HIV-positive infants can be treated with multiple antiretroviral agents although the therapy has limited effectiveness, researchers report in a study published in the Pediatric Infectious Disease Journal (2002;21(6):518-525). Albert Faye and colleagues at Robert Debre Hospital in Paris and other institutions in France conducted a study to "assess tolerance and efficacy of early multitherapy including a protease inhibitor for infants perinatally infected with HIV."

Antiretroviral multitherapy slowed or reversed disease progression in infants, but was hampered by rapid viral resistance, Faye and coauthors found. The researchers evaluated protease inhibitor-based multitherapy in a group of 31 HIV-positive infants. Clinical progression and CD4 cell loss were halted in all of the treated children, without severe drug toxicity, they said. HIV RNA levels dropped by a median of 2.7 logs after 3 months, and more than half of the treated infants showed viral loads lower than 500 copies/mL after 6 months, study data showed. Two years after the initiation of multitherapy, however, the median viral load reduction had fallen to 1.7 logs, with only 18 percent of the study group showing viral loads below 500 copies/mL.

Most children with consistently high HIV RNA levels after 6 months carried viral populations with protease and/or reverse transcriptase resistance mutations. "Despite the absence of clinical or immunologic progression, the high frequency of virologic failure associated with genotypic resistance reveals the difficulties associated with implementing antiretroviral multitherapy in infants," Faye and colleagues concluded. "Suboptimal doses of protease inhibitor could be a factor contributing to treatment failure."

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