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20 - Metabolic complications of antiretroviral therapy in children

from Part III - Antiretroviral therapy

Published online by Cambridge University Press:  03 February 2010

By
Carol J. Worrell
Edited by
Steven L. Zeichner  and
Jennifer S. Read
Carol J. Worrell
Affiliation:
HIV and AIDS Malignancy Branch, National Cancer Institute, Bethesda, MD 20892
Steven L. Zeichner
Affiliation:
National Cancer Institute, Bethesda, Maryland
Jennifer S. Read
Affiliation:
National Cancer Institute, Bethesda, Maryland
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Summary

Introduction

The introduction of highly active antiretroviral therapy (HAART) has revolutionized the care of HIV-1 infected children and adults in the developed world. As the morbidity and mortality attributable to the complications of HIV infection itself have decreased, the recognition of unforeseen toxicities attributable to HAART has increased. Pediatricians who care for HIV-infected children and adolescents increasingly face a population that has had extensive and prolonged exposure to HAART. There is mounting evidence in the adult literature that the magnitude and breadth of toxicities associated with HAART can be substantial, yet there remains considerable uncertainty with respect to the definitions of particular syndromes, their etiology, their prevalence, the appropriate diagnostic criteria to be used in identifying them, and their management. Further, the consequences of these changes for the overall health of the patients remain unclear. The pediatric data are quite limited, and the available information suggests that the manifestations of such toxicities in HIV-infected children can be subtle and may vary with developmental stage, with different patterns manifesting in younger children than have been described in adults. Metabolic complications have been reported in association with the use of nucleoside reverse transcriptase inhibitors (NRTIs) and protease inhibitors (PIs). Non-nucleoside reverse transcriptase inhibitors (NNRTIs) have not been directly implicated. There may be significant intra-class variability, with individual drugs within a given class associated more strongly than others with specific complications.

Type
Chapter
Information
Textbook of Pediatric HIV Care , pp. 319 - 333
Publisher: Cambridge University Press
Print publication year: 2005

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