Featured Research

from universities, journals, and other organizations

Nevirapine use may be beneficial for some HIV-infected children who have achieved viral suppression

Date:
September 7, 2010
Source:
JAMA and Archives Journals
Summary:
HIV-infected children in South Africa who were exposed to the drug nevirapine at birth (used to help prevent mother-to-child HIV transmission) and then received a protease inhibitor (PI) for viral suppression achieved lower rates of viremia (virus in the blood stream) if they were switched to nevirapine, compared to children who continued on the PI-based regimen, according to a new study.

HIV-infected children in South Africa who were exposed to the drug nevirapine at birth (used to help prevent mother-to-child HIV transmission) and then received a protease inhibitor (PI) for viral suppression achieved lower rates of viremia (virus in the blood stream) if they were switched to nevirapine, compared to children who continued on the PI-based regimen, according to a study in the September 8 issue of JAMA. PI-based therapies generally have a higher cost compared to nevirapine, which may leave some children excluded from treatment.

Current guidelines for nevirapine-exposed (at birth) infants advise that treatment be initiated with regimens based on ritonavir-boosted lopinavir. There are many limitations of continuing to use PI-based regimens indefinitely in young children, including its unpleasant taste (which poses adherence challenges for children too young to be prescribed tablets); concerns about metabolic toxicities with long-term use during critical periods of child development; and high cost, a major disincentive to implementing optimal primary therapy recommendations in several sub-Saharan African countries, according to background information in the article.

Ashraf Coovadia, M. B. Ch. B., of the University of the Witwatersrand, Johannesburg, South Africa, and colleagues conducted a clinical trial to examine whether nevirapine-based therapy would be as effective as ritonavir-boosted lopinavir in maintaining viral suppression among nevirapine-exposed children if only initiated once viral suppression had been achieved with the initial PI-based regimen. The trial was conducted between April 2005 and May 2009 at a hospital in Johannesburg among 195 children who achieved viral suppression of less than 400 copies/mL for 3 or more months from a group of 323 nevirapine-exposed children who initiated PI-based therapy before 24 months of age. Control group children continued to receive ritonavir-boosted lopinavir, stavudine, and lamivudine (n = 99). Among the children that switched therapies, nevirapine was substituted for ritonavir-boosted lopinavir (n = 96). Children were followed up for 52 weeks after randomization.

The researchers found that there was better virologic suppression in the switch group than the control group, based on a primary end point of plasma viremia of more than 50 copies/mL. Confirmed viremia of more than 1,000 copies/mL (a safety end point) was more common among children in the switch group than the control group.

"CD4 cell response was better in the switch group. Older age was associated with viremia greater than 50 copies/mL in the control group. Inadequate adherence and drug resistance before treatment were associated with confirmed viremia greater than 1,000 copies/mL in the switch group," the authors write.

"Guidelines now recommend starting treatment among all HIV-infected infants as soon as possible after diagnosis following a trial demonstrating better outcomes if treatment is initiated immediately rather than waiting until standard prognostic indicators are reached. Thus, large numbers of HIV-infected infants should be initiating ritonavir-boosted lopinavir-based treatment, but the high cost of this regimen poses a barrier in many low-resource settings."

"Our results suggest that a majority of nevirapine-exposed children who are successfully treated with initial regimens based on ritonavir-boosted lopinavir and achieve viral suppression could benefit from the switch strategy, which would allow reductions in costs of pediatric treatment programs. However, switching should only be undertaken with adequate virologic monitoring. Although the value of virologic monitoring in HIV treatment is strongly emphasized in well-resourced settings, most programs in low-resource settings do not include it as part of routine services because of cost. Simple algorithms could be developed for targeted virologic testing to safely implement the switch strategy," the authors conclude.


Story Source:

The above story is based on materials provided by JAMA and Archives Journals. Note: Materials may be edited for content and length.


Journal Reference:

  1. Coovadia et al. Reuse of Nevirapine in Exposed HIV-Infected Children After Protease Inhibitor-Based Viral Suppression: A Randomized Controlled Trial. JAMA The Journal of the American Medical Association, 2010; 304 (10): 1082 DOI: 10.1001/jama.2010.1278

Cite This Page:

JAMA and Archives Journals. "Nevirapine use may be beneficial for some HIV-infected children who have achieved viral suppression." ScienceDaily. ScienceDaily, 7 September 2010. <www.sciencedaily.com/releases/2010/09/100907163327.htm>.
JAMA and Archives Journals. (2010, September 7). Nevirapine use may be beneficial for some HIV-infected children who have achieved viral suppression. ScienceDaily. Retrieved April 19, 2014 from www.sciencedaily.com/releases/2010/09/100907163327.htm
JAMA and Archives Journals. "Nevirapine use may be beneficial for some HIV-infected children who have achieved viral suppression." ScienceDaily. www.sciencedaily.com/releases/2010/09/100907163327.htm (accessed April 19, 2014).

Share This



More Health & Medicine News

Saturday, April 19, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

'Holy Grail' Of Weight Loss? New Find Could Be It

'Holy Grail' Of Weight Loss? New Find Could Be It

Newsy (Apr. 18, 2014) In a potential breakthrough for future obesity treatments, scientists have used MRI scans to pinpoint brown fat in a living adult for the first time. Video provided by Newsy
Powered by NewsLook.com
Little Progress Made In Fighting Food Poisoning, CDC Says

Little Progress Made In Fighting Food Poisoning, CDC Says

Newsy (Apr. 18, 2014) A new report shows rates of two foodborne infections increased in the U.S. in recent years, while salmonella actually dropped 9 percent. Video provided by Newsy
Powered by NewsLook.com
Scientists Create Stem Cells From Adult Skin Cells

Scientists Create Stem Cells From Adult Skin Cells

Newsy (Apr. 17, 2014) The breakthrough could mean a cure for some serious diseases and even the possibility of human cloning, but it's all still a way off. Video provided by Newsy
Powered by NewsLook.com
Obama: 8 Million Healthcare Signups

Obama: 8 Million Healthcare Signups

AP (Apr. 17, 2014) President Barack Obama gave a briefing Thursday announcing 8 million people have signed up under the Affordable Care Act. He blasted continued Republican efforts to repeal the law. (April 17) Video provided by AP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins