In:
Pediatric Infectious Disease Journal, Ovid Technologies (Wolters Kluwer Health), Vol. 36, No. 6 ( 2017-06), p. 588-594
Abstract:
Poorer virologic response to nevirapine- versus efavirenz-based antiretroviral therapy (ART) has been reported in adult systematic reviews and pediatric studies. 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). 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. 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.
Type of Medium:
Online Resource
ISSN:
0891-3668
DOI:
10.1097/INF.0000000000001505
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2017
detail.hit.zdb_id:
2020216-7
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