Successful simplification of protease inhibitor-based HAART with triple nucleoside regimens in children vertically infected with HIV

Paolo Palma, Maria Luisa Romiti, Caterina Cancrini, Simone Pensieroso, Carla Montesano, Marilina B. Santucci, Stefania Bernardi, Alessandra M. Martino, Paolo Rossi, Guido Castelli-Gattinara

Research output: Contribution to journalArticlepeer-review


OBJECTIVE: To assess the virological, immunological and metabolic effects of switching from an efficacious first-line protease inhibitor (PI)-based HAART to a simplified triple nucleoside reverse transcriptase inhibitor (NRTI) regimen in children vertically infected with HIV. DESIGN: Prospective, open-label, before-after study of 20 vertically infected children with at least 12 consecutive months of undetectable viral load under a PI-based HAART and no previous history of NRTI treatment. METHODS: At study entry, HAART was shifted to a triple-NRTI combination. RESULTS: The children were aged 2 to 18 years (median, 7.9) and were followed for 96 weeks. All were receiving a PI-based regimen for an average duration of 4 years before enrollment. At study entry, 12 patients (60%) switched to abacavir, 5 (25%) to lamivudine; 2 (10%) to zidovudine and 2 to didanosine (10%). All but one patient maintained plasma HIV RNA <50 copies/ml during the entire follow-up. No immunological failure was observed at week 96. A trend of normalization (P <0.001) of T cell receptor Vβ families of the CD8 cell subset was detected in 19/20 (95%), with an increased HIV-specific CD8 T cell response (P <0.01) in 17/20 (85%). Dyslipidaemia significantly improved during the follow up (P <0.001). No new cases of lipodystrophy were detected. CONCLUSIONS: Switching to triple-NRTI regimens in selected HIV-infected children with an extremely low likelihood of harbouring nucleoside-associated mutations maintains viral suppression and immunological function, improving metabolic abnormalities and the effort to take medication for up to 96 weeks.

Original languageEnglish
Pages (from-to)2465-2472
Number of pages8
JournalAIDS (London, England)
Issue number18
Publication statusPublished - Dec 2007


  • CD8 T lymphocytes
  • HIV-1 infected children
  • Simplification
  • T cell Vβ

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology


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