Switch to efavirenz unlikely to cause drug resistance, NIH-funded study suggests
HIV-infected children exposed in the womb to nevirapine, a drug used to prevent mother-to-child HIV transmission, can safely and effectively transition to efavirenz, a similar drug recommended for older children and adults, according to a study funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), part of the National Institutes of Health.
Efavirenz is used as part of HIV therapy for adults and children older than three years of age. A different class of anti-HIV drugs, lopinavir/ritonavir, is recommended for infants and young children. Switching children to efavirenz offers several advantages, including once-daily dosing, easier storage, better taste, and lower cost. Prior to the new study, however, doctors lacked guidance on when to switch to efavirenz. There also was concern that efavirenz may be less effective in children exposed to nevirapine because the drugs attack HIV in similar ways, leading to potential drug resistance.
Researchers led by Louise Kuhn, Ph.D., of Columbia University, conducted a randomized clinical trial in Johannesburg, South Africa, to evaluate whether or not nevirapine-exposed children, who have their infection under control, can transition to efavirenz without risk of the virus rebounding and becoming detectable in blood. Approximately 300 boys and girls at least 3 years old were followed for 48 weeks, with half continuing on lopinavir/ritonavir and the other half switching to efavirenz.
The team found that both groups of children had similar rates of viral rebound—26 in the efavirenz group and 42 in the lopinavir/ritonavir group, suggesting that switching to efavirenz is effective. Furthermore, the efavirenz group had higher levels of CD4 T cells, key immune cells wiped out by HIV, and better liver function, suggesting that efavirenz is less toxic and safer than lopinavir/ritonavir. The researchers are currently conducting a follow-up study to evaluate the long-term effects of switching to efavirenz.
Coovadia A et al. Efavirenz-Based Antiretroviral Therapy Among Nevirapine-Exposed HIV-Infected Children in South Africa: A Randomized Clinical Trial. JAMA DOI: 10.1001/jama.2015.13631
Rohan Hazra, M.D., chief of NICHD's Maternal and Pediatric Infectious Disease Branch, is available to discuss the study.
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About the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD): The NICHD sponsors research on development, before and after birth; maternal, child, and family health; reproductive biology and population issues; and medical rehabilitation. For more information, visit the Institute's website at http://www.nichd.nih.gov/.
About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit http://www.nih.gov.