Virologic Response to First-line Efavirenz- or Nevirapine-based Antiretroviral Therapy in HIV-infected African Children

The Pediatric Infectious Disease Journal
Adeodata KekitiinwaARROW Trial Team

Abstract

Poorer virologic response to nevirapine- versus efavirenz-based antiretroviral therapy (ART) has been reported in adult systematic reviews and pediatric studies. We compared drug discontinuation and viral load (VL) response in ART-naïve Ugandan/Zimbabwean children ≥3 years of age initiating ART with clinician-chosen nevirapine versus efavirenz in the ARROW trial. Predictors of suppression <80, <400 and <1000 copies/mL at 36, 48 and 144 weeks were identified using multivariable logistic regression with backwards elimination (P = 0.1). A total of 445 (53%) children received efavirenz and 391 (47%) nevirapine. Children receiving efavirenz were older (median age, 8.6 vs. 7.5 years nevirapine, P < 0.001) and had higher CD4% (12% vs. 10%, P = 0.05), but similar pre-ART VL (P = 0.17). The initial non-nucleoside-reverse-transcriptase-inhibitor (NNRTI) was permanently discontinued for adverse events in 7 of 445 (2%) children initiating efavirenz versus 9 of 391 (2%) initiating nevirapine (P = 0.46); at switch to second line in 17 versus 23, for tuberculosis in 0 versus 26, for pregnancy in 6 versus 0 and for other reasons in 15 versus 5. Early (36-48 weeks) virologic suppression <80 copies/mL was superior with efavirenz, particularly in...Continue Reading

References

Aug 19, 2007·Journal of Acquired Immune Deficiency Syndromes : JAIDS·Moses R KamyaUNKNOWN Academic Alliance for AIDS Care and Prevention in Africa
Mar 11, 2010·Journal of Acquired Immune Deficiency Syndromes : JAIDS·Susan D EmmettElizabeth A Reddy
Oct 27, 2011·AIDS Research and Therapy·Torsak BunupuradahJintanat Ananworanich
Dec 1, 2011·Journal of Acquired Immune Deficiency Syndromes : JAIDS·Vincent J TukeiAdeodata Kekitiinwa
Feb 24, 2012·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Michele W TangRobert W Shafer
Jun 19, 2012·Journal of Comparative Effectiveness Research·Jose R Castillo-Mancilla, Thomas B Campbell
May 2, 2013·JAMA : the Journal of the American Medical Association·Elizabeth D LowenthalRobert Gross
Nov 5, 2014·South African Medical Journal = Suid-Afrikaanse Tydskrif Vir Geneeskunde·Edward Machage MgeleaS Aboud
Nov 13, 2014·AIDS·Trinh DuongUNKNOWN Collaborative HIV Paediatric Study Steering Committee
Dec 6, 2014·The Pediatric Infectious Disease Journal·Torsak BunupuradahUNKNOWN Pediatric PROGRESS Study Team
Apr 12, 2016·AIDS·Victor MusiimeUNKNOWN ARROW Trial Team

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Citations

Nov 29, 2017·Clinical Drug Investigation·Elke WynbergCaroline Foster
Jul 12, 2018·Journal of Acquired Immune Deficiency Syndromes : JAIDS·Annette H SohnMary-Ann Davies

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