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Two-year outcomes of children on non-nucleoside reverse transcriptase inhibitor and protease inhibitor regimens in a South African pediatric antiretroviral program.
Pediatr Infect Dis J. 2008 Nov; 27(11):993-8.PI

Abstract

BACKGROUND

Few data exist on the efficacy of the limited regimens for children with HIV, which are available in sub-Saharan Africa.

METHODS

Retrospective cohort study to evaluate the clinical and laboratory outcomes of 391 children who received protease inhibitor (PI) or non-nucleoside reverse transcription inhibitor (nNRTI)-containing highly active antiretroviral regimens (HAART) from a Cape Town clinic. Endpoints included CD4% and count, viral loads, weight-for-age Z score (WAZ), survival, drug changes, and loss to follow-up over 24 months. A generalized estimating equation population-averaged model was used to identify associations with virological suppression, and a log-rank test explored associations with survival.

RESULTS

Overall, this cohort achieved a sustained doubling of median CD4% from baseline, steady increase of median WAZ, and survival of 91%, despite only 49% virologic suppression at 24 months. However, when analyzed according to regimen, PI-containing regimens had better virologic suppression at all time points. There were no differences in immunologic and growth endpoints between regimens or in survival. In a multivariate model predicting virologic suppression at any duration up to 24 months and adjusting for baseline CD4%, regimen, age, baseline WAZ, duration of HAART, and year of HAART initiation, nNRTI-based regimens (odds ratio [OR]: 0.38; 95% confidence interval [CI]: 0.19-0.77) and length of time on HAART were inversely associated with virologic suppression. Age (OR: 1.23 per year; 95% CI: 1.09-1.39) was positively associated with virologic suppression.

CONCLUSIONS

The benefits of HAART are substantial in this setting, although PI regimens achieved greater virologic suppression than nNRTIs. Further exploration of regimens and dosing of antiretrovirals for children in these settings is needed.

Authors+Show Affiliations

School of Child and Adolescent Health, University of Cape Town, South Africa. hbjaspan@hotmail.comNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18818556

Citation

Jaspan, Heather B., et al. "Two-year Outcomes of Children On Non-nucleoside Reverse Transcriptase Inhibitor and Protease Inhibitor Regimens in a South African Pediatric Antiretroviral Program." The Pediatric Infectious Disease Journal, vol. 27, no. 11, 2008, pp. 993-8.
Jaspan HB, Berrisford AE, Boulle AM. Two-year outcomes of children on non-nucleoside reverse transcriptase inhibitor and protease inhibitor regimens in a South African pediatric antiretroviral program. Pediatr Infect Dis J. 2008;27(11):993-8.
Jaspan, H. B., Berrisford, A. E., & Boulle, A. M. (2008). Two-year outcomes of children on non-nucleoside reverse transcriptase inhibitor and protease inhibitor regimens in a South African pediatric antiretroviral program. The Pediatric Infectious Disease Journal, 27(11), 993-8. https://doi.org/10.1097/INF.0b013e31817acf7b
Jaspan HB, Berrisford AE, Boulle AM. Two-year Outcomes of Children On Non-nucleoside Reverse Transcriptase Inhibitor and Protease Inhibitor Regimens in a South African Pediatric Antiretroviral Program. Pediatr Infect Dis J. 2008;27(11):993-8. PubMed PMID: 18818556.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Two-year outcomes of children on non-nucleoside reverse transcriptase inhibitor and protease inhibitor regimens in a South African pediatric antiretroviral program. AU - Jaspan,Heather B, AU - Berrisford,Alison E, AU - Boulle,Andrew M, PY - 2008/9/27/pubmed PY - 2008/12/17/medline PY - 2008/9/27/entrez SP - 993 EP - 8 JF - The Pediatric infectious disease journal JO - Pediatr Infect Dis J VL - 27 IS - 11 N2 - BACKGROUND: Few data exist on the efficacy of the limited regimens for children with HIV, which are available in sub-Saharan Africa. METHODS: Retrospective cohort study to evaluate the clinical and laboratory outcomes of 391 children who received protease inhibitor (PI) or non-nucleoside reverse transcription inhibitor (nNRTI)-containing highly active antiretroviral regimens (HAART) from a Cape Town clinic. Endpoints included CD4% and count, viral loads, weight-for-age Z score (WAZ), survival, drug changes, and loss to follow-up over 24 months. A generalized estimating equation population-averaged model was used to identify associations with virological suppression, and a log-rank test explored associations with survival. RESULTS: Overall, this cohort achieved a sustained doubling of median CD4% from baseline, steady increase of median WAZ, and survival of 91%, despite only 49% virologic suppression at 24 months. However, when analyzed according to regimen, PI-containing regimens had better virologic suppression at all time points. There were no differences in immunologic and growth endpoints between regimens or in survival. In a multivariate model predicting virologic suppression at any duration up to 24 months and adjusting for baseline CD4%, regimen, age, baseline WAZ, duration of HAART, and year of HAART initiation, nNRTI-based regimens (odds ratio [OR]: 0.38; 95% confidence interval [CI]: 0.19-0.77) and length of time on HAART were inversely associated with virologic suppression. Age (OR: 1.23 per year; 95% CI: 1.09-1.39) was positively associated with virologic suppression. CONCLUSIONS: The benefits of HAART are substantial in this setting, although PI regimens achieved greater virologic suppression than nNRTIs. Further exploration of regimens and dosing of antiretrovirals for children in these settings is needed. SN - 0891-3668 UR - https://www.unboundmedicine.com/medline/citation/18818556/Two_year_outcomes_of_children_on_non_nucleoside_reverse_transcriptase_inhibitor_and_protease_inhibitor_regimens_in_a_South_African_pediatric_antiretroviral_program_ L2 - https://doi.org/10.1097/INF.0b013e31817acf7b DB - PRIME DP - Unbound Medicine ER -