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Abstract
The role of enfuvirtide (T-20) in multiresistant congenital HIV disease treated since birth
Manfredi R.1, Calza L.1, Chiodo F.1
Introduction: Children with congenital HIV infection treated shortly after birth with frequent and prolonged suboptimal antiretroviral combinations, are prone to develop extensive viral resistance.
Methods: A 15-year-old boy who received antiretrovirals since birth, with suboptimal treatments carried out for many years,since the age of 6 had AIDS,recently complicated by a suspected disseminated atypical mycobacteriosis,recurrent pneumonia,uveitis,weight loss, fever,and severe lipodystrophy.
Results: Despite 21 different lines of anti-HIV treatment, an extensive pattern of mutations to both reverse transcriptase and protease gene was demonstrated,with further deterioration of virological and immunological parameters (up to a viral load of 180,000 copies/mL, and a CD4+ lymphocyte count of 35 cells/µL). A novel change of antiretroviral regimen was proposed in mid-May 2004, including three drugs with residual in vitro activity at virtual phenotype (lopinavir-ritonavir, didanosine, and stavudine),plus parenteral enfuvirtide, administered at 45 mg twice daily (after informed consent was obtained by parents).After nine months of combined therapy, the clinical course had a remarkable ameliorement,with disappearance of fever and respiratory signs-symptoms,improved uveitis,and weight gain. Laboratory assessment performed in end-January 2005 showed a drop of HIV-RNA (from 180,000 to 14.000 copies/mL: -1.5 Log10),and a significant increase of CD4+ count (from 35 to 85 cells/µL: +243%),in absence of clinical and laboratory abnormalities. Also local injection of enfuvirtide was delivered by our patient spontaneously and with very favorable adherence,in absence of relevant local untoward events. Further follow-up and resistance testing are warranted to confirm these preliminary observations.
Conclusions: Enfuvirtide (T-20),a member of a novel class of HIV fusion inhibitors,may be also used as a part of salvage regimens,preferably when at least two drugs remain active at resistance testing. Despite concomitant introduction of enfuvirtide for both adults and children (McKinney RE.Curr Opin Pediatr 2004;16:76), clinical experiences in pediatric age are still very infrequent,and specific efficacy and safety trials are lacking,while pharmacokinetic and pharmacodynamic experiences are ongoing.
The 3rd IAS Conference on HIV Pathogenesis and Treatment
Abstract no.
MoPe9.2C01
Suggested Citation
"ManfrediR., et al.
The role of enfuvirtide (T-20) in multiresistant congenital HIV disease treated since birth.
Poster Exhibition:
The 3rd IAS Conference on HIV Pathogenesis and Treatment:
Abstract no.
MoPe9.2C01"
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