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Green H, Gibb DM, Walker AS, Pillay D, Butler K, Candeias F, Castelli-Gattinara G, Compagnucci A, Della Negra M, de Rossi A, Feiterna-Sperling C, Giaquinto C, Harper L, Levy J, Saidi Y, Wintergerst U. Lamivudine/abacavir maintains virological superiority over zidovudine/lamivudine and zidovudine/abacavir beyond 5 years in children. AIDS 2007; 21:947-55. [PMID: 17457088 DOI: 10.1097/qad.0b013e3280e087e7] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe the long-term efficacy over 5 years of regimens including combinations of abacavir, lamivudine and/or zidovudine in previously untreated children in the PENTA 5 trial. DESIGN PENTA 5 was a 48-week randomised controlled trial comparing three dual nucleoside reverse transcriptase inhibitor (NRTI) combinations as part of first triple antiretroviral therapy (ART). METHODS 128 ART-naïve children were randomised to zidovudine\lamivudine (n = 36), zidovudine\abacavir (45) or lamivudine\abacavir (47). Asymptomatic children (n = 55) were also randomised to nelfinavir or placebo; all other children received open-label nelfinavir. Analyses are intent-to-treat and adjusted for minor baseline imbalances and receipt of nelfinavir/placebo. RESULTS Median follow-up was 5.8 years. By 5 years, 17 (47%), 28 (64%) and 18 (39%) children had changed their randomised NRTIs in the zidovudine\lamivudine, zidovudine\abacavir and lamivudine\abacavir groups respectively, but 18%, 50% and 50% of these changes were either early single drug substitutions for toxicity or switches with viral suppression (HIV-1 RNA < 400 copies/ml; e.g. to simplify regimen delivery). At 5 years, 55%/32% zidovudine\lamivudine, 50%/25% zidovudine\abacavir and 79%/63% lamivudine\abacavir had HIV-1 RNA < 400/< 50 copies/ml respectively (p = 0.03/p = 0.003). Mean increase in height-for-age 0.42, 0.68, 1.05 (p = 0.02); weight-for-age 0.03, 0.13, 0.75 (p = 0.02). Reverse transcriptase resistance mutations emerging on therapy differed between the groups: zidovudine\lamivudine (M41L, D67N, K70R, M184V, L210W, T215Y); zidovudine\abacavir (M41L, D67N, K70R, L210W, T215F/Y, K219Q); lamivudine\abacavir (K65R, L74V, Y115F, M184V). CONCLUSIONS Five year data demonstrate that lamivudine\abacavir is more effective in terms of HIV-1 RNA suppression and growth changes, with lower rates of switching with detectable HIV-1 RNA than zidovudine\lamivudine or zidovudine\abacavir, and should be preferred as first-line NRTI backbone.
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Affiliation(s)
- H Green
- MRC Clinical Trials Unit, 222 Euston Road, London, NW1 2DA, UK.
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Abstract
Herpetic whitlow applies to a primary or recurrent herpes simplex infection of the fingers. It is a rare condition in immunocompetent patients, and usually has a rapid evolution and prompt response to treatment. We report a 10-year-old girl referred to our department of infectious diseases with recurrent and unresponsive ulcerated and necrotic lesions of the fingers of both hands as a first sign of human immunodeficiency virus infection. Numerous instances of extensive or recurrent herpes lesions of the mouth, lips, and perianal areas have been found in the literature, but we have not found any report of periungual infection as a first manifestation of human immunodeficiency virus infection. Pediatricians and dermatologists need to be aware of this association in order to make an early diagnosis and start treatment of these patients' disease.
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Affiliation(s)
- M El Hachem
- Department of Dermatology, Bambino Gesu Children's Hospital- Research Institute, Rome, Italy.
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De Rossi A, Walker AS, Forni DD, Klein N, Gibb DM, Aboulker JP, Babiker A, Compagnucci A, Darbyshire J, Debré M, Gersten M, Giaquinto C, Gibb DM, Jones A, Aboulker JP, Babiker A, Blanche S, Bohlin AB, Butler K, Castelli-Gattinara G, Clayden P, Darbyshire J, Debré M, de Groot R, Faye A, Giaquinto C, Gibb DM, Griscelli C, Grosch-Wörner I, Levy J, Lyall H, Mellado Pena M, Nadal D, Peckham C, Ramos Amador JT, Rosado L, Rudin C, Scherpbier H, Sharland M, Tovo PA, Valerius N, Wintergerst U, Boucher C, Clerici M, de Rossi A, Klein N, Loveday C, Muñoz-Fernandez M, Pillay D, Rouzioux C, Babiker A, Darbyshire J, Gibb DM, Harper L, Johnson D, Kelleher P, McGee L, Poland A, Walker AS, Aboulker JP, Carrière I, Compagnucci A, Debré M, Eliette V, Leonardo S, Moulinier C, Saidi Y, Galli L, Foot A, Kershaw H, Caul O, Tarnow-Mordi W, Petrie J, McIntyre P, Appleyard K, Gibb DM, Novelli V, Klein N, McGee L, Ewen S, Johnson M, Gibb DM, Cooper E, Fisher T, Barrie R, Norman J, King D, Larsson-Sciard EL. Relationship between Changes in Thymic Emigrants and Cell-Associated HIV-1 Dna in HIV-1-Infected Children Initiating Antiretroviral Therapy. Antivir Ther 2005. [DOI: 10.1177/135965350501000104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives and methods To investigate the relationship between cell-associated HIV-1 dynamics and recent thymic T-cell emigrants, HIV-1 DNA and T-cell receptor rearrangement excision circles (TREC, a marker of recent thymic emigrants) were measured in peripheral blood mononuclear cells in 181 samples from 33 HIV-1-infected children followed for 96 weeks after antiretroviral therapy (ART) initiation. Results At baseline, HIV-1 DNA was higher in children with higher TREC ( P=0.02) and was not related to age, CD4 or HIV-1 RNA in multivariate analyses ( P>0.3). Overall, TREC increased and HIV-1 DNA decreased significantly after ART initiation, with faster HIV-1 DNA declines in children with higher baseline TREC ( P=0.009). The greatest decreases in HIV-1 DNA occurred in children with the smallest increases in TREC levels during ART ( P=0.002). However, this inverse relationship between changes in HIV-1 DNA and TREC tended to vary according to the phase of HIV-1 RNA decline ( P=0.13); for the same increase in TREC, HIV-1 DNA decline was much smaller during persistent or transient viraemia compared with stable HIV-1 RNA suppression. Conclusions Overall, these findings indicate that TREC levels predict HIV-1 DNA response to ART and suggest that immune repopulation by thymic emigrants adversely affects HIV-1 DNA decline in the absence of persistent viral suppression, possibly by providing a cellular source for viral infection and replication.
