Effect of antiretroviral combination therapy (zidovudine/didanosine or zidovudine/lamivudine) on quantitative plasma human immunodeficiency virus-ribonucleic acid in children and adolescents infected with human immunodeficiency virus.

OBJECTIVE: To assess human immunodeficiency virus (HIV) ribonucleic acid load in children and adolescents with HIV infection who are being treated with antiretroviral combination therapy. STUDY DESIGN: Five patients whose disease progressed with their prior antiretroviral therapy had treatment regimens changed to zidovudine (ZDV)/didanosine (DDI) (group A), and the regimens of six patients were changed to ZDV/lamivudine (3TC) (group B). Patients were followed every 4 to 8 weeks for an average period of 8.6 months. Serial determinations of viral copy numbers and CD4 cells were performed. RESULTS: In group A patients' mean relative changes in CD4 cells showed a 20% increase after 4 months (difference not significant (NS)) and a return to baseline after 8 months; in group B patients' mean relative increases of CD4 cells were 72% (p = 0.046) and 50% (NS), respectively. In group A mean relative viral load increased 21% (0.08 log10, NS) and 71% (0.23(10) log, NS), whereas in group B viral load decreased 22% (0.1 log10, NS) and 74% (0.58 log10, p = 0.03) after 4 and 8 months, respectively. After starting antiretroviral combination therapy in group A, there was a slight trend of a decreasing ratio of viral load per number of CD4 cells, whereas in group B this ratio significantly decreased, indicating a marked suppression of viral turnover with ZDV/3TC treatment. CONCLUSION: In a small cohort of pediatric patients, combination therapy with ZDV/3TC was well tolerated and had a strong and sustained effect on the decrease of viral loads similar to results obtained in adults. In patients with ZDV/DDI therapy the reduction of viral load was less pronounced, but treatment groups A and B were not comparable for statistic evaluation.

Analysis of the V3 loop sequences from 10 HIV type 1-infected AIDS patients from Paraguay.

PIP: HIV-1 consists of eight subtypes, A through H, and group O. The HIV epidemic has only recently come to Paraguay. According to available data from the National AIDS Control Program of Paraguay, there were only 95 individuals known to have had AIDS in the country by the end of 1994. The authors report their findings from the study of HIV-1 from ten people with AIDS living in Asuncion. The subjects were male, with AIDS-related symptoms, and largely contracted HIV through homosexual contact. Some, however, contracted HIV through IV drug use or heterosexually. The nucleic acid sequences obtained from the collected viruses grown in tissue culture have been deposited in GenBank under accession numbers U28949 through U28959. All of the isolated viruses are of subtype B. Virus PY.3616, however, had a V3 loop with the rare motif APGR. The individual from whom this virus was obtained acquired his HIV infection through IV drug use, most probably in Argentina. Two viruses were obtained with V3 loop crown motifs of GPRR and GWRR (PY.12838 and PY.12839), motifs which have not been previously described, but which come close to the V3 loops of HIV-1 isolates found in Brazil with a crown motif GWGR, and also GMGR and GFGR. A motif with an arginine at another position, GRGQ, has been found in HIV-1 subtype H in Cameroon. The different motifs found in the sequences of the Paraguayan patients show greater homogeneity than those of African patients in the Central African Republic and in Paris. The observed diversity reflects the connection of Paraguayans with Brazil and other countries where HIV-1 subtype B prevails. The authors note that their findings are most likely representative of the ongoing, young HIV epidemic in Paraguay.^ieng