Even drug-resistant HIV infection responds to right treatment

May 02, 2004

Once expected to die in early childhood, children born with HIV are now surviving into their teens and early adulthood thanks to research advances over the past decade. However, it's also likely these children will develop drug resistance due to sequential exposure to HIV treatments, including antiretroviral (ARV) therapies.

Researchers at the Johns Hopkins Children's Center say that with careful planning and adherence to treatment plans, these patients can stay healthy. In a new study, presented today at the annual Pediatric Academic Societies' meeting in San Francisco, they report successful treatment of six HIV-positive children using tailored genotype-linked testing and a web-based algorithm tool to assist in medication decisions.

"If HIV patients develop a drug resistance, the results could possibly be life-threatening, since resistance reduces the chance a new drug regimen will be successful," says the study's lead author, Nancy Hutton, M.D., director of the Intensive Primary Care Clinic at the Children's Center.

"However, these findings show it is possible to create an effective salvage therapy using such technological tools as genotype testing in conjunction with web-based algorithms to find the most appropriate treatment for each individual patient, as long as the treatments are initiated in a controlled setting to ensure that every single dose is given every single time and to monitor and control side effects if they occur," she adds.

Each patient in the Hopkins study underwent genotype analysis and any detected gene mutations were entered into the algorithm. New regimens of three or more ARV agents from two or three classes were created for each patient based on the "least bad" combination of agents according to drug resistance scores generated on the website ( http://hivdb.stanford.edu/ ). New regimens were initiated with directly observed therapy in an inpatient rehabilitation unit that included weekly monitoring for virus response.

Study co-authors were Genevieve Parsons, Mary Joyner, Carolyn Kiefner, Stephanie Lee, Deborah Persaud and George Siberry from the Children's Center.
The Pediatric Academic Societies' meeting is the largest gathering of pediatricians and pediatric researchers in the United States. This year, the state of children's health will be the focus of more than 2,500 presentations to nearly 5,700 leaders in pediatric research, advocacy, and patient care from the United States and scores of other nations. The Pediatric Academic Societies represents pediatricians who practice, teach, and conduct research at academic health centers. Member organizations are The American Pediatric Society, The Society for Pediatric Research, and the Ambulatory Pediatric Association.

Johns Hopkins Medicine

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