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de Castro JAC, de Lima TR, Silva DAS. Health-Related Physical Fitness Evaluation in HIV-Diagnosed Children and Adolescents: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:541. [PMID: 38791753 PMCID: PMC11121308 DOI: 10.3390/ijerph21050541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/14/2024] [Accepted: 04/20/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Health-related physical fitness has been widely used to investigate the adverse effects of HIV infection/ART in children and adolescents. However, methods/protocols and cut-points applied for investigating health-related physical fitness are not clear. The aim of this scoping review was to map the literature to identify gaps in knowledge regarding the methods/protocols and cut-points. METHODS A scoping review, following the Joana Briggs Institute (JBI) guidelines, was conducted through ten major databases. Search followed the PCC strategy to construct block of terms related to population (children and adolescents), concept (health-related physical fitness components) and context (HIV infection). RESULTS The search resulted in 7545 studies. After duplicate removal, titles and abstracts reading and full text assessment, 246 studies were included in the scoping review. Body composition was the most investigated component (n = 244), followed by muscular strength/endurance (n = 23), cardiorespiratory fitness (n = 15) and flexibility (n = 4). The World Health Organization growth curves, and nationals' surveys were the most reference values applied to classify body composition (n = 149), followed by internal cut-points (n = 30) and cut-points developed through small populations (n = 16). Cardiorespiratory fitness was classified through cut-points from three different assessment batteries, as well as cut-points developed through studies with small populations, muscular strength/endurance and flexibility were classified through the same cut-points from five different assessment batteries. CONCLUSIONS The research on muscular strength/endurance, cardiorespiratory fitness and flexibility has been scarcely explored. The lack of studies that investigated method usability as well as reference values was evidenced.
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Affiliation(s)
- João Antônio Chula de Castro
- Graduate Program of Physical Education, Sports Center, Federal University of Santa Catarina, Florianopolis 88040-900, SC, Brazil; (J.A.C.d.C.); (T.R.d.L.)
| | - Tiago Rodrigues de Lima
- Graduate Program of Physical Education, Sports Center, Federal University of Santa Catarina, Florianopolis 88040-900, SC, Brazil; (J.A.C.d.C.); (T.R.d.L.)
- Graduate Program in Human Movement Sciences, University of the State of Santa Catarina, Florianopolis 88080-350, SC, Brazil
| | - Diego Augusto Santos Silva
- Graduate Program of Physical Education, Sports Center, Federal University of Santa Catarina, Florianopolis 88040-900, SC, Brazil; (J.A.C.d.C.); (T.R.d.L.)
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da Silva Cunha de Medeiros RC, dos Santos IK, de Oliveira ALV, de Goes CJD, de Medeiros JA, da Silva TAL, de Souza Araujo J, de Alcântara Varela PW, Cobucci RN, de Araújo Tinoco Cabral BG, Dantas PMS. Comparison of Muscle Strength, Aerobic Capacity and Body Composition between Healthy Adolescents and Those Living with HIV: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115675. [PMID: 34073166 PMCID: PMC8198095 DOI: 10.3390/ijerph18115675] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/13/2021] [Accepted: 02/14/2021] [Indexed: 02/05/2023]
Abstract
Background: The adverse effects of antiretroviral therapy associated with complications generated by human immunodeficiency virus (HIV) promote impairments in physical fitness in adolescents. Objective: To analyze the aerobic capacity, muscle strength, and body composition of adolescents living with HIV compared with a healthy population of the same age. Methods: Searches were performed in the MEDLINE, Embase, Web of Science, Scopus and SportDiscus databases until September 2019 and updated in April 2020. Eligibility Criteria: adolescents of both sexes in the age group from 10 to 19 years; living with HIV; cross-sectional, case–control, cohort studies; comparing with a healthy population. Mean differences and 95% Confidence intervals (CIs) were calculated using RevMan (software for systematic reviews). Results: Five articles were included, involving 197 adolescents living with HIV (16 to 18 years) and 185 without infection (13 to 18 years), with the sample in each study ranging from 15 to 65 adolescents. Aerobic capacity and muscle strength were reduced in adolescents with HIV, and body mass index was also significantly lower in this group. Conclusion: Adolescents living with HIV have impaired cardiorespiratory fitness, muscle strength, and body composition when compared to their uninfected peers. However, this systematic review provides limited evidence on the differences between the physical fitness outcomes of adolescents living with HIV compared to healthy adolescents.
