Virologic outcomes of HIV-infected children undergoing a single-class drug substitution from Lopinavir/Ritonavir- to Efavirenz-based antiretroviral treatment: A retrospective cohort study
type: CreativeWork
description: Major advances have been made in preventing mother to child transmission of HIV (PMTCT), as well as in decreasing morbidity and mortality amongst HIV-infected infants and children. However, maintenance of excellent adherence to combination antiretroviral therapy (cART) lifelong is required to achieve optimal benefits. In addition, treatment options for children are limited by potential drug-resistance following PMTCT exposure, availability of appropriate and palatable formulations, long-term toxicity concerns and drug-interactions - notably with co-treatment for tuberculosis. Given these challenges, drug simplification strategies for children remains an important area of research. The World Health Organisation (WHO) recommends lopinavir/ritonavir-based (LPV/r) cART as first-line for children <36 months old with the option to substitute LPV/r with a non-nucleoside reverse transcriptase inhibitor if virologic suppression is maintained. This simplification strategy is potentially cost-saving, regimen-sparing and more tolerable, with a better long-term side-effect profile. Consequently, benefits should also exist in terms of adherence. The main evidence in support of this strategy has come from trials conducted by the Nevirapine Resistance Studies (NEVEREST) group. In particular, the NEVEREST 3 trial showed that substituting LPV/r for efavirenz (EFV) in children aged 36-60 months virologically suppressed on LPV/r-based cART was protective against viral rebound and had no effect on virological failure compared with remaining on LPV/r. To our knowledge, no studies to date have examined the virologic outcomes of children changed to an EFV-based regimen after initiating a LPV/r based regimen in routine, resource-constrained settings where selection of patients as eligible for EFV substitution and subsequent monitoring practices may be less rigorous than in a trial setting. At the International Epidemiologic Database to Evaluate AIDS - Southern Africa collaboration's (IeDEA-…
abstract: Major advances have been made in preventing mother to child transmission of HIV (PMTCT), as well as in decreasing morbidity and mortality amongst HIV-infected infants and children. However, maintenance of excellent adherence to combination antiretroviral therapy (cART) lifelong is required to achieve optimal benefits. In addition, treatment options for children are limited by potential drug-resistance following PMTCT exposure, availability of appropriate and palatable formulations, long-term toxicity concerns and drug-interactions - notably with co-treatment for tuberculosis. Given these challenges, drug simplification strategies for children remains an important area of research. The World Health Organisation (WHO) recommends lopinavir/ritonavir-based (LPV/r) cART as first-line for children <36 months old with the option to substitute LPV/r with a non-nucleoside reverse transcriptase inhibitor if virologic suppression is maintained. This simplification strategy is potentially cost-saving, regimen-sparing and more tolerable, with a better long-term side-effect profile. Consequently, benefits should also exist in terms of adherence. The main evidence in support of this strategy has come from trials conducted by the Nevirapine Resistance Studies (NEVEREST) group. In particular, the NEVEREST 3 trial showed that substituting LPV/r for efavirenz (EFV) in children aged 36-60 months virologically suppressed on LPV/r-based cART was protective against viral rebound and had no effect on virological failure compared with remaining on LPV/r. To our knowledge, no studies to date have examined the virologic outcomes of children changed to an EFV-based regimen after initiating a LPV/r based regimen in routine, resource-constrained settings where selection of patients as eligible for EFV substitution and subsequent monitoring practices may be less rigorous than in a trial setting. At the International Epidemiologic Database to Evaluate AIDS - Southern Africa collaboration's (IeDEA-…
author: Reichmuth, Kirsten Leah
language: eng
date published: 2015
date modified: 2026-07-22T22:22:54Z
provider: University of Cape Town
publisher: Networked Digital Library of Theses and Dissertations
type: WebPage
source organization: Department of Public Health and Family Medicine

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property ID: Handle
value: http://hdl.handle.net/11427/14257