Back to Search
Start Over
Plasma drug concentrations and virologic evaluations after stopping treatment with nonnucleoside reverse-transcriptase inhibitors in HIV type 1-infected children
- Source :
- Clinical Infectious Diseases, 46, 1601-8, Clinical Infectious Diseases, 46, 10, pp. 1601-8
- Publication Year :
- 2008
-
Abstract
- Contains fulltext : 71467.pdf (Publisher’s version ) (Open Access) BACKGROUND: The optimum strategy for stopping treatment with drugs that have different half-lives in a combination regimen to minimize the risk of selecting drug-resistant viruses remains unknown. We evaluated drug concentrations in plasma, human immunodeficiency virus (HIV) load, and development of drug resistance after a planned treatment interruption of a nonnucleoside reverse-transcriptase inhibitor (NNRTI)-containing regimen in HIV type 1-infected children. METHODS: Children with viral loads or =30% (for children aged 2-6 years) or CD4 cell percentages > or =25% and CD4 cell counts > or =500 cells/microL (for children aged 7-15 years) were randomized to either a planned treatment interruption or to continuous therapy. In the planned treatment interruption arm, either (1) treatment with nevirapine or efavirenz was stopped, and treatment with the remaining drugs was continued for 7-14 days, or (2) nevirapine or efavirenz were replaced by a protease inhibitor, and all drugs were stopped after 7-14 days. Sampling for determination of plasma drug concentrations, measurement of viral load, and drug resistance testing was scheduled at day 0, day 7 (drug concentrations only), day 14, and day 28 after interruption of treatment with an NNRTI. RESULTS: Treatment with an NNRTI was interrupted for 35 children (20 were receiving nevirapine, and 15 were receiving efavirenz). Median time from NNRTI cessation to stopping all drugs was 9 days (range, 6-15 days) for nevirapine and 14 days (range, 6-18 days) for efavirenz. At 7 days, 1 (5%) of 19 and 4 (50%) of 8 children had detectable nevirapine and efavirenz concentrations, respectively; efavirenz remained detectable in 3 (25%) of 12 children at 14 days. At 14 days, viral load was > or =50 copies/mL in 6 of 16 children interrupting treatment with nevirapine (range, 52-7000 copies/mL) and in 2 of 12 children interrupting treatment with efavirenz (range, 120-1600 copies/mL). No new NNRTI mutations were observed. CONCLUSIONS: In children with virological suppression who experienced interruption of treatment with an NNRTI, staggered or replacement stopping strategies for a median of 9 days for nevirapine and 14 days for efavirenz were not associated with the selection of NNRTI resistance mutations.
- Subjects :
- Cyclopropanes
Male
Time Factors
Infectious diseases and international health [NCEBP 13]
HIV Infections
Drug resistance
Pharmacology
THERAPY
PROPHYLAXIS
2726 Microbiology (medical)
chemistry.chemical_compound
Plasma
immune system diseases
Medicine
Child
Reverse-transcriptase inhibitor
RESISTANCE, THERAPY, EXPOSURE, PHARMACOGENETICS, PROPHYLAXIS
virus diseases
Drug holiday
Viral Load
Infectious Diseases
Alkynes
Child, Preschool
Reverse Transcriptase Inhibitors
Female
Viral load
medicine.drug
Microbiology (medical)
medicine.medical_specialty
Efavirenz
Nevirapine
Adolescent
CD4-CD8 Ratio
610 Medicine & health
Article
Invasive mycoses and compromised host [N4i 2]
Internal medicine
Drug Resistance, Viral
Humans
Protease inhibitor (pharmacology)
EXPOSURE
PHARMACOGENETICS
business.industry
Poverty-related infectious diseases [N4i 3]
2725 Infectious Diseases
Benzoxazines
CD4 Lymphocyte Count
Regimen
chemistry
Withholding Treatment
10036 Medical Clinic
Mutation
HIV-1
Microbial pathogenesis and host defense [UMCN 4.1]
business
RESISTANCE
Subjects
Details
- Language :
- English
- ISSN :
- 10584838
- Database :
- OpenAIRE
- Journal :
- Clinical Infectious Diseases, 46, 1601-8, Clinical Infectious Diseases, 46, 10, pp. 1601-8
- Accession number :
- edsair.doi.dedup.....e9428bb7140b14cab2921aa8a80c9159