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Affiliation(s)
- Rafaela Catherine da Silva Cunha de Medeiros
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte, Natal 59078-970, Brazil; (I.K.d.S.); (J.A.d.M.); (T.A.L.d.S.); (B.G.d.A.T.C.); (P.M.S.D.)
- Correspondence:
| | - Isis Kelly dos Santos
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte, Natal 59078-970, Brazil; (I.K.d.S.); (J.A.d.M.); (T.A.L.d.S.); (B.G.d.A.T.C.); (P.M.S.D.)
| | | | - Carlos Jean Damasceno de Goes
- Department of Physical Activity, Federal University of Rio Grande do Norte, Natal 59078-970, Brazil; (C.J.D.d.G.); (J.d.S.A.); (P.W.d.A.V.)
| | - Jason Azevedo de Medeiros
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte, Natal 59078-970, Brazil; (I.K.d.S.); (J.A.d.M.); (T.A.L.d.S.); (B.G.d.A.T.C.); (P.M.S.D.)
| | - Tatiane Andreza Lima da Silva
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte, Natal 59078-970, Brazil; (I.K.d.S.); (J.A.d.M.); (T.A.L.d.S.); (B.G.d.A.T.C.); (P.M.S.D.)
| | - Juliany de Souza Araujo
- Department of Physical Activity, Federal University of Rio Grande do Norte, Natal 59078-970, Brazil; (C.J.D.d.G.); (J.d.S.A.); (P.W.d.A.V.)
| | - Phelipe Wilde de Alcântara Varela
- Department of Physical Activity, Federal University of Rio Grande do Norte, Natal 59078-970, Brazil; (C.J.D.d.G.); (J.d.S.A.); (P.W.d.A.V.)
| | - Ricardo Ney Cobucci
- Biotechnology Graduate Program, Potiguar University of Rio Grande do Norte, Natal 59078-970, Brazil;
| | - Breno Guilherme de Araújo Tinoco Cabral
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte, Natal 59078-970, Brazil; (I.K.d.S.); (J.A.d.M.); (T.A.L.d.S.); (B.G.d.A.T.C.); (P.M.S.D.)
- Department of Physical Activity, Federal University of Rio Grande do Norte, Natal 59078-970, Brazil; (C.J.D.d.G.); (J.d.S.A.); (P.W.d.A.V.)
| | - Paulo Moreira Silva Dantas
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte, Natal 59078-970, Brazil; (I.K.d.S.); (J.A.d.M.); (T.A.L.d.S.); (B.G.d.A.T.C.); (P.M.S.D.)
- Department of Physical Activity, Federal University of Rio Grande do Norte, Natal 59078-970, Brazil; (C.J.D.d.G.); (J.d.S.A.); (P.W.d.A.V.)
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Mu Y, Kodidela S, Wang Y, Kumar S, Cory TJ. The dawn of precision medicine in HIV: state of the art of pharmacotherapy. Expert Opin Pharmacother 2018; 19:1581-1595. [PMID: 30234392 DOI: 10.1080/14656566.2018.1515916] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Combination antiretroviral therapy (ART) reduces viral load to under the limit of detection, successfully decreasing HIV-related morbidity and mortality. Due to viral mutations, complex drug combinations and different patient response, there is an increasing demand for individualized treatment options for patients. AREAS COVERED This review first summarizes the pharmacokinetic and pharmacodynamic profile of clinical first-line drugs, which serves as guidance for antiretroviral precision medicine. Factors which have influential effects on drug efficacy and thus precision medicine are discussed: patients' pharmacogenetic information, virus mutations, comorbidities, and immune recovery. Furthermore, strategies to improve the application of precision medicine are discussed. EXPERT OPINION Precision medicine for ART requires comprehensive information on the drug, virus, and clinical data from the patients. The clinically available genetic tests are a good starting point. To better apply precision medicine, deeper knowledge of drug concentrations, HIV reservoirs, and efficacy associated genes, such as polymorphisms of drug transporters and metabolizing enzymes, are required. With advanced computer-based prediction systems which integrate more comprehensive information on pharmacokinetics, pharmacodynamics, pharmacogenomics, and the clinically relevant information of the patients, precision medicine will lead to better treatment choices and improved disease outcomes.
