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HIV Drugs Work for the Young

Adult drug treatment also works in children, says new study

WEDNESDAY, Nov. 21, 2001 (HealthDayNews) -- The rigorous combination drug therapy that works well in adults infected with the virus that causes AIDS works just as well in young people, a study finds.

"There were concerns about the extent to which children could adhere to the regimen, but we found similar effectiveness across age, ethnic groups and educational level," says lead study author Steven Gortmaker, senior lecturer at the Harvard School of Public Health.

The drug regimen produced a striking reduction in the death rate among the 1,028 young people, from newborns to people aged 20, who were enrolled in the study starting in 1996. In that year, only 7 percent of people with HIV were receiving the combination therapy, says a report in the latest issue of The New England Journal of Medicine. That rose to 73 percent by 1999, accompanied by a steady drop in the death rate, from 5.3 percent in 1996 to 0.7 percent in 1999.

Gortmaker says, "These results provide good news. The thing we found most reassuring was that the effects were almost uniform among all the subgroups."

Treatment requirements have been simplified somewhat for younger patients, says Dr. Joseph Cervia, director of the Comprehensive HIV Care and Research Center at Long Island Jewish Medical Center, in New Hyde Park, N.Y. Patients now take the antiviral drugs only twice a day, rather than the more complex schedule of previous years. Dosages also are changed to keep pace with weight gain. "As the child grows, so does the dose," Cervia says.

Pediatric HIV infection and AIDS are major global problems. The United Nations estimates more than 1.4 million young people worldwide carry the virus. Incidence is much lower in the United States. The Centers for Disease Control and Prevention lists only 263 active pediatric AIDS cases for 1999, the latest available data. The best estimate is that only a few thousand young people in the United States are infected with HIV.

One reason why that number is low is a widely used program to prevent infection in newborns, Cervia says. Most pediatric cases of HIV infection occur during pregnancy, when an infected mother transmits the virus to her fetus. A study in 1995 showed that giving a pregnant woman antiviral drugs during pregnancy and delivery prevents transmission of the virus, he says.

"The strategy of providing antiviral therapy to women during pregnancy has reduced the number of perinatal transmissions to under 2 percent," Cervia says. "Elective Cæsarean delivery also reduces transmission."

Prevention obviously is preferable to treatment for several reasons, Cervia says. "The downside is that these children will have to take the drugs indefinitely. It is not a cure," he says.

Gortmaker adds another caution: "We still do need to be aware of complications, side effects and equal access to the medical centers that provide combination therapy."

What To Do

Prevention of AIDS starts with knowledge about the behavior that increases exposure to HIV, such as use of contaminated needles and unprotected sex.

Comprehensive information about HIV and AIDS among young people is offered by the National Pediatric and Family HIV Research Center and the Division of AIDS at the National Institute of Allergy and Infectious Diseases.

Also, check The Body for simple explanations of HIV and AIDS.

SOURCES: Interviews with Steven Gortmaker, Ph.D., senior lecturer, Harvard School of Public Health, Boston; Joseph Cervia, director, Comprehensive HIV Care and Research Center, Long Island Jewish Medical Center, New Hyde Park, N.Y.; Nov. 22, 2001, The New England Journal of Medicine
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