Erica Maxine Lazarus, Kennedy Otwombe, Lee Fairlie, Sanlie Untiedt, Avy Violari, Fatima Laher, Denise Evans and Leon Levin
Background: Treatment options for HIV-infected children failing combination antiretroviral therapy (ART) are limited. We describe lamivudine monotherapy (LM) as a holding strategy for ART-experienced virologically-failing children where a definitive suppressive regimen was not possible.
Methods: A retrospective review of data collected until the end of July 2010 from four sites in Johannesburg, South Africa was performed. Inclusion criteria were age ≤16 years with documented HIV-1 infection and use of LM for at least three months.
Results: Twenty three patients (52% female) were identified. Median age at LM was 8.02 years (IQR: 4.07–11.80). LM was initiated for intractable adherence issues in 20/23 children (87%) and for multi-drug resistance precluding construction of an active new regimen in 3/23 (13%). The median duration of LM was 6.13 months (IQR: 3.93–9.31). At six months post LM initiation, CD4 count decreased by 23% but did not reach pre-ART levels. Neither nadir CD4 (p=0.35) nor pre-LM ART regimen (p=0.50) predicted CD4 count decline. LM was stopped in nine children, seven of whom restarted combination ART. Reasons to restart ART were: immunological progression n=3, disease progression n=1 and adherence issues resolved n=3. The other 14 (60.9%) children were continuing LM at time of data collection. No deaths occurred during follow-up.
Conclusion: LM should be investigated through clinical trial as a short-term holding strategy in paediatric patients, where suppressive ART is challenging due to adherence or drug availability problems.
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