October 15, 1997

Issues Regarding Antiretroviral Treatment for Patients With HIV-1 Infection

Author Affiliations

University of Washington and Children's Hospital and Medical Center Seattle

JAMA. 1997;278(15):1234. doi:10.1001/jama.1997.03550150038026

To the Editor.  —The Consensus Statement by Dr Carpenter and colleagues,1 while providing a paradigm for antiretroviral therapy of adults, does not address the therapy of HIV-1 infected children.A recent report by Luzuriaga and colleagues2 demonstrated the propensity for the HIV-1 infection of young infants and children to rapidly develop drug resistance during treatment with the combination of zidovudine, didanosine, and nevirapine. While HIV-1 RNA levels were markedly suppressed after starting therapy, at least 5 of the 8 children had a rebound in HIV-1 RNA levels and developed drug resistance within 6 months of initiating treatment. This is in stark contrast to the duration of the antiviral responses to this combination therapy observed in adults, most of whom had persistent suppression of viral replication to below the limits of detection for at least 10 months.3A similar propensity for HIV-1 to rapidly develop resistance has been observed among