Antiretroviral treatment for children with peripartum nevirapine exposure

January 01, 0001

Antiretroviral treatment for children with peripartum nevirapine exposure

Single-dose nevirapine is the cornerstone of the regimen for prevention of mother-to-child transmission of human immunodeficiency virus (HIV) in resource-limited settings, but nevirapine frequently selects for resistant virus in mothers and children who become infected despite prophylaxis. These authors from multiple countries conducted a randomized trial of initial therapy with zidovudine and lamivudine plus either nevirapine or ritonavir-boosted lopinavir in HIV-infected children 6 to 36 months of age, in six African countries, who qualified for treatment according to World Health Organization (WHO) criteria. Results are reported for the cohort that included children exposed to single-dose nevirapine prophylaxis. The primary end point was virologic failure or discontinuation of treatment by study week 24. Enrollment in this cohort was terminated early on the recommendation of the data and safety monitoring board.

They found: "A total of 164 children were enrolled. The median percentage of CD4+ lymphocytes was 19%; a total of 56% of the children had WHO stage 3 or 4 disease. More children in the nevirapine group than in the ritonavir-boosted lopinavir group reached a primary end point (39.6% vs. 21.7). Baseline resistance to nevirapine was detected in 18 of 148 children (12%) and was predictive of treatment failure. No significant between-group differences were seen in the rate of adverse events."

The authors concluded: "Among children with prior exposure to single-dose nevirapine for perinatal prevention of HIV transmission, antiretroviral treatment consisting of zidovudine and lamivudine plus ritonavir-boosted lopinavir resulted in better outcomes than did treatment with zidovudine and lamivudine plus nevirapine. Since nevirapine is used for both treatment and perinatal prevention of HIV infection in resource-limited settings, alternative strategies for the prevention of HIV transmission from mother to child, as well as for the treatment of HIV infection, are urgently required."

If nevirapine is used for prophylaxis it isn’t a good choice for treatment.

For the full abstract, click here.

N Engl J Med 363:1510-152, 14 0October 2010
© 2010 to the Massachusetts Medical Society
Antiretroviral Treatment for Children with Peripartum Nevirapine Exposure. Paul Palumbo, Jane C. Lindsey, Michael D. Hughes, et al. Correspondence to Dr. Palumbo:

Category: B. Blood/Blood Forming Organs/Immune Mechanisms, GH. Global Health. Keywords: HIV, children, nevirapine, peripartum prophylaxis, randomized controlled trial, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 2 November 2010 2010

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