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Surprising boost for children with AIDS.

Surprising boost for children with AIDS

AIDS tends to show up differently in children and adults. While both suffer frequent infections, children have more visible brain disease. In fact, several studies suggest brain damage will eventually occur in all AIDS-afflicted children. And that's what makes a new National Cancer Institute (NCIe study encouraging.

Aimed at establishing the safety and tolerable doeses of the drug zidovudine (also known as AZT) in children, the year-long study quickly -- and unexpectedly--prompted reversals in intellectual impairment. Nonetheless, five of the 21 participants died of the disease.

The study was the first to deliver the drug through a continuous intravenous infusion pump. Zidovudine, which is quickly lost from the body and can be very toxic, is usually given by periodic injections or by mouth. Both approaches deliver an initial peak dose that quickly drops. The NCI researchers wanted to see whether lower-dose, continuous-level treatment might improve children's toelrance or the drug's efficacy.

All study participants, aged 14 months to 12 years, carried the HIV virus and showed symptoms of AIDS. "We didn't anticipate that the improvement would be so dramatic," says Philip A. Pizzo, NCI's head of pediatrics and infectious diseases. But the new approach, described in the Oct. 6 NEW ENGLAND JOURNAL OF MEDICINE, brought neurologic improvements in every child, beginning in as little as three or four weeks. In one 11-year-old whose IQ had dropped 28 points--to 77--after HIV infection, IQ returned to 99 after nine months of treatment. Equally significant changes were seen in younger children, who regained the ability to walk, talk or exhibit other lost developmental achievements.

The study included no untreated "control" patients against whom to compare the regimen's effects. However, many of the children appeared to suffer fewer opportunistic infections after starting treatment and showed improvements in appetite, weight gain, energy, lymph node disease, liver and spleen size, and levels of T-4 lymphocytes targeted by the virus.

The neurologic improvements appear to have been independent of -- and more dramatic than -- these other changes. In fact, even children with no obvious IQ or developmental impairment showed neurologic improvement after treatment. This suggests, Pizzo says, that impaired cognitive function may be among the earliest manifestations of pediatric AIDS. In hopes of limiting AIDS transmission to infants, the federal government is considering treating pregnant AIDS victims with zidovudine, officials say.
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Title Annotation:use of AZT reverses intellectual impairment
Author:Raloff, Janet
Publication:Science News
Date:Oct 8, 1988
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