Combo Drug Therapy Protects HIV-Positive Children
Incidence of opportunistic infections reduced up to 14-fold, report says
TUESDAY, July 18, 2006 (HealthDay News) -- Powerful drug 'cocktails' that suppress HIV have dramatically reduced the number of opportunistic infections in HIV-positive children in the United States, a new study finds.
The report, published in the July 19 issue of the Journal of the American Medical Association, said that since the wide-scale use of highly active antiretroviral therapy (HAART), the rate of opportunistic infections in American children with HIV has decreased between twofold and 14-fold.
"HAART therapy combined with secondary prophylaxis has done a great job of reducing the burden of opportunistic infection in HIV-positive children," said study author Phil Gona, a research assistant professor of mathematics and statistics at Boston University.
HIV affects nearly 1 million Americans, according to the National Institute of Allergy and Infectious Diseases (NIAID). Up to one-quarter of those infected aren't aware they have the infection, reports the NIAID. The virus destroys the ability of the body's immune system to fight infections. The result is that infections, such as pneumonia, can quickly become life-threatening.
Gona said that research in adults had shown that HAART, which helps keep HIV at bay, significantly reduced the number of infections. One study found that after nine months on HAART, the incidence rate of infection dropped from 15.1 events per 100 person-years to as low as 2.1 events per 100 person-years, according to Gona.
Researchers wanted to learn if the same dramatic reductions in infections were occurring in children.
Using a database of nearly 3,000 youngsters with HIV, the researchers compared the incidence of opportunistic infections before the widespread use of HAART to the incidence of infections during the HAART era.
The average age of the children was 8, and the average follow-up time was just over three years.
The researchers found that the rates of common infections decreased significantly. The incidence rate of bacterial pneumonia was 2.15 per 100 person-years in the HAART era vs. 11.1 per 100 person-years in the pre-HAART era. The incidence rate for herpes zoster was 1.11 per 100 person-years after the introduction of HAART and 2.9 per 100 person-years before HAART.
Other infections that were down significantly included: dermatophyte infections, oral candidiasis, tuberculosis, mycobacterium avium, cytomegalovirus retinitis and pneumocystis jeroveci pneumonia.
"The medications we use to treat HIV infections have very real benefits in terms of survival and in terms of reducing complications," said editorial author Dr. Joseph Harwell, an assistant professor of medicine in pediatrics at Brown Medical School in Providence, R.I. "I have not seen a child who is on therapy with an opportunistic infection in the last five years."
However, while much progress has been made in the United States, both Gona and Harwell pointed out that these medications aren't in common use where they're truly needed.
"In the U.S. people are doing well, but that's not where most people with HIV live. Most live in sub-Saharan Africa," said Harwell. Sub-Saharan Africa covers most of the African continent. Of the 2.3 million children who have HIV worldwide, only about 11,000 of those are in the United States, according to Harwell's editorial.
He said one of the biggest barriers to treatment in Africa has to do with a key cultural difference. In the United States, people will seek out and take preventive medications. In Africa, he said, it's difficult to get people to see a doctor on a regular basis when they're asymptomatic, as people with HIV can be for some time. He said that inadequate training of physicians and other health-care providers is also a barrier to treatment in some areas right now.
Gona added that the cost of these medications is also an issue.
"In this country, people have access to HAART and secondary prophylaxis whenever we need it, but the epicenter of HIV is in the sub-Saharan region and they don't have access. Hopefully, access to these medications will be available someday in that region," Gona said.
To learn more about medications used to treat HIV, visit the American Academy of Family Physicians.