Effective antiretroviral therapy resolves HIV organ-specific complications in 3 children

Highly active antiretroviral therapy (HAART) is known to reduce the incidence of opportunistic infections in HIV-infected patients, and a recent study of 3 HIV-infected children finds that it also resolves the organ-specific complications of the virus itself.

In a study reported in the February 1st issue of Clinical Infectious Diseases, Dr Frank T. Saulsbury from the University of Virginia Health System in Charlottesville describes the clinical course of 3 HIV-infected children who were treated with HAART.

The first case involved a perinatally infected boy who was diagnosed with a dilated cardiomyopathy at age 7 months. After several admissions for pulmonary oedema, the patient was given zidovudine, lamivudine, and ritonavir at age 3.5 years. The patient’s CD4 cell count and viral load level steadily improved, and 1 year later he was asymptomatic with normal cardiac function.

The second patient, a perinatally infected girl, was diagnosed with red cell aplasia at age 12 months. She was treated for a likely parvovirus B19 infection until the work-up results proved negative. The patient remained anaemic and reticulocytopenic for 18 months before being treated with zidovudine, lamivudine, and ritonavir at age 2.5 years. Her CD4 cell count and viral load level improved steadily, and her haemoglobin concentration normalized.

The final patient, also a perinatally infected girl, was diagnosed with a nephropathy at age 21 months. At age 3.5 years, ritonavir was added to the zidovudine and didanosine regimen that she was receiving. Within 2 months, her CD4 cell count and viral load level had improved. By 12 months, the proteinuria had resolved, and urinary protein excretion was normal.

“To date, the major benefit of HAART has been a decline in morbidity and mortality due to opportunistic infections,” Dr Saulsbury points out. “Although there is very little information concerning the value of HAART for patients with organ-specific complications, the present report suggests that a variety of noninfectious complications of HIV infection are amenable to HAART.”