Abacavir in Kids with HIV-Associated Encephalopathy
January 4, 2007
(Reuters Health) -
High-dose abacavir provides significant clinical, immunological, and virological responses in children with HIV-associated encephalopathy (HIV-AE), according to a report in the December issue of The Pediatric Infectious Disease Journal.
Adults with HIV-associated dementia have previously been shown to have good responses to high-dose abacavir, the authors explain, but few studies have assessed its efficacy in children with HIV-AE.
Dr. Jesus Saavedra-Lozano from Hospital de Fuenlabrada, Madrid, and colleagues evaluated the safety and virological, immunological, and neuropsychological efficacy of highly active antiretroviral therapy that included high-dose abacavir in 17 children with HIV-AE.
Median plasma HIV RNA declined by 2.29 log10 copies/mL after 48 weeks of treatment, the authors report, and median cerebrospinal fluid (CSF) HIV RNA declined by 0.94 log10 copies/mL.
Similarly, mean plasma concentrations of soluble tumor necrosis factor receptor II decreased by 177.1 pg/mL and median CSF concentrations decreased by 17 pg/mL, the results indicate.
Children younger than 6 years showed significant improvements after treatment in all neuropsychological parameters, the researchers note, whereas older children did not experience significant improvements in neuropsychological outcomes (though the sample size of this subgroup was small).
Neurological examinations did not differ between baseline and week 48, the report indicates.
Treatment was generally well tolerated in all but two children who had a possible hypersensitivity reaction to abacavir, the investigators report.
"The children in this study were heavily pretreated and yet demonstrated a significantly favorable outcome," the authors note.
"The use of antiretroviral medications with good CNS penetration such as high-dose abacavir and efavirenz may have accounted for these positive results. The role of larger doses of antiretroviral drugs with good CNS penetration in HIV-infected individuals with neurological disease warrants further investigation in larger cohorts," the researchers add.
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