RESUMO
We measured serum osteocalcin levels in prepubertal children with human immunodeficiency virus (HIV) infection receiving highly active antiretroviral therapy including a protease inhibitor and uninfected control children. Osteocalcin values were significantly elevated in the HIV-infected patients. Though osteocalcin serves as an index of bone formation, it likely functions as a negative regulator of bone formation. Further study is necessary to determine whether protease inhibitors normalize bone physiology or decrease bone formation and reduce bone mineral density in children receiving these therapies.
Assuntos
Terapia Antirretroviral de Alta Atividade , Osso e Ossos/metabolismo , Infecções por HIV/tratamento farmacológico , Infecções por HIV/metabolismo , Osteocalcina/sangue , Estudos de Casos e Controles , Criança , Pré-Escolar , Estudos Transversais , Feminino , Inibidores da Protease de HIV/uso terapêutico , Humanos , MasculinoRESUMO
An 8-year-old girl developed ataxia-telangiectasia. Western blotting of lysate revealed absence of the ATM protein, and 2 mutations in the ATM gene were found. Subsequently, the patient developed increased respiratory symptoms. Open lung biopsy revealed lymphocytic interstitial pneumonitis, which is not characteristic of ataxia-telangiectasia. There was a therapeutic response to glucocorticosteroid treatment.
Assuntos
Ataxia Telangiectasia/complicações , Hepatomegalia/etiologia , Imunoglobulina M/sangue , Doenças Pulmonares Intersticiais/etiologia , Esplenomegalia/etiologia , Ataxia Telangiectasia/imunologia , Criança , Feminino , HumanosRESUMO
OBJECTIVES: Abacavir (ABC) is a potent inhibitor of human immunodeficiency virus type 1 (HIV-1) reverse transcriptase. We compared the efficacy, safety, and tolerability of combination therapy with ABC, lamivudine (3TC), and zidovudine (ZDV) versus 3TC and ZDV in antiretroviral experienced HIV-1-infected children over 48 weeks. METHODS: Two hundred five HIV-1-infected children who had received previous antiretroviral therapy and had CD4(+) cell counts >/=100 cells/mm(3) were stratified by age and by previous treatment. Participants were randomly assigned to receive ABC (8 mg/kg twice daily [BID]) plus 3TC (4 mg/kg BID) and ZDV (180 mg/m(2) BID; ABC/3TC/ZDV group) or ABC placebo plus 3TC (4 mg/kg BID) and ZDV (180 mg/m(2); 3TC/ZDV group). Participants who met a protocol-defined switch criteria (plasma HIV-1 RNA >0.5 log(10) copies/mL above baseline at week 8 or >10 000 copies/mL after week 16) had the option to switch to open-label ABC plus any antiretroviral combination or continue randomized therapy or withdraw from the study. RESULTS: The Kaplan-Meier estimates (95% confidence interval) of the proportion of participants who maintained HIV-1 RNA levels 10 000 copies/mL, a significantly higher proportion of participants in the ABC/3TC/ZDV group had HIV-1 RNA
Assuntos
Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Fármacos Anti-HIV/uso terapêutico , Didesoxinucleosídeos/administração & dosagem , Lamivudina/administração & dosagem , Zidovudina/administração & dosagem , Adolescente , Fármacos Anti-HIV/efeitos adversos , Contagem de Linfócito CD4 , Criança , Pré-Escolar , Intervalos de Confiança , Progressão da Doença , Método Duplo-Cego , Esquema de Medicação , Quimioterapia Combinada , Feminino , Crescimento/efeitos dos fármacos , HIV-1/genética , Humanos , Lactente , Masculino , RNA Viral/análise , RNA Viral/efeitos dos fármacosRESUMO
OBJECTIVE: To evaluate lymphocyte reconstitution after protease inhibitor therapy in children with human immunodeficiency virus (HIV) infection. STUDY DESIGN: Forty-four HIV-infected children receiving ritonavir monotherapy followed by the addition of zidovudine and didanosine were evaluated during a phase I/II clinical trial. The cohort had a median age of 6.8 years and advanced disease (57% Centers for Disease Control and Prevention stage C, 73% immune stage 3) and was naive to protease inhibitor therapy. RESULTS: After 4 weeks of therapy, there was a significant increase in CD4(+) and CD8(+) T cells. CD4(+) T cells continued to increase, whereas CD8(+) T cells returned to baseline by 24 weeks. Unexpectedly, there was a significant increase in B cells. Changes in CD4(+) T-cell subsets revealed an initial increase in CD4(+) CD45RO T cells followed by a sustained increase in CD4(+) CD45RA T cells. Children <6 years of age had the highest increase in all lymphocyte populations. Significant improvement in CD4(+) T-cell counts was observed even in those children whose viral burden returned to pre-therapy levels. CONCLUSIONS: Early increases in lymphocytes after ritonavir therapy are a result of recirculation, as shown by increases in B cells and CD4(+) CD45RO and CD8(+) T cells. Children exhibited a high potential to reconstitute CD4(+) CD45RA T cells even with advanced disease and incomplete viral suppression.