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Objectives: To investigate the intestinal absorptive processes in
children with HIV infection
before and after treatment with combination therapy that includes ritonavir. To
test the hypothesis
that combination therapy improves intestinal function.
Design: Intestinal function tests were performed in 10 children with
advanced HIV disease at the enrollment and after 3 and 6 months of therapy with
ritonavir combined with two HIV reverse transcriptase inhibitors. HIV viral load
and CD4 cell counts were also determined; body weight was monitored.
Methods: The D-xylose absorption test, the steatocrit and the determination
of fecal alpha1-antitrypsin
concentration were used to evaluate carbohydrate and fat absorption, as well as
fecal protein loss. Serum iron levels were measured to indirectly evaluate iron
absorption. HIV-1 RNA-polymerase chain reaction (PCR) and immunofluorescence
imaging were used to evaluate virologic and immunologic responses.
Results: In all, 9 children had carbohydrate malabsorption, 3 steatorrhea,
2 protein loss, and 7 iron deficiency. Most tests produced normal results after
3 months of therapy, and all abnormalities were abolished 6 months after
institution of combination therapy. Mean results of each of four absorption
tests were significantly changed on combination therapy. Viral load was
progressively reduced and CD4 count was increased, with an inverse relationship.
An evident shift of body weight pattern toward catch-up growth was observed in
all children.
Conclusions: Ritonavir combination therapy results in prompt and
sustained restoration of intestinal function, which is associated with reduction
in viral load, increase in CD4 counts, and gain in body weight.
*Department of Pediatrics, University Federico II, Naples, Italy.
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