Use of Antiretroviral Therapy in Children and Pregnant Women

  • Ross E. McKinneyJr.
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 394)


The pathogenesis and clinical manifestations of HIV infection in children are distinct from the same process in adults, with differences which provide unique opportunities to understand the nature of HIV infection in both categories of patients. Within the pediatric population, the relatively uniform time of infection (close to the time of birth) means that a large group of patients is available for studies of early intervention. In addition, because the disease tends to progress more quickly in children than adults, studies which require clinical endpoints may be able to be completed more quickly or with fewer individuals. Finally, preliminary studies of viral load in infants indicate that their immune system may be unable to control HIV replication well, permitting maintenance of high viral copy numbers at a time when adults have declining amounts of virus. Thus, there may be a particular role for antiviral therapy in the early suppression of virus during infancy, allowing the immune system time to mature in order to respond to the infection.


Human Immunodeficiency Virus Human Immunodeficiency Virus Type Human Immunodeficiency Virus Transmission Intravenous Immune Globulin Symptomatic Human Immunodeficiency Virus 
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  1. 1.
    Bryson YJ, Luzuriaga K, Sullivan JL, Wara DW. Proposed definitions for in utero versus intrapartum transmission of HIV-1. N Engl J Med 1992; 327: 1246–7PubMedCrossRefGoogle Scholar
  2. 2.
    Soeiro R, Rubinstein A, Rashbaum WK, Lyman WD. Maternofetal transmission of AIDS: frequency of human immunodeficiency virus type 1 nucleic acid sequences in human fetal DNA. J Infect Dis 1992; 166: 699–703PubMedCrossRefGoogle Scholar
  3. 3.
    Goeddert JJ, Duliege AM, Amos CI, et al. International registry of HIV exposed twins. high risk of HIV-1 infection for first-born twins. Lancet 1991; 338: 1471–1475Google Scholar
  4. 4.
    Fauci AS. Multifactorial nature of human immunodeficiency virus disease: Implications for therapy. Science 1993; 262: 1011–1018Google Scholar
  5. 5.
    Daar ES, Moudgil T, Meyer RD, Ho DD. Transient high levels of viremia in patients with primary human immunodeficiency virus type 1 infection. N Engl J Med 1991; 324: 961–964PubMedCrossRefGoogle Scholar
  6. 6.
    Luzuriaga K, McQuilken P, Alimenti A, et al. Early viremia and immune responses in vertical human immunodeficiency virus type I infection. J Infect Dis 1993; 167: 1008–1013PubMedCrossRefGoogle Scholar
  7. 7.
    Palumbo PE, Kwok S, Waters S, et al. Viral measurement by polymerase chain reaction-based assays in human immunodeficiency virus-infected infants. J Pediatr 1995; 126: 592–595PubMedCrossRefGoogle Scholar
  8. 8.
    Oxtoby MJ. Vertically acquired HIV infection in the United States. in Pizzo PA, Wilfert CM (eds) Pediatric AIDS: the challenge of HIV infection in infants, children, and adolescents, second edition ( Baltimore: Williams & Wilkins, 1994 ) pp. 3–20Google Scholar
  9. 9.
    McKinney RE, Robertson JWR, Duke Pediatric AIDS Clinical Trials Unit. The effect of human immunodeficiency virus infection on the growth of young children. J Pediatr 1993; 123: 579–582PubMedCrossRefGoogle Scholar
  10. 10.
    Auger I, Thomas P, DeGruttola V, et al. Incubation periods for paediatric AIDS patients. Nature 1988; 336: 575–577.PubMedCrossRefGoogle Scholar
  11. 11.
    European Collaborative Study. Children born to women with HIV-1 infection: natural history and risk of transmission. Lancet 1991; 337: 253–260CrossRefGoogle Scholar
  12. 12.
    Bryson Y, Chen I, Miles S, et al. A prospective evaluation of HIV co-culture for early diagnosis of perinatal HIV infection. [Abstract W.B.2014] in proceedings and abstracts, VII international conference on AIDS (Florence) 1991: 185Google Scholar
  13. 13.
    Dabis F, Msellati P, Dunn D, et al. Estimating the rate of mother-to-child transmission of HIV. Report of a workshop on methodological issues Ghent (Belgium), 17–20 February 1992. AIDS 1993; 7: 1139–1148PubMedCrossRefGoogle Scholar
  14. 14.
    Connor EM, Sperling RS, Gelber R, et al. Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment. N Engl J Med 1994; 331: 1173–80PubMedCrossRefGoogle Scholar
  15. 15.
    McKinney RE, Maha MA, Connor EM, et al. A multicenter trial of oral zidovudine in children with advanced human immunodeficiency virus disease. N Engl J Med 1991; 324: 1018–1025PubMedCrossRefGoogle Scholar
  16. 16.
    Pizzo PA, Eddy J, Falloon J, et al. Effect of continuous intravenous infusion of zidovudine (AZT) in children with symptomatic HIV Infection. N Engl J Med 1988; 319: 889–896PubMedCrossRefGoogle Scholar
  17. McKinney RE, Pizzo PA. Scott GB, et al. Safety and tolerance of intermittent intravenous and oral zidovudine therapy in human immunodeficiency virus infected pediatric patients. J Pediatr 1990; 116:640–647Google Scholar
  18. 18.
    Spector SA, Blanchard S, Connor EM, et al. Results of a clinical trial comparing two doses of 2’3’dideoxycytidine (ddC) in the treatment of children with symptomatic human immunodeficiency virus (HIV) infection who were intolerant or had failed zidovudine (ZDV) therapy (ACTG 138) [Abstract 11651. Pediatr Res 1994; 35: 197AGoogle Scholar
  19. 19.
    Ammann AJ, Schiffman G, Abrams D, et al. B-cell immunodeficiency in acquired immune deficiency syndrome. JAMA 1984; 251. 1447–1449PubMedCrossRefGoogle Scholar
  20. 20.
    The National Institute of Child Health and Human Development Intravenous Immunoglobulin Study Group. Intravenous immune globulin for the prevention of bacterial infections in children with symptomatic human immunodeficiency virus infection. N Engl J Med 1991; 325: 73–80CrossRefGoogle Scholar
  21. 21.
    Hardy WD, Feinberg J, Finkelstein DM, Power ME, He W, Kaczka C, Frame PT, Holmes M, Waskin H, Fass RI, et al. A controlled trial of trimethoprim-sulfamethoxasole or aerosolized pentamidine for secondary prophylaxis of Pneumocystis carinii pneumonia in patients with the acquired immunodeficiency syndrome. AIDS Clinical Trials Group Protocol 021. N Engl J Med 1992; 327: 1842–8PubMedCrossRefGoogle Scholar
  22. 22.
    Spector SA, Gelber RD, McGrath N, et al. A controlled trial of intravenous immune globulin for the prevention of serious bacterial infections in children receiving zidovudine for advanced human immunodeficiency virus infection. N Engl J Med 1994; 331: 1181–1187PubMedCrossRefGoogle Scholar

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© Springer Science+Business Media New York 1996

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  • Ross E. McKinneyJr.

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