July 20, 2006 (AIDSmeds)—Adults are not the only HIV-positive people who benefit
significantly from anti-HIV drug treatment. According to the results of
large study, HIV-positive children are also experiencing far fewer opportunistic infections (OIs)
than they were prior to the availability of combination therapy. The
study, conducted by the Pediatric AIDS Clinical Trials Group (ACTG) of
the National Institutes of Health, is the first to look at the changing
rates of OIs among children since combination treatment became the
standard-of-care approximately ten years ago.
Results
from PACTG study 219C included 2,767 children who were enrolled between
September 2000 and December 2004. The experiences of the children in
PACTG 219C – meaning the incidence, or number, of new opportunistic
infections reported – were compared to those of 3,3331 HIV-positive
children enrolled in 13 other PACTG studies conducted between October
1988 and August 1998 (the years before combination anti-HIV treatment
became the norm).
According to the study results, published in the July 19, 2006, issue of the Journal of the American Medical Association (JAMA),
approximately 90% of the children enrolled were infected with HIV
around the time of birth. Fifty-two percent of the study participants
were girls and 59% were black. On average, the children were 8.2 years
of age at the time of enrollment and were followed in the study for
approximately 3.4 years.
During the study, 395
children – 14% of the study population – experienced at least one OI.
The most common infections among the children were bacterial pneumonia, herpes zoster, fungal infections of the skin (dermatophyte infections), and thrush (oral candidiasis).
Compared
to the children in earlier PACTG studies, the children in PACTG 219C
were significantly more likely to living OI-free. Cases of bacterial
pneumonia, herpes zoster, dermatophyte infections, and oral candidiasis
were all higher in the pre-combo therapy years. Rates of other
infections, including MAC, CMV, and TB,
were also higher in children prior to the increased use of pediatric
combination treatment. In fact, in PACTG 219C, rates of these other
life-threatening OIs were very low.
While the study
authors note that children receiving combination anti-HIV treatment are
still at risk for disease-causing infections – for many of the same
reasons as HIV-positive results on treatment (e.g., poor adhere and
drug resistance) – they also stress that OIs are now uncommon in
children and infection rates continue to be lower than those reported
before combination therapy became the mainstay pediatric option.
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