; 2008 Nov 3; Bethesda, MD: National Institutes of Health; 2008.
Chen TK, Aldrovandi GM. Review of HIV antiretroviral drug resistance. Pediatr Infect Dis J. 2008; 27: 749-52.
Resino S, Resino R, Leon J, et al. Impact of long-term viral suppression in CD4+ recovery of HIV-children on highly active antiretroviral therapy. BMC Infect Dis. 2006; 6: 10.
Zhang F, Haberer JE, Zhao Y, et al. Chinese pediatric highly active antiretroviral therapy observational cohort: a 1-year analysis of clinical, immunologic, and virologic outcomes. J Acquir Immune Defic Syndr. 2007; 46: 594-8.