Infectious Disease

Azithromycin reduces exacerbations in youngsters with HIV-associated persistent lung illness

December 31, 2020

2 min read

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Ferrand does not report any relevant financial information. In the study you will find all relevant financial information from all other authors.

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Children with HIV-associated chronic lung disease have acute respiratory exacerbations.

“The pharmacokinetics of is not only safe and well tolerated, but also [azithromycin] are unique, with high intracellular uptake and slow liver excretion, ”wrote Dr. Rashida A. Ferrand, Senior Lecturer in the Clinical Research Department at the London School of Hygiene and Tropical Medicine, London, and colleagues. “The resulting high tissue concentrations made weekly dosing possible and potentially reduced non-compliance.”

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The double-blind, placebo-controlled, randomized clinical trial (mean age 15.3 years; 51%) of perinatally acquired HIV and HIV-associated chronic lung disease who received antiretroviral therapy for 6 months or more. Participants in azithromycin orally administered once a week (n = 174) or placebo (n = 173) for 48 weeks.

The primary result was the mean difference in the FEV1 z-score using the intention-to-treat analysis. Secondary outcomes included acute airway exacerbations, all-cause hospital admissions, mortality, and weight-for-age Z-score.

A total of 162 participants in the azithromycin group and 146 participants in the placebo group had primary outcome data with a non-significant FEV1-z score of 0.06 (95% CI, -0.1-0.21; P = 0 , 48).

The acute respiratory exacerbation rates were 12.1 events per 100 person-years in the azithromycin group compared to 24.7 events per 100 person-years in the placebo group (HR = 0.5; 95% CI, 0.27-0, 93; P = 0.03). Ospitalization rates were not significant with 1.3 events for the azithromycin group and 7.1 events for the placebo group (HR = 0.24; 95% CI, 0.06-1.07; P = 0.56) . A weight-for-age Z-score with a score 0.03 (95% CI, -0.08-0.14; P = 0.56) higher in the azithromycin group than in the placebo group is not significant -Group.

The researchers observed 3 deaths in the placebo group and deaths in the azithromycin group. There were no drug-related serious adverse events.

According to the researchers, azithromycin treatment antimicrobial resistance in the respiratory microbiome, the macrolide azithromycin increase resistance in bystanders.

“These concerns justify the need for a selective treatment approach. Future studies should investigate [azithromycin] therapeutic effects against factors such as disease severity and pattern, functional impairment, and extent of immunodeficiency, to identify patients who would benefit most from such an intervention, ”the researchers wrote. “Future research should identify groups of patients who would benefit most from this intervention, optimal treatment duration and dosage schedules, and sustainability of the treatment effect.”

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