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Affiliation(s)
| | - Anita De Rossi
- Department of Oncology and Surgical Sciences, AIDS Reference Centre, Padova, Italy
| | | | - Davide De Forni
- Department of Oncology and Surgical Sciences, AIDS Reference Centre, Padova, Italy
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- PHL Regional Virus Laboratory, Bristol
| | - H Kershaw
- PHL Regional Virus Laboratory, Bristol
| | - O Caul
- Ninewells Hospital and Medical School, Dundee
| | | | | | | | | | - DM Gibb
- Newham General Hospital, London
| | | | - N Klein
- Newham General Hospital, London
| | - L McGee
- Newham General Hospital, London
| | - S Ewen
- Newham General Hospital, London
| | | | - DM Gibb
- St Bartholemew's Hospital, London
| | - E Cooper
- St Bartholemew's Hospital, London
| | - T Fisher
- St Bartholemew's Hospital, London
| | | | - J Norman
- Chelsea and Westminster Hospital, London
| | - D King
- University College London Medical School
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Gatti G, Castelli-Gattinara G, Cruciani M, Bernardi S, De Pascalis CR, Pontali E, Papa L, Miletich F, Bassetti D. Pharmacokinetics and pharmacodynamics of nelfinavir administered twice or thrice daily to human immunodeficiency virus type 1-infected children. Clin Infect Dis 2003; 36:1476-82. [PMID: 12766843 DOI: 10.1086/375062] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2002] [Accepted: 02/10/2003] [Indexed: 11/03/2022] Open
Abstract
We studied the pharmacokinetics and pharmacodynamics of nelfinavir administered 2 or 3 times per day to human immunodeficiency virus type 1 (HIV-1)-infected children receiving highly active antiretroviral therapy containing nelfinavir. The geometric mean trough concentrations of nelfinavir for the thrice- and twice-daily regimens were 1.55 mg/L and 1.11 mg/L, respectively (P=not significant). Nelfinavir concentrations did not correlate with total daily dose, dose per kilogram of weight, age, weight, previous protease inhibitor (PI) experience, or CD4(+) cell percentage. In the 25 PI-naive children, the virus load reductions at 24 weeks of treatment with the twice- and thrice-daily regimens were comparable. A significantly higher percentage of children in the twice-daily group had a trough concentration of nelfinavir of less than the inhibitory concentration of 95% (P=.042). The decrease in the virus load at 24 weeks of treatment was not correlated with the trough concentration of nelfinavir. The variability of trough concentrations was extremely high, particularly among recipients of the twice-daily regimen, resulting in a higher number of patients with subinhibitory concentrations of nelfinavir in this group.
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Affiliation(s)
- G Gatti
- Gaslini Childrens Hospital, Genoa, Italy.
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Matarese G, Castelli-Gattinara G, Cancrini C, Bernardi S, Romiti ML, Savarese C, Di Giacomo A, Rossi P, Racioppi L. Serum leptin and CD4+ T lymphocytes in HIV+ children during highly active antiretroviral therapy. Clin Endocrinol (Oxf) 2002; 57:643-6. [PMID: 12390339 DOI: 10.1046/j.1365-2265.2002.01634.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Because leptin, the adipocyte-derived hormone, affects thymocyte survival, proliferation of naïve T lymphocytes and the production of proinflammatory cytokines, we aimed to investigate the role of this molecule in immunoreconstitution during highly active antiretroviral therapy (HAART). DESIGN Prospective longitudinal cohort study. A series of 20 HIV+ children were studied. The subjects were grouped by their increase in serum leptin levels after HAART. METHODS All participants were weight-stable, free of endocrine disorders and opportunistic infections and equally distributed for sex (males, n=10; females, n=10). Body mass index (BMI), serum lipids, leptin, CD4+ T cells and HIV-1 RNA were measured before initiation of HAART and after a 2-year follow-up. RESULTS Serum leptin concentration positively correlated with CD4+ lymphocyte number before treatment. HAART significantly reduced viraemia and increased serum levels of lipids in all patients, whereas a significant increase in CD4+ cells and serum leptin was observed in the majority of patients. Notably, in children where HAART was not effective in increasing CD4+ lymphocyte counts, serum leptin did not increase. CONCLUSION To our knowledge, these findings reveal for the first time a novel link among CD4+ T lymphocytes, serum leptin and highly active anteretroviral theraphy.
