OBJECTIVE: In adults, nucleoside reverse transcriptase inhibitor-only antiretroviral regimens (NOARs) with ≥3 nucleoside reverse transcriptase inhibitors are less potent than highly active antiretroviral therapy (HAART). Published pediatric experience with NOARs is limited; thus, we wished to better define the virological, immunological and toxicological effects of NOARs in children and adolescents. METHODS: We analyzed data from NOAR-treated participants in LEGACY, a multicenter observational cohort study of HIV-infected children and adolescents. NOAR-treated case-participants were matched to participants without prior NOAR who initiated HAART during the same year for comparison. RESULTS: Of 575 participants with data from time of HIV diagnosis through 2006, 67 (12%) received NOARs for at least 24 weeks; most (46%) received the fixed dose combination of zidovudine/lamivudine/abacavir. NOAR use peaked in 2001 to 2002. NOAR-treated participants were significantly older and more treatment experienced than HAART-treated participants. Virologic outcomes, including the percentage of participants with a plasma HIV RNA viral load <400 copies/mL at week 24 (47% versus 34%) and the mean 24-week change in log10 plasma HIV RNA viral load from baseline (-0.63 versus -1.02), were similar between NOAR- and HAART-treated participants, but virologic rebound was more likely in NOAR-treated participants (77% versus 54%, P = 0.02). Increase in CD4 percentage points from baseline to 24 weeks was negligible in NOAR-treated participants compared with HAART-treated participants (0.95% versus 10.1%, P < 0.001). Anemia and leukopenia were more commonly reported with NOARs than HAART. DISCUSSION: Week 24 virologic outcomes were similar between NOAR- and HAART-treated participants, but NOAR durability was poorer and their use was associated with less immunologic reconstitution. NOARs should play a limited role in pediatric and adolescent antiretroviral therapy.
OBJECTIVE: In adults, nucleoside reverse transcriptase inhibitor-only antiretroviral regimens (NOARs) with ≥3 nucleoside reverse transcriptase inhibitors are less potent than highly active antiretroviral therapy (HAART). Published pediatric experience with NOARs is limited; thus, we wished to better define the virological, immunological and toxicological effects of NOARs in children and adolescents. METHODS: We analyzed data from NOAR-treated participants in LEGACY, a multicenter observational cohort study of HIV-infectedchildren and adolescents. NOAR-treated case-participants were matched to participants without prior NOAR who initiated HAART during the same year for comparison. RESULTS: Of 575 participants with data from time of HIV diagnosis through 2006, 67 (12%) received NOARs for at least 24 weeks; most (46%) received the fixed dose combination of zidovudine/lamivudine/abacavir. NOAR use peaked in 2001 to 2002. NOAR-treated participants were significantly older and more treatment experienced than HAART-treated participants. Virologic outcomes, including the percentage of participants with a plasma HIV RNA viral load <400 copies/mL at week 24 (47% versus 34%) and the mean 24-week change in log10 plasma HIV RNA viral load from baseline (-0.63 versus -1.02), were similar between NOAR- and HAART-treated participants, but virologic rebound was more likely in NOAR-treated participants (77% versus 54%, P = 0.02). Increase in CD4 percentage points from baseline to 24 weeks was negligible in NOAR-treated participants compared with HAART-treated participants (0.95% versus 10.1%, P < 0.001). Anemia and leukopenia were more commonly reported with NOARs than HAART. DISCUSSION: Week 24 virologic outcomes were similar between NOAR- and HAART-treated participants, but NOAR durability was poorer and their use was associated with less immunologic reconstitution. NOARs should play a limited role in pediatric and adolescent antiretroviral therapy.
Authors: Patricia A Garvie; Patricia M Flynn; Marvin Belzer; Paula Britto; Chengcheng Hu; Bobbie Graham; Michael Neely; George D McSherry; Stephen A Spector; Aditya H Gaur Journal: J Adolesc Health Date: 2010-12-18 Impact factor: 5.012
Authors: John A Bartlett; Michael J Fath; Ralph Demasi; Ashwaq Hermes; Joseph Quinn; Elsa Mondou; Franck Rousseau Journal: AIDS Date: 2006-10-24 Impact factor: 4.177
Authors: Roy M Gulick; Heather J Ribaudo; Cecilia M Shikuma; Stephanie Lustgarten; Kathleen E Squires; William A Meyer; Edward P Acosta; Bruce R Schackman; Christopher D Pilcher; Robert L Murphy; William E Maher; Mallory D Witt; Richard C Reichman; Sally Snyder; Karin L Klingman; Daniel R Kuritzkes Journal: N Engl J Med Date: 2004-04-29 Impact factor: 91.245
Authors: Asda Vibhagool; Pedro Cahn; Mauro Schechter; Fiona Smaill; Luis Soto-Ramirez; Giampiero Carosi; Maria Montroni; Cristina E Pharo; Jamie C Jordan; Nicola E Thomas; Gill Pearce Journal: Curr Med Res Opin Date: 2004-07 Impact factor: 2.580
Authors: C Katlama; S Fenske; B Gazzard; A Lazzarin; N Clumeck; J Mallolas; A Lafeuillade; J-P Mamet; L Beauvais Journal: HIV Med Date: 2003-04 Impact factor: 3.094