Use of structured treatment interruptions to manage limited drug supplies has proven surprisingly successful in a Nairobi orphanage, according to a brief report published in the online edition of Clinical Infectious Diseases.
Doctors treated three children with CD4 cell counts below 20 cells/mm3 judged to be close to death with a combination of zidovudine tablets or suspension, lamivudine suspension and either nelfinavir powder or abacavir tablets. Treatment started in August 2000, and was initially expected to last six months if the donated drugs were dosed in a week on, week off pattern.
Subsequent donations allowed treatment to be sustained for at least 26 months in this fashion with no further CDC C3 opportunistic infections. All three children (aged 5 to 6 years old) experienced viral load reduction of at least 1 log during the first six months of treatment, together with robust CD4 cell increases (in two cases above 300 cells/mm3 by the end of the first year’s treatment, with an increase above 100 cells/mm3 in the third child).
A further 22 children have been enrolled since 2000, and a marked reduction in deaths has been recorded at the orphanage, which saw 67 deaths between 1995 and 2000. Three deaths have occurred since the introduction of STI-guided HAART.
A number of studies are planned to investigate the value of treatment interruption in resource-limited settings, including a paediatric version of the DART study, which will randomise participants to receive continuous HAART or to stop HAART after a period, with resumption to be guided by CD4 cell counts.
Reference
Chakraborty R et al. Management of severely immunocompromised human immunodeficiency virus type 1-infected African orphans with structured treatment interruption: another kind of salvage therapy. Clinical Infectious Diseases 36: online edition, 2003.