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Affiliation(s)
- Ying Mu
- a Department of Clinical Pharmacy and Translational Science , University of Tennessee Health Science Center College of Pharmacy , Memphis , USA
| | - Sunitha Kodidela
- b Department of Pharmaceutical Science , University of Tennessee Health Science Center College of Pharmacy , Memphis , USA
| | - Yujie Wang
- b Department of Pharmaceutical Science , University of Tennessee Health Science Center College of Pharmacy , Memphis , USA
| | - Santosh Kumar
- b Department of Pharmaceutical Science , University of Tennessee Health Science Center College of Pharmacy , Memphis , USA
| | - Theodore J Cory
- a Department of Clinical Pharmacy and Translational Science , University of Tennessee Health Science Center College of Pharmacy , Memphis , USA
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Augustemak de Lima LR, Petroski EL, Moreno YMF, Silva DAS, Trindade EBDMS, de Carvalho AP, Back IDC. Dyslipidemia, chronic inflammation, and subclinical atherosclerosis in children and adolescents infected with HIV: The PositHIVe Health Study. PLoS One 2018; 13:e0190785. [PMID: 29320547 PMCID: PMC5761890 DOI: 10.1371/journal.pone.0190785] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 12/20/2017] [Indexed: 12/12/2022] Open
Abstract
HIV-infected children and adolescents may be at risk for cardiovascular disease due to chronic inflammation and exacerbation of risk factors. The aim of this study was as follows: 1) compare cardiovascular risk factors, chronic inflammation, and carotid intima-media thickness (IMTc) between the HIV and control groups; 2) determine the association of HIV and antiretroviral (ART) regimens with cardiovascular risk factors, chronic inflammation, and IMTc; and 3) identify variables associated with elevated IMTc. Cross-sectional analysis of 130 children and adolescents, 8-15 years of age, divided into HIV-infected (n = 65) and healthy control (n = 65) participants. Body fat, blood pressure, glycemia, insulin, and glycated hemoglobin, total cholesterol and fractions (LDL-C and HDL-C), triglycerides, C-reactive protein (CRP), interleukin (IL)-6, tumor necrosis factor-alpha (TNF-α), and the IMTc were measured. The results showed HIV-infected children and adolescents had higher levels of glycemia (87.9 vs. 75.9 mg.dL-1, p< 0.001), LDL-c (94.7 vs. 79.5 mg.dL-1, p = 0.010), triglycerides (101.2 vs. 61.6 mg.dL-1, p< 0.001), CRP (1.6 vs. 1.0 mg.L-1, p = 0.007), IL-6 (1.42 vs. 0.01 pg.mL-1, p< 0.001), TNF-α (0.49 vs. 0.01 pg.mL-1, p< 0.001), mean IMTc (0.526 vs. 0.499 mm, p = 0.009), and lower HDL-c (53.7 vs. 69.4 mg.dL-1, p< 0.001) compared to controls. Systolic blood pressure (β = 0.006, p = 0.004) and TNF-α (β = -0.033, p = 0.029) accounted for 16% of IMTc variability in HIV-infected children and adolescents. In patients using protease inhibitors-based ART, male gender (β = -0.186, p = 0.008), trunk body fat (β = -0.011, p = 0.006), glucose (β = 0.005, p = 0.046), and IL-6 (β = 0.017, p = 0.039) accounted for 28% of IMTc variability. HIV-infected children and adolescents may be at risk for premature atherosclerosis due to chronic inflammation and dyslipidemia. Interventions with the potential to improve lipid profile, mitigate inflammation, and reduce cardiovascular risk are needed.
