HIV and children: new treatments look promising

Celia Christie-Samuels and Bernard Pécoul, 

co-chairs of the Catching children before they fall satellite session.

New treatment options may soon be available for HIV-positive children and adolescents.

Treatment options for babies and children are currently more limited than those available to adults, and there is a need for new drugs to treat this group.

The Washington conference heard that new paediatric formulations of some drugs have been developed.

Research was also presented showing that combinations including integrase inhibitors or the NNRTI etravirine (Intelence) achieve good results and are safe in children.

A new paediatric formulation of tenofovir (Viread) was shown to be a safe treatment for the prevention of mother-to-child transmission of HIV. A single 600mg dose of tenofovir was given to pregnant women during labour. Infants were treated with a daily 6mg/kg dose of tenofovir for seven days. Good concentrations of the drug were achieved and it caused no serious side-effects.

Results of a study looking at the safety and efficacy of therapy based on the ritonavir-boosted protease inhibitor fosamprenavir (Telzir/Lexiva) were also presented to the conference. After 48 weeks of treatment, up to 78% of children achieved an undetectable viral load. The safety profile of the drug was similar to that seen in adults.

Forty-eight week results from a study investigating the use of raltegravir (Isentress), in combination with other anti-HIV drugs, showed that it suppressed viral load to below 50 in 57% of patients and that CD4 cell count increased by over 150 cells/mm³. On the basis of these results, an application has been made in the US for a licence to use the drug in HIV-positive children and adolescents.

The experimental integrase inhibitor dolutegravir also did well in a small study involving children aged between 2 and 18 years of age. After four weeks of treatment, 70% of patients had a viral load below 40 copies/ml and the treatment also achieved good increases in CD4 cell percentage.

The effectiveness of etravirine was monitored in highly-treatment experienced children. After a year of therapy with a combination that included the drug, 56% had an undetectable viral load.