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Affiliation(s)
- G Matarese
- Istituto di Endocrinologia e Oncologia Sperimentale, Consiglio Nazionale delle Ricerche and Cattedra di Immunologia, Dipartimento di Biologia e Patologia Cellulare e Molecolare, Università di Napoli Federico II, Roma, Italy
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Romiti ML, Cancrini C, Castelli-Gattinara G, Di Cesare S, Ciaffi P, Bernardi S, De Gasperi MR, Halapi E, Rossi P. Kinetics of the T-cell receptor CD4 and CD8 V beta repertoire in HIV-1 vertically infected infants early treated with HAART. AIDS 2001; 15:2075-84. [PMID: 11684926 DOI: 10.1097/00002030-200111090-00002] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine the kinetics and the relationship between the T-cell receptor V beta (TCRBV) complementary determining region 3 length, the CD4 T-cell count and HIV viral load changes in HIV-1 infected infants treated early with highly active antiretroviral therapy (HAART) during 1 year of follow-up. DESIGN Two HIV-1 vertically infected infants, two HIV-1 vertically exposed uninfected and two healthy controls were analysed by spectratyping. Evaluation of viral load, CD4 naive and memory cell counts and a proliferation test were also carried out. METHODS Twenty-six families and subfamilies of the TCR on CD4 and CD8 T cells were analyzed by spectratyping. Flow cytometric analysis on peripheral blood mononuclear cells for CD4CD45Ra, CD4CD45Ro, CD8CD38, proliferation tests and plasma viral load measurements were performed at baseline, 1, 6 and after 12 months of therapy. RESULTS HAART induced a marked reduction of viral load in both HIV-1 infected infants and an increase to normal CD4 T-cell count in the symptomatic infant. At baseline the TCRBV family distribution in the majority of CD8 and a few of the CD4 T cells was highly perturbed, with several TCRBV families showing a monoclonal/oligoclonal distribution. During HAART a normalization of the TCR repertoire in both CD8 and CD4 subsets occurred. TCR repertoire normalization was associated with a good virological and immunological response. CONCLUSION These results suggest that complete and early virus replication control as a result of early HAART leads to a marked reduction of T-cell oligoclonality and is an essential prerequisite to the development of a polyclonal immune response in HIV-1 infected infants.
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Affiliation(s)
- M L Romiti
- Division of Immunology and Infectious Diseases, Children's Hospital Bambino Gesu, Rome, Italy
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Jansson M, Orlandi P, Scarlatti G, Moschese V, Romiti ML, Cancrini C, Mancia L, Livadiotti S, Castelli-Gattinara G, Rossi P, Halapi E. Role of immunity in maternal-infant HIV-1 transmission. Acta Paediatr Suppl 1997; 421:39-45. [PMID: 9240856 DOI: 10.1111/j.1651-2227.1997.tb18318.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Factors influencing human immunodeficiency virus type 1 (HIV-1) mother-to-child transmission include both immunological and virological parameters: higher viral loads have been associated with clinical stage of HIV-1-infected individuals as well as higher risk of mother-to-child transmission. Furthermore, we have shown that transmitting mothers more frequently harbour HIV-1 isolates with rapid/high syncytium-inducing (SI) biological phenotype than non-transmitting mothers do. Genetically homogeneous virus populations have been found in HIV-1-infected children at birth, in contrast to the heterogeneous virus populations often found in their infected mothers. This observation suggests that a few virus variants are transmitted or initially are replicating in the child. By comparing the HIV-1 gp120 V3 region of sequentially obtained samples from infected children with samples obtained from their mothers at delivery we found, however, that multiple variants of HIV-1 with different outgrowth kinetics can be transmitted. In addition, we have obtained results indicating an impaired ability of the immune response to adapt to the sequence evolution of HIV-1 in transmitting mothers, as assessed by measuring serum reactivities to peptides representing selected yet closely related V3 sequences. By analysing the presence of antibodies in maternal serum at delivery, which neutralize autologous isolates as well as other primary virus isolates, we have indications that a protective immunity in HIV-1 mother-to-child transmission might exist. Immunotherapy has been assessed in infected adult individuals by passive immunization with a variety of HIV-1-specific antibody products. Data from these studies indicated a differential response to therapy according to the stage of the disease. Active vaccine strategies, including envelope glycoproteins, pursued so far in seronegative adult subjects have shown limitations because broadly neutralizing antibodies, such as can be found in infected individuals, have not been evoked. Further investigations are therefore needed to give support for the potential use of either passive and/or active immunization for the prevention of HIV-1 mother-to-child transmission.
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Affiliation(s)
- M Jansson
- Microbiology and Tumorbiology Center, Karolinska Institute, Stockholm, Sweden
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