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Affiliation(s)
- Luiz Rodrigo Augustemak de Lima
- Research Centre for Kinanthropometry and Human Performance. Department of Physical Education. Federal University of Santa Catarina. Florianópolis, Santa Catarina, Brazil
| | - Edio Luiz Petroski
- Research Centre for Kinanthropometry and Human Performance. Department of Physical Education. Federal University of Santa Catarina. Florianópolis, Santa Catarina, Brazil
| | - Yara Maria Franco Moreno
- Department of Nutrition and Postgraduate Program in Nutrition. Federal University of Santa Catarina. Florianópolis, Santa Catarina, Brazil
| | - Diego Augusto Santos Silva
- Research Centre for Kinanthropometry and Human Performance. Department of Physical Education. Federal University of Santa Catarina. Florianópolis, Santa Catarina, Brazil
| | | | - Aroldo Prohmann de Carvalho
- Department of Pediatrics, Medical School. Federal University of Santa Catarina. Florianópolis, Santa Catarina, Brazil
- Hospital Infantil Joana de Gusmão. Florianópolis, Santa Catarina, Brazil
| | - Isabela de Carlos Back
- Department of Pediatrics, Medical School. Federal University of Santa Catarina. Florianópolis, Santa Catarina, Brazil
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Safety and Efficacy of Atorvastatin in Human Immunodeficiency Virus-infected Children, Adolescents and Young Adults With Hyperlipidemia. Pediatr Infect Dis J 2017; 36:53-60. [PMID: 27749649 PMCID: PMC5154931 DOI: 10.1097/inf.0000000000001352] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Human immunodeficiency virus (HIV)-infected children receiving antiretroviral therapy (ART) have increased prevalence of hyperlipidemia and risk factors for cardiovascular disease. No studies have investigated the efficacy and safety of statins in this population. METHODS HIV-infected youth 10 to <24 years of age on stable ART with low-density lipoprotein cholesterol (LDL-C) ≥130 mg/dL for ≥6 months initiated atorvastatin 10 mg once daily. Atorvastatin was increased to 20 mg if LDL-C efficacy criteria (LDL-C < 110 mg/dL or decreased ≥30% from baseline) were not met at week 4. Primary outcomes were safety and efficacy. RESULTS Twenty-eight youth initiated atorvastatin; 7 were 10-15 years and 21 were 15-24 years. Mean baseline LDL-C was 161 mg/dL (standard deviation 19 mg/dL). Efficacy criteria were met at week 4 by 17 of 27 (63%) participants. Atorvastatin was increased to 20 mg in 10 participants. Mean LDL-C decreased from baseline by 30% (90% confidence interval: 26%, 35%) at week 4, 28% (90% confidence interval: 23%, 33%) at week 24 and 26% (90% confidence interval: 20%, 33%) at week 48. LDL-C was less than 110 mg/dL in 44% at week 4, 42% at week 12 and 46% at weeks 24 and 48. Total cholesterol, non high-density lipoprotein (non-HDL)-C and apolipoprotein B decreased significantly, but IL-6 and high-sensitivity C-reactive protein did not. Two participants in the younger age group discontinued study for toxicities possibly related to atorvastatin. CONCLUSIONS Atorvastatin lowered total cholesterol, LDL-C, non HDL-C and apolipoprotein B in HIV-infected youth with ART-associated hyperlipidemia. Atorvastatin could be considered for HIV-infected children with hyperlipidemia, but safety monitoring is important particularly in younger children.
