Antiretroviral regimen associated with less virological failure among HIV-infected children

Elizabeth D. Lowenthal, M.D., M.S.C.E., of the University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, and colleagues conducted a study to determine whether there was a difference in time to virological failure between HIV-infected children initiating nevirapine vs. efavirenz-based antiretroviral treatment in Botswana.

"More than 2 million children worldwide are infected with (HIV), approximately 90 percent of whom live in sub-Saharan Africa," according to background information in the article. "Worldwide, the nonnucleoside reverse transcriptase inhibitors (NNRTIs) efavirenz and are commonly used in first-line antiretroviral regimens in both adults and children with . Data on the of these medications in children are limited. … Most countries favor nevirapine-based regimens for the majority of children due to perceived comparable effectiveness at lower cost."

The study included children (3-16 years of age) who initiated efavirenz-based (n=421) or nevirapine-based (n=383) treatment between April 2002 and January 2011 at a large pediatric HIV care setting in Botswana. The primary outcome was time from initiation of therapy to virological failure, defined as lack of plasma HIV RNA suppression to less than 400 copies/mL by 6 months or confirmed HIV RNA of 400 copies/mL or greater after suppression.

With a median (midpoint) follow-up time of 69 months, the researchers found that 57 children (13.5 percent) initiating treatment with efavirenz and 101 children (26.4 percent) initiating treatment with nevirapine had virological failure. There were 11 children (2.6 percent) receiving efavirenz and 20 children (5.2 percent) receiving nevirapine who never achieved virological suppression.

"In this large cohort of children infected with HIV, time to virological failure was longer among children receiving efavirenz vs. nevirapine. With the majority of the world's receiving nevirapine-based antiretroviral therapy, these findings may have significant public health importance," the authors write. "… more work should be done to make efavirenz a cost-effective option for pediatric programs in resource-limited settings."

More information: JAMA. 2013;309[17]:1803-1809

add to favorites email to friend print save as pdf

Related Stories

New drug adds to arsenal against AIDS

Jul 15, 2011

A new drug, rilpivirine, can add powerfully to the combination of medications used to control HIV for first-time patients, researchers conclude in Friday's issue of The Lancet.

Recommended for you

Small changes in eGFR with TDF preexposure prophylaxis

Dec 23, 2014

(HealthDay)—For HIV-1-uninfected members of serodiscordant couples, tenofovir disoproxil fumarate (TDF) used as preexposure prophylaxis (PrEP) is associated with a small decrease in estimated glomerular ...

FDA to ease ban on blood donations by gay men

Dec 23, 2014

Federal officials have moved closer to overturning a decades-old ban on blood donations from gay and bisexual men, but activists say the proposed alternative would continue to stigmatize men who have sex ...

Consumer group sues Aetna, alleges discrimination

Dec 23, 2014

A consumer advocacy group has filed a class-action lawsuit against Aetna Inc. saying a new policy violates the privacy of people with HIV and AIDS by requiring them to get their medications from its mail-order pharmacy.

Cambodia orders probe into mass HIV infection

Dec 18, 2014

Cambodian Prime Minister Hun Sen on Thursday ordered a probe into an apparent mass HIV infection believed to have been spread by contaminated needles, as the number of suspected cases passed 100.

User comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.