Word: hiv
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Dates: during 1990-1999
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Such delays can prove fatal. Tanya (not her real name), an 11-year-old from Miami who is HIV positive, had to watch her younger sister die last year while they waited for permission to take a protease inhibitor. Both girls had been infected in utero; their mother died a couple of years later. "The [pharmaceutical company] said they didn't have the right dosage for children," the girls' foster mother recalls. "They told us to hold out. But by the time she got accepted, it was too late [for Tanya's sister]." In February, Tanya started combination therapy with...
...clinical trials. Kline recalls attending the international AIDS conference in Vancouver, Canada, last July and being overwhelmed by the flood of reports detailing how well various protease inhibitors were working on adults. "I couldn't in good conscience come back to Houston and take care of 300 kids with HIV and keep telling families that we couldn't offer protease inhibitors because we didn't know the correct dose," he remembers thinking. So Kline designed a simple study of 20 kids, ages 4 to 12, and made an educated guess at a dose that might be strong enough...
...just because they can get protease inhibitors into their youngest patients doesn't mean that pediatricians are eager to do so. With children as with adults, patients' first response to a protease inhibitor is often their best. If they take the drug too soon, the HIV in their body can become resistant not only to that particular drug but to the whole family of protease inhibitors. As a result, most doctors will give the drugs only to those children who are clearly deteriorating...
Still, pediatricians are following the experiments of AIDS pioneer Dr. David Ho with great interest. Ho believes that doctors must hit HIV early and hard if they ever hope to clear the virus from the body. If the current generation of protease inhibitors, or new ones being developed, are successful in vanquishing HIV in adults, then pediatricians may consider using a similar approach with newborns. But they would need a lot more safety data before they could even attempt such an experiment. For one thing, babies' livers are too immature to process the powerful drugs. A full-strength dose might...
...more likely next step, therefore, would be to place pregnant women who are HIV positive on a combination of protease inhibitors and AZT. About 1 in 4 children born to untreated HIV-positive mothers develop the infection themselves. The use of AZT during pregnancy has cut that transmission rate to 8%. In the next few months researchers will begin putting HIV-infected mothers on combination therapy with protease inhibitors to see if they can cut the rate to zero. But protease inhibitors are so much more powerful and potentially toxic than AZT that no one knows what harm it might...