Management of paediatric HIV-1 resistance
Identifieur interne : 001D73 ( Pmc/Corpus ); précédent : 001D72; suivant : 001D74Management of paediatric HIV-1 resistance
Auteurs : Ravindra K. Gupta ; Diana Gibb ; Deenan PillaySource :
- Current opinion in infectious diseases [ 0951-7375 ] ; 2009.
Abstract
Children have higher rates of virological failure than adults, often associated with more extensive resistance and limited second-line options. In order to maintain clinical benefits of highly active antiretroviral therapy (HAART) into adulthood, particularly for children starting at a young age, strategies are needed to limit the emergence of resistance and to offer highly effective subsequent lines of therapy. Similarly, well resourced settings face challenges regarding extensive resistance accumulated over the past decade or more, particularly resulting from suboptimal therapies.
Rates of resistance at failure of nonnucleoside reverse-transcriptase inhibitor based HAART are higher in developing countries than in well resourced settings. In the latter, second-generation protease inhibitors tipranavir and darunavir are promising, with tipranavir now licensed for those above 2 years and darunavir showing good trial results in children above 6 years. However, combination with new classes such as integrase inhibitors (currently in phase I trials) and CCR5 antagonists (no paediatric data yet) will probably be necessary to gain maximal long-term benefits.
Common goals in paediatric HIV for both resource-rich and resource-limited settings are to limit vertical transmission, minimize emergence of resistant viruses in both mother and child where prevention of mother-to-child transmission fails, and limit resistance in children starting HAART. Optimal sequencing of regimens in the absence of resistance testing is a priority research area. Paediatric studies using newer classes of agents are of paramount importance, as well as expanding access to existing antiretrovirals.
Url:
PubMed: 19405216
PubMed Central: 2735039
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PMC:2735039Le document en format XML
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<author><name sortKey="Gupta, Ravindra K" sort="Gupta, Ravindra K" uniqKey="Gupta R" first="Ravindra K." last="Gupta">Ravindra K. Gupta</name>
<affiliation><nlm:aff id="A1"> University College London, Windeyer Building</nlm:aff>
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<affiliation><nlm:aff id="A3"> Centre for Infections, Health Protection Agency, London, UK</nlm:aff>
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<author><name sortKey="Gibb, Diana" sort="Gibb, Diana" uniqKey="Gibb D" first="Diana" last="Gibb">Diana Gibb</name>
<affiliation><nlm:aff id="A2"> MRC Clinical Trials Unit</nlm:aff>
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<affiliation><nlm:aff id="A3"> Centre for Infections, Health Protection Agency, London, UK</nlm:aff>
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<front><div type="abstract" xml:lang="en"><sec id="S1"><title>Purpose of review</title>
<p id="P1">Children have higher rates of virological failure than adults, often associated with more extensive resistance and limited second-line options. In order to maintain clinical benefits of highly active antiretroviral therapy (HAART) into adulthood, particularly for children starting at a young age, strategies are needed to limit the emergence of resistance and to offer highly effective subsequent lines of therapy. Similarly, well resourced settings face challenges regarding extensive resistance accumulated over the past decade or more, particularly resulting from suboptimal therapies.</p>
</sec>
<sec id="S2"><title>Recent findings</title>
<p id="P2">Rates of resistance at failure of nonnucleoside reverse-transcriptase inhibitor based HAART are higher in developing countries than in well resourced settings. In the latter, second-generation protease inhibitors tipranavir and darunavir are promising, with tipranavir now licensed for those above 2 years and darunavir showing good trial results in children above 6 years. However, combination with new classes such as integrase inhibitors (currently in phase I trials) and CCR5 antagonists (no paediatric data yet) will probably be necessary to gain maximal long-term benefits.</p>
</sec>
<sec id="S3"><title>Summary</title>
<p id="P3">Common goals in paediatric HIV for both resource-rich and resource-limited settings are to limit vertical transmission, minimize emergence of resistant viruses in both mother and child where prevention of mother-to-child transmission fails, and limit resistance in children starting HAART. Optimal sequencing of regimens in the absence of resistance testing is a priority research area. Paediatric studies using newer classes of agents are of paramount importance, as well as expanding access to existing antiretrovirals.</p>
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University College London, Windeyer Building</aff>
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MRC Clinical Trials Unit</aff>
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Centre for Infections, Health Protection Agency, London, UK</aff>
<author-notes><corresp id="CR1">Correspondence to Ravindra K. Gupta, MRCP, University College London, Windeyer Building, 46 Cleveland Street, London W1T 4JF, UK Tel: +44 7748 98 52 96; e-mail: <email>rebmrag@ucl.ac.uk</email>
or <email>rgupta2@nhs.net</email>
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<volume>22</volume>
<issue>3</issue>
<fpage>256</fpage>
<lpage>263</lpage>
<abstract><sec id="S1"><title>Purpose of review</title>
<p id="P1">Children have higher rates of virological failure than adults, often associated with more extensive resistance and limited second-line options. In order to maintain clinical benefits of highly active antiretroviral therapy (HAART) into adulthood, particularly for children starting at a young age, strategies are needed to limit the emergence of resistance and to offer highly effective subsequent lines of therapy. Similarly, well resourced settings face challenges regarding extensive resistance accumulated over the past decade or more, particularly resulting from suboptimal therapies.</p>
</sec>
<sec id="S2"><title>Recent findings</title>
<p id="P2">Rates of resistance at failure of nonnucleoside reverse-transcriptase inhibitor based HAART are higher in developing countries than in well resourced settings. In the latter, second-generation protease inhibitors tipranavir and darunavir are promising, with tipranavir now licensed for those above 2 years and darunavir showing good trial results in children above 6 years. However, combination with new classes such as integrase inhibitors (currently in phase I trials) and CCR5 antagonists (no paediatric data yet) will probably be necessary to gain maximal long-term benefits.</p>
</sec>
<sec id="S3"><title>Summary</title>
<p id="P3">Common goals in paediatric HIV for both resource-rich and resource-limited settings are to limit vertical transmission, minimize emergence of resistant viruses in both mother and child where prevention of mother-to-child transmission fails, and limit resistance in children starting HAART. Optimal sequencing of regimens in the absence of resistance testing is a priority research area. Paediatric studies using newer classes of agents are of paramount importance, as well as expanding access to existing antiretrovirals.</p>
</sec>
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