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Antiretroviral use in Italian children with perinatal HIV infection over a 14‐year period

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Abstract:

Abstract

Background:  Information on the use of new antiretroviral drugs in children in the real setting of clinical fields is largely unknown.

Methods:  Data from 2554 combined antiretroviral therapy (cART) regimens administered to 911 children enrolled in the Italian Register for HIV infection in children, between 1996 and 2009, were analysed. Factors potentially associated with undetectable viral load and immunological response to cART were explored by Cox regression analysis.

Results:  Proportion of protease inhibitor (PI)‐based regimens significantly decreased from 88.0% to 51.2% and 54.9%, while proportion on non‐nucleoside reverse transcriptase inhibitor (NNRTI)‐based regimens increased from 4.5% to 38.8% and 40.2% in 1996–1999, 2000–2004 and 2005–2009, respectively (p < 0.0001). Significant change in the use of each antiretroviral drug occurred over the time periods (p < 0.0001). Factors independently associated with virological and immunological success were as follows: later calendar periods, younger age at regimen (only for virological success) and higher CD4+ T‐lymphocyte percentage at baseline. Use of unboosted PI was associated with lower adjusted hazard ratio (aHR) of virological or immunological success with respect to NNRTI‐ and boosted PI‐based regimens, with no difference among these two latter types.

Conclusion:  Use of new generation antiretroviral drugs in Italian HIV‐infected children is increasing. No different viro‐immunological outcomes between NNRTI‐ and boosted PI‐based cART were observed.

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.1651-2227.2012.02675.x

Affiliations: 1: Department of Science for Woman and Child Health, University of Florence, Florence, Italy 2: Department of Paediatrics, University of Turin, Turin, Italy 3: Lisi Catiuscia Department of Statistics, University of Florence, Florence, Italy 4: Department of Paediatrics, L. Sacco Hospital, University of Milan, Milan, Italy 5: Paediatric Immunology Department-Bambino Gesù Children’s Hospital, Rome, Italy 6: Department of Maternal and Paediatric Sciences, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy 7: Infectious Diseases Clinic, San Martino Hospital, University of Genoa, Genova, Italy 8: Department of Paediatrics, Padua University, Padova, Italy 9: Paediatric Clinic, Brescia University, Brescia, Italy 10: Department of Paediatrics, ‘Federico II’ University, Naples, Italy 11: Department of Infectious Diseases, University of Pavia, Pavia, Italy 12: Paediatric Clinic, ‘S. Orsola’ Hospital, Bologna University, Bologna, Italy 13: Paediatric Oncologic Unit, Maternal-Paediatric Department, Azienda Ospedaliera-Universitaria Policlinico Modena, Modena, Italy 14: Paediatric Department San Paolo Hospital, University of Milan, Milan, Italy 15: Paediatric Infectious Disease Unit, Giovanni XXIII Hospital, Bari, Italy 16: Paediatric Clinic, Cagliari University, Cagliari, Italy 17: Paediatric Department, University Hospital of Parma, Parma, Italy

Publication date: July 1, 2012

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