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2005-05-10-Short Lag Seen In Kids' HIV Treatments
New Pediatric HIV Treatments Not Always Used Immediately, Study Shows
New pediatric HIV treatments have "a short lag" before catching on, a study in The Journal of the American Medical Association shows.
The lag is reported by researchers including Susan Brogly, PhD, of the Center for Biostatistics in AIDS Research.
Great strides have been made in developing treatments for HIV, the virus that causes AIDS. Still, more work is needed to save children in America and around the world, says a journal editorial by Ram Yogev, MD.
"While it is possible to celebrate the tremendous change in the outcomes of HIV-infected children treated with HAART (highly active antiretroviral therapy), it is even more important to continue to prioritize research for the survivors who are now living with a chronic disease," writes Yogev, who works in the infectious diseases division of Children's Memorial Hospital in Chicago.
HIV's Global Reach
Nearly 40 million people worldwide live with HIV, and 2.2 million of them are younger than 15 years old, says the World Health Organization (WHO).
The U.S. has a relatively small number of children with HIV/AIDS, says the National Institute of Allergy and Infectious Diseases (NIAID), a branch of the National Institutes of Health (NIH).
There were a reported 9,300 children living with HIV/AIDS in the U.S. from 1981 through 2002, says the NIAID, citing CDC data. Minorities were disproportionately affected, especially African-Americans.
Almost all HIV-infected children get the virus from their mothers before or during birth, or through breastfeeding. Some have contracted HIV from sexual and physical abuse from infected adults, or from tainted blood before the U.S. began screening its blood supply for HIV, says NIAID.
'Short Lag' Reported
Anti-HIV drugs have lengthened the lives of many people with HIV/AIDS, including children.
From 1985 to 1999, AIDS cases among U.S. children dropped 81%, says the CDC. From 1998 to 2002, the estimated number of U.S. children dying of AIDS fell 68%, says the NIAID, citing CDC data.
However, new HIV treatments were often not immediately adopted by the pediatric community, say Brogly and colleagues.
They studied 766 American children who were infected with HIV around the time of birth. The kids -- all born before January 2004 -- were treated at university-affiliated HIV clinics.
Of the children who were started on antiretroviral therapy (ART) from 1998-2003, nearly one in five (22%) didn't immediately get the type of ART medication recommended in pediatric guidelines, say researchers.
Making the HIV Treatment Switch
Eventually, children were often switched to the latest HIV treatments, the study shows. The reasons for the switches weren't available, and the researchers say the children may not be typical of all kids with HIV.
"The clinicians, patients, and caregivers may have been reluctant to use novel treatment in the absence of recommendations for use in children," write Brogly and colleagues.
'Surprising' and 'Disappointing' Data
It was "surprising" that older and combined treatment medications were still given to less than 15% of children in 2003, says Yogev.
Another finding -- that only half of the HIV-infected children born from 2000 to 2003 were given the anti-HIV drug AZT in the first six weeks of life -- was "disappointing," says Yogev. Giving the medication to pregnant mothers and their newborns reduces the risk of transmission.
In the late 1980s, Yogev attended the funerals of his pediatric patients with HIV/AIDS. Now, Yogev says he's been attending their high school graduations.
"There are probably many unknown issues that will appear as patients live longer and use more complex regimens," he says. Such issues may also be seen in children treated in other parts of the world, he says, calling for more research.
When to Start
Another study in the journal showed that HIV-infected 3-year-olds had improved survival and decreased early HIV progression when advanced therapy was started at a very early age (younger than 3 months old).
That study was small, says Yogev. "Unfortunately, it remains unclear when to initiate ART in children," he says.
If a woman knows she's HIV-positive, treatment may help protect her children even before she gives birth. "Physicians need to be more vigilant in offering HIV testing to all pregnant women, including those who do not receive prenatal care," says Yogev.
SOURCES: Brogly, S. The Journal of the American Medical Association, May 11, 2005; vol 293: pp 2213-2220. Yogev, R. The Journal of the American Medical Association, May 11, 2005; vol 293: pp 2272-2274. World Health Organization: "Global Summary of the AIDS Epidemic, December 2004." National Institute of Allergy and Infectious Diseases: "HIV Infection in Infants and Children." Morbidity and Mortality Weekly Report, June 1, 2001; vol 50: pp 430-434. Berk, D. The Journal of the American Medical Association, May 11, 2005; vol 293: pp 2221-2231. News release, JAMA/Archives.