trimethoprim--sulfamethoxazole-drug-combination and Hepatitis--Viral--Human

PENTA Guidelines aim to provide practical recommendations for treating children with HIV infection in Europe. Changes to guidance since 2004 have been informed by new evidence and by expectations of better outcomes following the ongoing success of antiretroviral therapy (ART). Participation in PENTA trials of simplifying treatment is encouraged. The main changes are in the following sections: 'When to start ART': Treatment is recommended for all infants, and at higher CD4 cell counts and percentages in older children, in line with changes to adult guidelines. The number of age bands has been reduced to simplify and harmonize with other paediatric guidelines. Greater emphasis is placed on CD4 cell count in children over 5 years, and guidance is provided where CD4% and CD4 criteria differ. 'What to start with': A three-drug regimen of two nucleoside reverse transcriptase inhibitors (NRTIs) with either a nonnucleoside reverse transcriptase inhibitor (NNRTI) or a boosted protease inhibitor (PI) remains the first choice combination. Lamivudine and abacavir are the NRTI backbone of choice for most children, based on long-term follow-up in the PENTA 5 trial. Stavudine is no longer recommended. Whether to start with an NNRTI or PI remains unclear, but PENPACT 1 trial results in 2009 may help to inform this. All PIs should be ritonavir boosted. Recommendations on use of resistance testing, therapeutic drug monitoring and HLA testing draw from data in adults and from European paediatric cohort studies. Recently updated US and WHO paediatric guidelines provide more detailed review of the evidence base. Differences between guidelines are highlighted and explained.

Topics: Adolescent; Adult; Age Factors; Anti-Infective Agents; Anti-Retroviral Agents; Antiretroviral Therapy, Highly Active; Child; Child, Preschool; Drug Resistance, Viral; Europe; Female; Hepatitis, Viral, Human; HIV Infections; HIV Long-Term Survivors; HIV-1; Humans; Infant; Infant, Newborn; Infectious Disease Transmission, Vertical; Patient Education as Topic; Pneumonia, Pneumocystis; Pregnancy; Randomized Controlled Trials as Topic; RNA, Viral; Treatment Failure; Trimethoprim, Sulfamethoxazole Drug Combination; Tuberculosis; Young Adult

We sought to study asymptomatic pancreatic enzyme abnormalities in patients with human immunodeficiency virus (HIV) infection.. Serial serum amylase and lipase determinations were performed in ambulatory HIV-seropositive patients in whom pancreatitis was not suspected.. Eighty-six patients were enrolled in the study. Fifty-two patients (60%) were found to have abnormal amylase or lipase values on at least one determination. Only 12 (14% of all patients) had a more than twofold elevation of pancreatic enzymes. Seven patients had transient elevations of lipase within 3 months after the initiation of antiretroviral therapy. Independent factors associated with abnormal pancreatic enzymes were: positive serology for chronic hepatitis B or C, history of intravenous cotrimoxazole administration for the treatment of Pneumocystis carinii pneumonia, stage B of HIV disease, and HIV risk factors other than male homosexuality (mainly intravenous drug use). None of the patients developed clinical pancreatitis.. Asymptomatic mild to moderate elevations of amylase or lipase are common in HIV-positive patients, and are usually associated with positive serology for chronic hepatitis B or C, and medications, especially antiretrovirals and intravenous cotrimoxazole.

Topics: Adult; Aged; Amylases; Anti-Infective Agents; Female; Hepatitis, Viral, Human; HIV Infections; HIV Seropositivity; Homosexuality; Humans; Lipase; Male; Middle Aged; Risk Factors; Substance Abuse, Intravenous; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: AIDS-Related Opportunistic Infections; Alanine Transaminase; Aspartate Aminotransferases; Bilirubin; Cholestasis; Giant Cells; Hepatitis, Viral, Human; Hepatomegaly; HIV Infections; HIV Seropositivity; Humans; Infant; Liver; Pentamidine; Pneumonia, Pneumocystis; Splenomegaly; Trimethoprim, Sulfamethoxazole Drug Combination; Zidovudine