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Triple nucleoside analogue therapy with Zidovudine (AZT), Lamivudine (3TC) and Abacavir (ABC) in the Paediatric HIV London South Network (PHILS-NET) cohort

C J Wells1, M Sharland2, C J Smith3, G Du Mont4, C S Ball5, F A I Riordan6, H C Underhill7
1Pharmacy Dept, St George's Hospital, London, United Kingdom; 2Paediatric Infectious Diseases Unit, St George's Hospital, London, United Kingdom; 3Royal Free Centre for HIV Medicine & Department of Primary Care & Population Sciences, London, United Kingdom; 4Paediatric Department, St Thomas' Hospital, London, United Kingdom; 5Department of Child Health, Kings College Hospital, London, United Kingdom; 6Department of Child Health, Birmingham Heartlands Hospital, Birmingham, United Kingdom; 7Paediatric Department, Mayday University Hospital, Thornton Heath, United Kingdom

Background Concerns about toxicity and tolerability of protease inhibitors (PIs) and lack of data on alternative regimens led to the investigation by this service network of the conveniently formulated triple nucleoside regimen AZT/3TC/ABC.
Method A prospective, multi-centre audit using observational analysis to identify outcome data and the influencing factors.

Results 24 children, median age 4.8 years (range:0.2-11.6 years) were studied. 75% were antiretroviral (ARV) naive. Only 3 had previous PI or non-nucleoside analogue therapy. Median length of follow up was 0.94 years.

On treatment median CD4 cell counts were 414 (IQR: 226,652) (baseline), 504 (IQR: 371,1032) (3m), 457 (IQR: 333,958) (6m) and 452 (IQR: 332,1321) (12m). Mean viral load (VL) log copies/ml was 5.16 (IQR: 4.58,5.31) (baseline), 2.60 (IQR: 2.30,4.03) (3m), 2.66 (IQR: 2.30,4.15) (6m) and 3.34 (IQR: 1.69,4.65) (12m).

The proportion of children achieving a VL below 400 copies/ml was 4.35% (baseline), 60% (3m), 60% (6m) and 50% (12m). The proportion of children of children achieving a VL below 50 copies/ml was 0% (baseline), 20% (3m), 20% (6m) and 40% (12m).

Better responses were achieved in ARV naive children and those with a z-score of less than -3. Positive virological response (achieving an undetectable VL or > a 3 log drop) was seen in children with a basline VL below or above 5.18log copies/ml.

5 children stopped treatment after a mean of 1.3 years (range 0.5-1.8years). This was due to intolerance (1), virological failure (2) and withdrawal for social reasons (1). One child with severe sickle cell disease and AIDS, on hydroxyurea, stable on AZT/3TC/ABC, developed fulminant hyperlactaemia, hypoglycaemia and died.

Conclusions This analysis is the first data to demonstrate that AZT/3TC/ABC is simple to use, well tolerated and achieves similar virological and immunological results to other paediatric ARV combinations.

The XIV International AIDS Conference
Abstract no. TuPeB4625

Suggested Citation
" C J Wells , , et al. Triple nucleoside analogue therapy with Zidovudine (AZT), Lamivudine (3TC) and Abacavir (ABC) in the Paediatric HIV London South Network (PHILS-NET) cohort. Poster Exhibition: The XIV International AIDS Conference: Abstract no. TuPeB4625"