Effectiveness and Safety of Atazanavir Use for the Treatment of Children and Adolescents Living With HIV: A Systematic Review
BackgroundAtazanavir/ritonavir is recommended as a preferred second-line antiretroviral regimen in children older than 3 months, alternatively to lopinavir/ritonavir. We performed a systematic review to assess safety and effectiveness of atazanavir use in children and adolescents.MethodsWe searched...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-05-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2022.913105/full |
| _version_ | 1811247221825339392 |
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| author | Laura Saint-Lary Marc Harris Dassi Tchoupa Revegue Julie Jesson Françoise Renaud Martina Penazzato Claire L. Townsend John O'Rourke Valériane Leroy WHO HIV Hepatitis and STIs (HHS) Department |
| author_facet | Laura Saint-Lary Marc Harris Dassi Tchoupa Revegue Julie Jesson Françoise Renaud Martina Penazzato Claire L. Townsend John O'Rourke Valériane Leroy WHO HIV Hepatitis and STIs (HHS) Department |
| author_sort | Laura Saint-Lary |
| collection | DOAJ |
| description | BackgroundAtazanavir/ritonavir is recommended as a preferred second-line antiretroviral regimen in children older than 3 months, alternatively to lopinavir/ritonavir. We performed a systematic review to assess safety and effectiveness of atazanavir use in children and adolescents.MethodsWe searched observational studies and clinical trials on Web of Science, Embase and Cochrane CENTRAL database between 2009/01/01 and 2020/10/01; as well as grey literature. We extracted safety (adverse events, grade 3 or 4 adverse events, treatment discontinuation) and effectiveness (CD4 cell counts and HIV viral load) outcomes. We estimated weighted summary pooled incidence with corresponding 95% confidence intervals.ResultsOut of the 1,085 records screened, we included five studies (one comparative cohort, three single phase 2-3 trial arms, one retrospective cohort) reporting 975 children and adolescents, of whom 56% (544) received atazanavir. Three studies reported all-cause treatment discontinuation rates, yielding a pooled incidence of 19% [15–22] at 12 months. The comparative cohort compared atazanavir to darunavir, with few grade 3–4 adverse events, except transient hyperbilirubinemia, occurring in half (92/188) of the atazanavir patients. No death occurred (two studies reporting). Four studies described increased CD4 cell counts and decreased HIV viral load at 6 or 12 months.ConclusionFew safety and effectiveness data were available for children and adolescents exposed to atazanavir. Transient grade 3–4 hyperbilirubinemia was the main adverse outcome reported. Immune and viral responses were descriptive. The use of atazanavir/ritonavir in children and adolescents needs further investigation, but remains a suitable option for a preferred second-line antiretroviral regimen.PROSPERO numberCRD42022309230 |
| first_indexed | 2024-04-12T15:06:11Z |
| format | Article |
| id | doaj.art-18297fa7b565466eb628c43289b0646d |
| institution | Directory Open Access Journal |
| issn | 2296-2360 |
| language | English |
| last_indexed | 2024-04-12T15:06:11Z |
| publishDate | 2022-05-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj.art-18297fa7b565466eb628c43289b0646d2022-12-22T03:27:56ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602022-05-011010.3389/fped.2022.913105913105Effectiveness and Safety of Atazanavir Use for the Treatment of Children and Adolescents Living With HIV: A Systematic ReviewLaura Saint-Lary0Marc Harris Dassi Tchoupa Revegue1Julie Jesson2Françoise Renaud3Martina Penazzato4Claire L. Townsend5John O'Rourke6Valériane Leroy7WHO HIV Hepatitis and STIs (HHS) DepartmentCERPOP, Inserm, Université de Toulouse, Université Paul Sabatier III, Toulouse, FranceCERPOP, Inserm, Université de Toulouse, Université Paul Sabatier III, Toulouse, FranceCERPOP, Inserm, Université de Toulouse, Université Paul Sabatier III, Toulouse, FranceGlobal HIV, Hepatitis and STIs Programme, World Health Organization, Geneva, SwitzerlandGlobal HIV, Hepatitis and STIs Programme, World Health Organization, Geneva, SwitzerlandWorld Health Organization, Geneva, SwitzerlandWorld Health Organization, Geneva, SwitzerlandCERPOP, Inserm, Université de Toulouse, Université Paul Sabatier III, Toulouse, FranceBackgroundAtazanavir/ritonavir is recommended as a preferred second-line antiretroviral regimen in children older than 3 months, alternatively to lopinavir/ritonavir. We performed a systematic review to assess safety and effectiveness of atazanavir use in children and adolescents.MethodsWe searched observational studies and clinical trials on Web of Science, Embase and Cochrane CENTRAL database between 2009/01/01 and 2020/10/01; as well as grey literature. We extracted safety (adverse events, grade 3 or 4 adverse events, treatment discontinuation) and effectiveness (CD4 cell counts and HIV viral load) outcomes. We estimated weighted summary pooled incidence with corresponding 95% confidence intervals.ResultsOut of the 1,085 records screened, we included five studies (one comparative cohort, three single phase 2-3 trial arms, one retrospective cohort) reporting 975 children and adolescents, of whom 56% (544) received atazanavir. Three studies reported all-cause treatment discontinuation rates, yielding a pooled incidence of 19% [15–22] at 12 months. The comparative cohort compared atazanavir to darunavir, with few grade 3–4 adverse events, except transient hyperbilirubinemia, occurring in half (92/188) of the atazanavir patients. No death occurred (two studies reporting). Four studies described increased CD4 cell counts and decreased HIV viral load at 6 or 12 months.ConclusionFew safety and effectiveness data were available for children and adolescents exposed to atazanavir. Transient grade 3–4 hyperbilirubinemia was the main adverse outcome reported. Immune and viral responses were descriptive. The use of atazanavir/ritonavir in children and adolescents needs further investigation, but remains a suitable option for a preferred second-line antiretroviral regimen.PROSPERO numberCRD42022309230https://www.frontiersin.org/articles/10.3389/fped.2022.913105/fulladolescentsatazanavirchildrenHIVeffectivenesssafety |
| spellingShingle | Laura Saint-Lary Marc Harris Dassi Tchoupa Revegue Julie Jesson Françoise Renaud Martina Penazzato Claire L. Townsend John O'Rourke Valériane Leroy WHO HIV Hepatitis and STIs (HHS) Department Effectiveness and Safety of Atazanavir Use for the Treatment of Children and Adolescents Living With HIV: A Systematic Review Frontiers in Pediatrics adolescents atazanavir children HIV effectiveness safety |
| title | Effectiveness and Safety of Atazanavir Use for the Treatment of Children and Adolescents Living With HIV: A Systematic Review |
| title_full | Effectiveness and Safety of Atazanavir Use for the Treatment of Children and Adolescents Living With HIV: A Systematic Review |
| title_fullStr | Effectiveness and Safety of Atazanavir Use for the Treatment of Children and Adolescents Living With HIV: A Systematic Review |
| title_full_unstemmed | Effectiveness and Safety of Atazanavir Use for the Treatment of Children and Adolescents Living With HIV: A Systematic Review |
| title_short | Effectiveness and Safety of Atazanavir Use for the Treatment of Children and Adolescents Living With HIV: A Systematic Review |
| title_sort | effectiveness and safety of atazanavir use for the treatment of children and adolescents living with hiv a systematic review |
| topic | adolescents atazanavir children HIV effectiveness safety |
| url | https://www.frontiersin.org/articles/10.3389/fped.2022.913105/full |
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