{"id":1638,"date":"2009-06-03T09:11:42","date_gmt":"2009-06-03T08:11:42","guid":{"rendered":"http:\/\/localhost.localdomain\/wpmu\/htb\/?p=1638"},"modified":"2013-08-16T13:46:44","modified_gmt":"2013-08-16T13:46:44","slug":"pi-based-art-in-hiv-infected-and-hivtb-coinfected-children-in-south-africa","status":"publish","type":"post","link":"https:\/\/i-base.info\/htb\/1638","title":{"rendered":"PI-based ART in children with HIV and HIV\/TB coinfection in South Africa"},"content":{"rendered":"

Polly Clayden, HIV i-Base<\/strong><\/p>\n

South African HIV guidelines recommend PI-based regimens for children <3 years old. Young children mostly receive lopinavir\/ritonavir (LPV\/r) but in some cases full-dose ritonavir (RTV) is used if a child is also being treated for TB.<\/strong><\/p>\n

Cordula Reitz and co-workers evaluated factors associated with virologic suppression among children receiving protease inhibitors in Johannesburg in the NEVEREST study.<\/p>\n

NEVERST enrolled HIV-infected children who had been perinatally exposed to nevirapine (NVP). Children age >6 months to 24 months received LPV\/r based ART and children less than 6 months old or receiving TB treatment (rifampicin\/isoniziazid for 6 months + pyrazinamide for 2 months) received RTV-based ART. All children received d4T+3TC.<\/p>\n

Viral suppression was defined as reducing viral load to <400 copies\/mL. Kaplan Meier methods were used to calculate the probability of achieving viral suppression at 9 months or death.<\/p>\n

This analysis included 254 children with a median age of 8.75 months (IQR 5.18-13.8), median CD4 percentage 18.95% (IQR 12.8-24.5) and 80.2% were WHO stage III or IV.<\/p>\n

Of these, 138 (54.3%) children started ART with a LPV\/r-based regimen and 116 (45.7%) a RTV-based regimen. 54 (46.6%) were <6 months old and 62 (54.3%) were receiving TB treatment (by 9 months an additional 37 [14.6%] children began TB treatment).<\/p>\n

The investigators reported an overall mortality rate of 14%. Higher mortality was significantly associated with younger age <12 months vs >12 months [AHR 2.9, 95%CI 1.1-7.8], pre-treatment weight for age z-score (WAZ) <-4 vs >-2 [AHR 3.3; 95%CI 1.4-8.2] and higher pre treatment viral load >750,000 copies\/mL vs <100,000 copies\/mL [AHR 3.1; 95%CI 0.4-23.5.<\/p>\n

The probability of viral suppression (<400 copies\/mL) was 83.7% at 9 months after starting ART. Children receiving TB treatment were less likely to achieve viral suppression than children never treated for TB, 78.3% vs 94.1% respectively.<\/p>\n

The overall probability of viral rebound at 4 months was 17.6%. Only TB treatment was associated with viral rebound; 8\/15 (53.3%) children who started TB treatment after ART and achieved viral suppression had viral rebound compared to 12% without TB and 2.8% probability among those who started TB treatment before ART, p<0.0001 [AHR 5.2; 95% CI 2.1-12.9].<\/p>\n

Although the researchers reported high rates of viral suppression among children <2 years they wrote; \u0093How best to treat HIV-infected children who require TB treatment remains an unsolved problem. There is an urgent need to further evaluate the pharmacokinetics and clinical outcomes in children co-treated for these two diseases so that evidence-based recommendations can be made.\u0094<\/p>\n

Comment<\/h3>\n

Once again, we need more PK data in younger children and better PI formulations.<\/strong><\/p>\n

Reference:<\/p>\n

Reitz et al. Virologic Response to protease inhibitor-based ART among children younger than 2 Years of age co-treated for TB in South Africa. 16th CROI, February 2009, Montreal, Canada. Abstract 910.
\nhttp:\/\/www.retroconference.org\/2009\/Abstracts\/34444.htm<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Polly Clayden, HIV i-Base South African HIV guidelines recommend PI-based regimens for children <3 years old. Young children mostly receive lopinavir\/ritonavir (LPV\/r) but in some cases full-dose ritonavir (RTV) is used if a child is also being treated for TB. …<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4,32,37],"tags":[63],"class_list":["post-1638","post","type-post","status-publish","format-standard","hentry","category-conference-reports","category-paediatric-care","category-tb-coinfection","tag-croi-2009"],"_links":{"self":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/1638","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/comments?post=1638"}],"version-history":[{"count":0,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/1638\/revisions"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/media?parent=1638"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/categories?post=1638"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/tags?post=1638"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}