Virologic response to first-line efavirenz- or nevirapine-based antiretroviral therapy in HIV-infected African children
<p>BACKGROUND: Poorer virologic response to nevirapine- versus efavirenz-based antiretroviral therapy (ART) has been reported in adult systematic reviews and pediatric studies.</p><p> METHODS: We compared drug discontinuation and viral load (VL) response in ART-naïve Ugandan/Zimbab...
| Main Authors: | , , , , , , , , , , |
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| Format: | Journal article |
| Language: | English |
| Published: |
Lippincott, Williams & Wilkins
2017
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| _version_ | 1826263352708431872 |
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| author | Kekitiinwa, A Szubert, A Spyer, M Katuramu, R Musiime, V Mhute, T Bakeera-Kitaka, S Senfuma, O Walker, A Gibb, D ARROW Trial Team, |
| author_facet | Kekitiinwa, A Szubert, A Spyer, M Katuramu, R Musiime, V Mhute, T Bakeera-Kitaka, S Senfuma, O Walker, A Gibb, D ARROW Trial Team, |
| author_sort | Kekitiinwa, A |
| collection | OXFORD |
| description | <p>BACKGROUND: Poorer virologic response to nevirapine- versus efavirenz-based antiretroviral therapy (ART) has been reported in adult systematic reviews and pediatric studies.</p><p> METHODS: 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). </p><p>RESULTS: 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 children with higher pre-ART VL (P = 0.0004); longer-term suppression was superior with nevirapine in older children (P = 0.05). Early suppression was poorer in the youngest and oldest children, regardless of NNRTI (P = 0.02); longer-term suppression was poorer in those with higher pre-ART VL regardless of NNRTI (P = 0.05). Results were broadly similar for <400 and <1000 copies/mL.</p><p> CONCLUSION: Short-term VL suppression favored efavirenz, but long-term relative performance was age dependent, with better suppression in older children with nevirapine, supporting World Health Organization recommendation that nevirapine remains an alternative NNRTI.</p> |
| first_indexed | 2024-03-06T19:50:24Z |
| format | Journal article |
| id | oxford-uuid:23c6b072-e680-461a-9a3a-b42cce3ab526 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-06T19:50:24Z |
| publishDate | 2017 |
| publisher | Lippincott, Williams & Wilkins |
| record_format | dspace |
| spelling | oxford-uuid:23c6b072-e680-461a-9a3a-b42cce3ab5262022-03-26T11:46:05ZVirologic response to first-line efavirenz- or nevirapine-based antiretroviral therapy in HIV-infected African childrenJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:23c6b072-e680-461a-9a3a-b42cce3ab526EnglishSymplectic Elements at OxfordLippincott, Williams & Wilkins2017Kekitiinwa, ASzubert, ASpyer, MKaturamu, RMusiime, VMhute, TBakeera-Kitaka, SSenfuma, OWalker, AGibb, DARROW Trial Team,<p>BACKGROUND: Poorer virologic response to nevirapine- versus efavirenz-based antiretroviral therapy (ART) has been reported in adult systematic reviews and pediatric studies.</p><p> METHODS: 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). </p><p>RESULTS: 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 children with higher pre-ART VL (P = 0.0004); longer-term suppression was superior with nevirapine in older children (P = 0.05). Early suppression was poorer in the youngest and oldest children, regardless of NNRTI (P = 0.02); longer-term suppression was poorer in those with higher pre-ART VL regardless of NNRTI (P = 0.05). Results were broadly similar for <400 and <1000 copies/mL.</p><p> CONCLUSION: Short-term VL suppression favored efavirenz, but long-term relative performance was age dependent, with better suppression in older children with nevirapine, supporting World Health Organization recommendation that nevirapine remains an alternative NNRTI.</p> |
| spellingShingle | Kekitiinwa, A Szubert, A Spyer, M Katuramu, R Musiime, V Mhute, T Bakeera-Kitaka, S Senfuma, O Walker, A Gibb, D ARROW Trial Team, Virologic response to first-line efavirenz- or nevirapine-based antiretroviral therapy in HIV-infected African children |
| title | Virologic response to first-line efavirenz- or nevirapine-based antiretroviral therapy in HIV-infected African children |
| title_full | Virologic response to first-line efavirenz- or nevirapine-based antiretroviral therapy in HIV-infected African children |
| title_fullStr | Virologic response to first-line efavirenz- or nevirapine-based antiretroviral therapy in HIV-infected African children |
| title_full_unstemmed | Virologic response to first-line efavirenz- or nevirapine-based antiretroviral therapy in HIV-infected African children |
| title_short | Virologic response to first-line efavirenz- or nevirapine-based antiretroviral therapy in HIV-infected African children |
| title_sort | virologic response to first line efavirenz or nevirapine based antiretroviral therapy in hiv infected african children |
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