Antiretroviral therapy (ART) for pediatric human immunodeficiency virus (HIV) infection has evolved from the single or dual nucleoside reverse transcriptase inhibitor (NRTI) regimens of the 1980s and early 1990s to today's complex regimens of NRTI in combination with protease inhibitors (PIs) and/or nonnucleoside reverse transcriptase inhibitors (NNRTIs), according to background information in the article. No previous studies have examined how novel therapies have been integrated into the clinical care of pediatric HIV infection, or if there is concordance between recommended guidelines and treatment in clinical practice.
Susan Brogly, Ph.D., of the Harvard School of Public Health, Boston and colleagues examined the changes in the treatment of pediatric HIV in the United States from 1987 to 2003. The study included 766 perinatally HIV-infected children from the Pediatric AIDS Clinical Trials Group 219C cohort born before January 1, 2004, who had not participated in an ART clinical trial.
The researchers found that single and dual NRTI regimens were used most frequently through 1997. In 1998, 2 years after protease inhibitors were approved for adult HIV infection and at the time pediatric guidelines were issued, regimens of highly active antiretroviral therapy including a protease inhibitor became most frequently used. From 1998-2003, 22 percent of children initiated ART with a regimen not recommended by pediatric guidelines. In additional analysis, the risk of switching decreased with age at ART initiation and increased with year of initiation. The risk of switching was higher in children who started with 1 or 2 NRTIs or an unconventional regimen vs. children who started on a protease inhibitor-containing regimen.
"The use of unorthodox regimens not recommended by the U.S. pediatric guidelines was relatively common, and was related to a shorter time to first regimen switch," the authors write. "Monitoring and documenting ART use in HIV-infected children can provide important insight regarding the clinical care of this population."
(JAMA. 2005;293:2213-2220. Available post-embargo at JAMA.com)
Editor's Note: For funding/support information, please see the JAMA article.
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