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Renal and Bone Adverse Effects of a Tenofovir-Based Regimen in the Treatment of HIV-Infected Children: A Systematic Review. Drug Saf 2016; 39:209-18. [PMID: 26692394 DOI: 10.1007/s40264-015-0371-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Tenofovir disoproxil fumarate (TDF)-containing regimens in the treatment of HIV-infected children have safety concerns with respect to renal and bone toxicity. OBJECTIVE The aim of this study was to systematically review and critically appraise the literature relating to the reported renal and bone adverse effects of TDF-based regimens in the treatment of HIV-infected children from 2 to 19 years old. METHODS Searches were performed using the Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, OvidSP, ScienceDirect and Web of Science databases and platforms. All primary studies involving tenofovir use in HIV-infected children were sought. Studies that involved the use of TDF for pre- and post-exposure prophylaxis, and treatment of chronic hepatitis B virus infection were excluded. Data on study characteristics, participant's characteristics, therapeutic intervention and adverse effects were extracted using a piloted tool. In addition, pharmacovigilance data from the WHO Adverse Reaction database were included. RESULTS We identified 19 studies that reported the presence of renal and bone adverse effects of TDF and these included a total of 1100 study participants. The reports were in distinctly heterogeneous participant groups. A total of 287 renal and bone adverse effects were reported (250 renal and 37 bone adverse effects). Approximately 238 (21.6 %) participants were affected by these adverse effects. Of these, 15 participants stopped their TDF-containing regimen due to these adverse effects. In addition, the pharmacovigilance data from the WHO Adverse Reaction database reported 101 renal and bone adverse effects for patients whose indication was HIV/AIDS. CONCLUSION This systematic review summarises the reports of renal and bone adverse effects of a TDF-containing regimen in the treatment of HIV-infected children. Our findings suggest that the benefits of using TDF in children need to be balanced against the potential risk of toxicity.
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Cohen S, Innes S, Geelen SPM, Wells JCK, Smit C, Wolfs TFW, van Eck-Smit BLF, Kuijpers TW, Reiss P, Scherpbier HJ, Pajkrt D, Bunders MJ. Long-Term Changes of Subcutaneous Fat Mass in HIV-Infected Children on Antiretroviral Therapy: A Retrospective Analysis of Longitudinal Data from Two Pediatric HIV-Cohorts. PLoS One 2015; 10:e0120927. [PMID: 26148119 PMCID: PMC4493065 DOI: 10.1371/journal.pone.0120927] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 02/09/2015] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE Longitudinal studies objectively evaluating changes in regional fat distribution of HIV-infected children assessed by whole body dual energy X-ray absorptiometry (DEXA) are scarce, whilst this long-term effect of HIV and antiretroviral therapy (cART) is an important issue in infected children in need for lifelong treatment. METHODS We assessed regional fat distribution over time, measured with sequential DEXA-scans in HIV-infected children on cART in cohorts from South Africa (SA) and the Netherlands (NL), and in healthy controls (SA). Limb and trunk fat Z-scores were calculated with the lambda-mu-sigma (LMS) method. Multivariable linear regression models with mixed effects were used to investigate the effect of cART compounds on body fat distribution over time. RESULTS In total, 218 children underwent 445 DEXA assessments with a median follow-up of 3.5 years. Fat mass in all limbs was decreased in HIV-infected children compared to controls (arm fat Z-score: coefficient -0.4813; P = 0.006, leg fat Z-score: coefficient -0.4345; P = 0.013). In the HIV-infected group, stavudine treatment was associated with lower subcutaneous fat mass (arm fat Z-score: coefficient -0.5838; P = 0.001), with an additional cumulative exposure effect (arm fat Z-score: coefficient -0.0867; P = 0.003). CONCLUSIONS Our study shows that subcutaneous fat loss is still prevalent in HIV-infected children on cART, and is strongly associated with cumulative stavudine exposure. These results underline the need for early detection of subcutaneous fat loss and alternative treatment options for HIV-infected children globally.
