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Efavirenz-based therapy produced less virologic failure in HIV-infected children
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Efavirenz-based antiretroviral regimens were associated with less virological failure in HIV-infected children than nevirapine-based antiretroviral regimens, according to study results published in JAMA.
“The finding of increased rates of virological failure among children receiving nevirapine suggests that more work should be done to make efavirenz a cost-effective option for pediatric antiretroviral treatment programs in resource-limited settings,” researchers wrote.
The retrospective cohort study included children aged 3 to 16 years assigned efavirenz-based (n=421) or nevirapine-based (n=383) antiretroviral treatment between 2002 and 2011 at a pediatric HIV care setting in Botswana.
Researchers found that 19.7% of participants experienced virological failure; 13.5% (95% CI, 10.4-17.2) were in the efavirenz group and 26.4% (95% CI, 22-31.1) were in the nevirapine group. The rate of failure was greater for nevirapine at all time points and the hazard of failure was proportional.
Researchers also found that 2.6% of participants assigned efavirenz and 5.2% assigned nevirapine never achieved virological suppression.
According to researchers, at 1, 2 and 5 years, the virological failure rates with efavirenz vs. nevirapine were 6.7% vs. 12.8%; 10.2% vs. 19.8%; and 12.8% vs. 25.1%, respectively.
“For clinicians in the United States, this study is unlikely to have a major impact on their practice,” Elizabeth Lowenthal, MD, MSCE, assistant professor of pediatrics at the Perelman School of Medicine at the University of Pennsylvania told Infectious Diseases in Children. “However, in resource-limited setting where greater than 90% of the world's HIV-infected children live, the findings may have major health-policy implications. Most of the world's children who are receiving treatment for HIV are being treated with nevirapine-based regimens. The study suggests that there will be more long-term treatment success if efavirenz-based treatments can be made available to them.”
Disclosure: See the study for a full list of disclosures.
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