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Switch-strategy in HIV-infected children safe, effective when closely monitored

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BOSTON — Although difficulties exist when switching HIV-infected children to a non-nucleoside reverse-transcriptase inhibitor-based regimen, these children may be safely switched to a nevirapine-based regimen with close and sufficient virological monitoring, according to Louise Kuhn, MD.

“Current recommendations for treating HIV-infected children encourage the use of ritonavir–boosted lopinavir-based regimens in children who have been exposed to nevirapine prophylaxis. This poses a challenge for low-resource settings because this regimen is much more expensive than other therapy regimens,” Kuhn, of the Gertrude H. Sergievsky Center at Columbia University College of Physicians and Surgeons, said during a press conference.

As indefinite continuation of protease-inhibitor therapy is costly and poses challenges to second-line therapies, Kuhn and colleagues set out to assess whether targeted virologic or drug-resistance testing could allow for implementation of a switch strategy in HIV-infected children in Johannesburg, South Africa.

The cohort included children aged younger than 2 years with HIV who were exposed to nevirapine prophylaxis and achieved less than 400 copies/mL for three months or longer when initially treated with a lopinavir/ritonavir-based regimen. Children were randomly assigned to a nevirapine prophylaxis-based regimen (n=96) or remained on the protease-inhibitor therapy (n=99).

By 156 weeks, about 40% of children in the nevirapine group maintained less than 50 copies/mL compared with 31.3% of children in the protease-inhibitor therapy regimen (P=.01). Conversely, 23.9% of children in the nevirapine group had confirmed viremia greater than 1,000 copies/mL vs. 11.1% of children in the protease-inhibitor therapy regimen group (P=.01).

All failures occurred by week 52 for children in the nevirapine group when compared with only 50% of failures in the protease-inhibitor therapy group.

According to Kuhn, pretreatment resistance testing can optimize the switch strategy allowing it to be targeted to those most likely to benefit when resistance results are not available at time of treatment initiation.

For more information:

• Kuhn L. #128. Presented at: The 18th Conference on Retroviruses and Opportunistic Infections; Feb. 27-March 2, 2011; Boston.

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