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Choice of antiretroviral drugs for postexposure prophylaxis for children: a systematic review.
Clin Infect Dis. 2015 Jun 01; 60 Suppl 3:S177-81.CI

Abstract

BACKGROUND

This systematic review aimed to assess the safety and efficacy of antiretroviral options for postexposure prophylaxis (PEP). Recognizing the limited data on the safety and efficacy of antiretroviral drugs for PEP in children, this review was extended to include consideration of data on the use of antiretroviral drugs for treatment of infants and children living with human immunodeficiency virus.

METHODS

The PEP literature was assessed to identify studies reporting safety and completion rates for children given PEP, and this information was complemented by safety and efficacy data for drugs used in antiretroviral therapy. The proportion of patients experiencing each outcome was calculated and data were pooled using random-effects meta-analysis.

RESULTS

Three prospective cohort studies reported outcomes of children given zidovudine (ZDV) plus lamivudine (3TC) as a 2-drug PEP regimen. The proportion of children completing the full 28-day course of PEP was 64.0% (95% confidence interval [CI], 41.2%-86.8%), whereas the proportion discontinuing due to adverse events was 4.5% (95% CI, .4%-8.6%). One randomized trial compared abacavir (ABC) plus lamivudine (3TC) and ZDV+3TC as part of a dual or triple first-line antiretroviral therapy regimen; this study showed better efficacy in the ABC-containing combinations and no difference in the time to first serious adverse event. Three randomized trials compared lopinavir/ritonavir (LPV/r) to nevirapine (NVP) for antiretroviral therapy and showed a lower risk of treatment discontinuations associated with LPV/r vs NVP (hazard ratio, 0.56 [95% CI, .41-.75]) but no difference in drug-related adverse events. The overall quality of the evidence was rated as very low.

CONCLUSIONS

This review supports ZDV+3TC+LPV/r as the preferred 3-drug regimen for PEP in children.

Authors+Show Affiliations

Department of HIV/AIDS, World Health Organization, Geneva, Switzerland.Division of HIV/AIDS Prevention, US Centers for Disease Control and Prevention, Atlanta, Georgia.Division of Paediatric Infectious Diseases, Department of Pediatrics and Child Health, Stellenbosch University and Tygerberg Children's Hospital, Cape Town, South Africa.Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda.Department of HIV/AIDS, World Health Organization, Geneva, Switzerland.

Pub Type(s)

Journal Article
Review
Systematic Review

Language

eng

PubMed ID

25972500

Citation

Penazzato, Martina, et al. "Choice of Antiretroviral Drugs for Postexposure Prophylaxis for Children: a Systematic Review." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 60 Suppl 3, 2015, pp. S177-81.
Penazzato M, Dominguez K, Cotton M, et al. Choice of antiretroviral drugs for postexposure prophylaxis for children: a systematic review. Clin Infect Dis. 2015;60 Suppl 3:S177-81.
Penazzato, M., Dominguez, K., Cotton, M., Barlow-Mosha, L., & Ford, N. (2015). Choice of antiretroviral drugs for postexposure prophylaxis for children: a systematic review. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 60 Suppl 3, S177-81. https://doi.org/10.1093/cid/civ110
Penazzato M, et al. Choice of Antiretroviral Drugs for Postexposure Prophylaxis for Children: a Systematic Review. Clin Infect Dis. 2015 Jun 1;60 Suppl 3:S177-81. PubMed PMID: 25972500.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Choice of antiretroviral drugs for postexposure prophylaxis for children: a systematic review. AU - Penazzato,Martina, AU - Dominguez,Ken, AU - Cotton,Mark, AU - Barlow-Mosha,Linda, AU - Ford,Nathan, PY - 2015/5/15/entrez PY - 2015/5/15/pubmed PY - 2016/2/5/medline KW - antiretroviral KW - children KW - postexposure prophylaxis KW - safety KW - tolerability SP - S177 EP - 81 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin Infect Dis VL - 60 Suppl 3 N2 - BACKGROUND: This systematic review aimed to assess the safety and efficacy of antiretroviral options for postexposure prophylaxis (PEP). Recognizing the limited data on the safety and efficacy of antiretroviral drugs for PEP in children, this review was extended to include consideration of data on the use of antiretroviral drugs for treatment of infants and children living with human immunodeficiency virus. METHODS: The PEP literature was assessed to identify studies reporting safety and completion rates for children given PEP, and this information was complemented by safety and efficacy data for drugs used in antiretroviral therapy. The proportion of patients experiencing each outcome was calculated and data were pooled using random-effects meta-analysis. RESULTS: Three prospective cohort studies reported outcomes of children given zidovudine (ZDV) plus lamivudine (3TC) as a 2-drug PEP regimen. The proportion of children completing the full 28-day course of PEP was 64.0% (95% confidence interval [CI], 41.2%-86.8%), whereas the proportion discontinuing due to adverse events was 4.5% (95% CI, .4%-8.6%). One randomized trial compared abacavir (ABC) plus lamivudine (3TC) and ZDV+3TC as part of a dual or triple first-line antiretroviral therapy regimen; this study showed better efficacy in the ABC-containing combinations and no difference in the time to first serious adverse event. Three randomized trials compared lopinavir/ritonavir (LPV/r) to nevirapine (NVP) for antiretroviral therapy and showed a lower risk of treatment discontinuations associated with LPV/r vs NVP (hazard ratio, 0.56 [95% CI, .41-.75]) but no difference in drug-related adverse events. The overall quality of the evidence was rated as very low. CONCLUSIONS: This review supports ZDV+3TC+LPV/r as the preferred 3-drug regimen for PEP in children. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/25972500/Choice_of_antiretroviral_drugs_for_postexposure_prophylaxis_for_children:_a_systematic_review_ L2 - https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/civ110 DB - PRIME DP - Unbound Medicine ER -