Effectiveness of a early initiation of protease inhibitor-sparing antiretroviral regimen in human immunodeficiency virus-1 vertically infected infants

Background : Vertically HIV-1-infected infants are at high risk of severe manifestations of the disease in the first year of life [1]. For this reason, we have elected, since 1996, to treat all infants born to HIV-1-infected mothers with a combination of 3 reverse transcriptase inhibitors as soon as the diagnosis of vertical transmission is established. Material and methods : This is a cohort study of the effectiveness and tolerance of therapy in the 17 HIV-1-infected infants followed from birth in 3 belgian paediatric reference centres since 1996. All of them had been treated according to these guidelines. Results : Treatment was initiated in all patients before 66 days of life. All but one were asymptomatic at initiation of therapy. Median follow-up was 56 months (range: 26-103). Twelve out of the 17 patients (70.6%), including 11/13 (85%) infants treated with the combination of zidovudine, lamivudine and nevirapine, experienced a complete viral suppression (<50 copies/mL) with their first drug regimen. Lack of compliance was acknowledged by the parents of 3 of the 5 infants whose initial regimen failed. At last follow-up, 12 patients were asymptomatic, two were CDC stage A and three were stage B; 15 had HIV-1 RNA levels of < 50 copies/mL and 14 had ≥25% CD4 lymphocytes. Among them 11 were still treated with their first line regimen (Figure 1). One child experienced a transient severe side effect, another child had clinical lipodystrophy and 4 developed hypercholesterolemia. Conclusions : Early initiation of treatment with 3 reverse transcriptase inhibitors appeared to be highly effective in this cohort of vertically HIV-1 infected infants. Parental adherence is crucial to the effectiveness of therapy.