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Affiliation(s)
- Sophie Cohen
- Department of Paediatric Haematology, Immunology, and Infectious Diseases, Emma Children’s Hospital, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Steve Innes
- KID-CRU (Children's Infectious Diseases Clinical Research Unit), Tygerberg Children’s Hospital and Stellenbosch University, Cape Town, South Africa
| | - Sibyl P. M. Geelen
- Department of Paediatrics, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Jonathan C. K. Wells
- Childhood Nutrition Research Centre, University College London, Institute of Child Health, London, United Kingdom
| | - Colette Smit
- Stichting HIV Monitoring, Amsterdam, The Netherlands
| | - Tom F. W. Wolfs
- Department of Paediatrics, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Berthe L. F. van Eck-Smit
- Department of Nuclear Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Taco W. Kuijpers
- Department of Paediatric Haematology, Immunology, and Infectious Diseases, Emma Children’s Hospital, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Peter Reiss
- Stichting HIV Monitoring, Amsterdam, The Netherlands
- Department of Global Health and Amsterdam Institute of Global Health and Development, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Henriette J. Scherpbier
- Department of Paediatric Haematology, Immunology, and Infectious Diseases, Emma Children’s Hospital, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Dasja Pajkrt
- Department of Paediatric Haematology, Immunology, and Infectious Diseases, Emma Children’s Hospital, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Madeleine J. Bunders
- Department of Paediatric Haematology, Immunology, and Infectious Diseases, Emma Children’s Hospital, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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Efficacy, safety and pharmacokinetics of tenofovir disoproxil fumarate in virologic-suppressed HIV-infected children using weight-band dosing. Pediatr Infect Dis J 2015; 34:392-7. [PMID: 25760566 DOI: 10.1097/inf.0000000000000633] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Tenofovir disoproxil fumarate (TDF) is approved for children but concerns remain about long-term renal and bone toxicity. We evaluated the efficacy, safety and pharmacokinetics of TDF in treatment-experienced children during 96 weeks. METHODS This was a prospective, open-label study in HIV-infected children 3-18 years of age (≥15 kg), with viral suppression on their first-line regimen without tenofovir. Children were given TDF/lamivudine/efavirenz once daily at entry; TDF was prescribed according to weight bands. Age-, gender- and CD4-matched controls receiving TDF-sparing regimens were concomitantly enrolled. Tenofovir pharmacokinetic assessment was performed at week 4. CD4 counts, HIV-1 RNA viral load and safety assessments were determined at baseline, 24, 48 and 96 weeks. RESULTS Eighty children were enrolled (40 per group); 35 (44%) were male. Median age was 12.2 (range 3.1-17.7) years. The median administered dose was 214 mg/m. Tenofovir geometric mean AUC0-24 hours, Cmax and C24 hours were 2.66 [90% confidence interval (CI) 2.49-2.84] μg hours/mL, 0.26 (0.24-0.29) μg/mL and 0.057 (0.052-0.062) μg/mL, respectively. Estimated glomerular filtration rate did not significantly change overtime. The fractional excretion of calcium slightly increased but fractional excretion of phosphate was unchanged among children in TDF group. The bone mineral density Z score decreased in the first 24 weeks of TDF treatment and was stable afterward. The TDF group had lower cholesterol levels (P = 0.001). Thirty-nine of 40 children remained virologically suppressed. No serious adverse event related to tenofovir. CONCLUSION TDF substitution in children and adolescents who were otherwise stable while receiving a first-line nonnucleoside reverse transcriptase inhibitor-based regimen achieved adequate exposure without clinically significant renal or bone adverse events over 96 weeks. While reassuring, these preliminary safety findings may not exclude delayed effects on renal function and bone density.
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Loomba-Albrecht LA, Bregman T, Chantry CJ. Endocrinopathies in children infected with human immunodeficiency virus. Endocrinol Metab Clin North Am 2014; 43:807-28. [PMID: 25169569 DOI: 10.1016/j.ecl.2014.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Endocrine changes (including adrenal insufficiency, disorders of growth and puberty, thyroid dysfunction, metabolic abnormalities and osteopenia) accompany human immunodeficiency virus (HIV) infection in pediatric patients. The cause of these changes is multifactorial and includes direct viral effects of HIV, and effects of antiretroviral therapy. These effects may be of particular importance in childhood given the critical developmental processes that occur during this time period and the likelihood of prolonged exposure to the virus and medications.
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Affiliation(s)
- Lindsey A Loomba-Albrecht
- Section of Endocrinology, Department of Pediatrics, University of California Davis Medical Center, 2516 Stockton Boulevard, Suite 384, Sacramento, CA 95817-2208, USA.
| | - Thea Bregman
- Department of Pediatrics, University of California Davis Medical Center, 2516 Stockton Boulevard, Suite 216, Sacramento, CA 95817, USA
| | - Caroline J Chantry
- Department of Pediatrics, University of California Davis Medical Center, 2516 Stockton Boulevard, Suite 334, Sacramento, CA 95817-2208, USA
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