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Combined therapy in human immunodeficiency virus-infected children —a 4-year experience

  • Infectious Diseases
  • Published:
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Abstract

From 1988 to 1991 the long-term efficacy of a combined therapy with a polyvalent immunoglobulin/cytomegalovirus (CMV) hyperimmunoglobulin, oral low dose zidovudine, oral cotrimoxazole or inhaled pentamidine was investigated in three groups of human immunodeficiency virus (HIV)-infected children. Group 1A consisted of three perinatally infected children with a CD4 cell decrease of >400, cells/μl per year. Group 1B were 17 perinatally infected children with a CD4 cell decrease of <400 cells/μl per year. Group 2 comprised eight haemophilic children infected by clotting factors. Despite combined therapy none of group 1A survived longer than 12 months showing a rapid loss of CD4 cell counts, progressive encephalopathy, wasting syndrome and severe bacterial, fungal and CMV reactivation. Under pure intravenous immunoglobulin (IVIG) therapy severe bacterial infections were seen in 1 of 12 children in group 1B. The majority of these patients showed increases or stabilisation of length and weight percentiles. In this group low dose zidovudine therapy was of benefit in HIV-associated neurological symptoms. Nevertheless combined therapy could not prevent further deterioration of CD4 cell counts. In group 2 severe bacterial infections were not seen under IVIG therapy. In this group a temporary increase (6 months) of CD4 cell counts under IVIG/zidovudine combined therapy occurred.Pneumocystis carinii pneumonia (PCP) prophylaxis with oral cotrimoxazole or inhaled pentamidine successfully prevented PCP in all three groups. Under CMV hyperimmunoglobulins (n=22), ten out of ten patients did not acquire primary CMV infection, whereas CMV reactivations mainly located in the CNS could not be prevented in 5 of 12 patients. Our findings indicate that this combined therapy showed remarkable differences in therapeutic efficacy in children with different modes of HIV progression. These modes must be considered for correct timing, dosage and evaluation of therapeutic measures.

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Abbreviations

PCP:

Pneumoystis carinii pneumonia

CMV:

cytomegalovirus

HIV:

human immunodeficiency virus

IVIG:

intravenous immunoglobulin

CNS:

central nervous system

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Authors and Affiliations

  1. Centre of Paediatrics, Departments of Haematology/Oncology and Infectious Diseases, J. W. Goethe University, Theodor-Stern-Kai 7, W-6000, Frankfurt am Main, Germany

    T. Güngör, M. Funk, R. Linde, I. Kynast, A. Allendorf, C. Lotz, S. Ehrenforth, D. Hofmann, B. Kornhuber & W. Kreuz

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  1. T. Güngör
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  2. M. Funk
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  3. R. Linde
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  4. I. Kynast
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  5. A. Allendorf
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  6. C. Lotz
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  7. S. Ehrenforth
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  8. D. Hofmann
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  9. B. Kornhuber
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  10. W. Kreuz
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Güngör, T., Funk, M., Linde, R. et al. Combined therapy in human immunodeficiency virus-infected children —a 4-year experience. Eur J Pediatr 152, 650–654 (1993). https://doi.org/10.1007/BF01955241

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  • DOI: https://doi.org/10.1007/BF01955241

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