{"id":29369,"date":"2015-12-01T12:19:56","date_gmt":"2015-12-01T12:19:56","guid":{"rendered":"http:\/\/i-base.info\/htb\/?p=29369"},"modified":"2015-12-01T16:31:59","modified_gmt":"2015-12-01T16:31:59","slug":"substituting-lopinavirritonavir-with-efavirenz-in-children-on-stable-art","status":"publish","type":"post","link":"https:\/\/i-base.info\/htb\/29369","title":{"rendered":"Substituting lopinavir\/ritonavir with efavirenz in children on stable ART"},"content":{"rendered":"

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

Virologic outcomes in children who were suppressed on lopinavir\/ritonavir (LPV\/r)-based ART and switched to efavirenz (EFV) were no worse than for those who remained on LPV\/r, in a South African retrospective cohort study.<\/strong><\/p>\n

These findings from the IeDEA cohort were presented at the 7th International Workshop on HIV Pediatrics in Vancouver.<\/p>\n

In 2013 World Health Organisation (WHO) guidelines added the option to substitute LPV\/r with EFV in children who had started with LPV\/r-based ART and had sustained virologic suppression. The evidence for this recommendation was mainly from the NEVEREST studies.<\/p>\n

The IeDEA study compared outcomes between virologically suppressed children aged three years and above who switched to EFV or stayed on LPV\/r in a routine clinical setting.<\/p>\n

Of 690 children, 36 substituted EFV at a median of 44.1 months old. The median follow up time was 25.8 months (15 to 34.2) and 24.4 months (18.1 to 31.7) in the substitution and stay groups respectively.<\/p>\n

At ART initiation, the children in the two groups were well matched, for age, CD4 percentage, weight-for-age z-score, WHO stage and viral load and at 42 months.<\/p>\n

Remaining on LPV\/r (stay group) was negatively associated with viral blip (an isolated viral load result >1000 copies\/mL that returned to <400 copies\/mL at next measurement) at 42 months. Blips occurred in 318 (48.6%) children in the stay group compared with 10 (27.8%) in the substitution group, p=0.015.<\/p>\n

Factors associated with EFV substitution included: favourable clinical response to ART, adjusted OR per 1 weight-for-age z-score increase 1.34 (95% CI:0.96 to 1.80); and viral blips adjusted OR 0.34 (95% CI: 0.15 to 0.79).<\/p>\n

Comment<\/h3>\n

Clearly the success of this strategy depends on access to viral load testing for widespread implementation.<\/strong><\/p>\n

References:<\/p>\n

    \n
  1. Reichmuth K et al. Virologic outcomes of children switched from lopinavir\/ritonavir to efavirenz-based treatment: a retrospective cohort study. 7th International Workshop on HIV Paediatrics, 17-18 July, Vancouver, Canada. Oral abstract 1.
    \n    http:\/\/regist2.virology-education.com\/2015\/7hivped\/05_Reichmuth.pdf<\/a><\/li>\n
  2. Bienczak et al. The effect of systematic exposure to efavirenz, sex and age on the risk of virological non-suppression in HIV-infected African children. 7th International Workshop on HIV Pediatrics, 17-18 July, Vancouver, Canada. Oral abstract 2.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    Polly Clayden, HIV i-Base Virologic outcomes in children who were suppressed on lopinavir\/ritonavir (LPV\/r)-based ART and switched to efavirenz (EFV) were no worse than for those who remained on LPV\/r, in a South African retrospective cohort study. These findings from …<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4,3,32],"tags":[214],"class_list":["post-29369","post","type-post","status-publish","format-standard","hentry","category-conference-reports","category-antiretrovirals","category-paediatric-care","tag-paediatric-workshop-7-vancouver-2015"],"_links":{"self":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/29369","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\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/comments?post=29369"}],"version-history":[{"count":0,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/29369\/revisions"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/media?parent=29369"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/categories?post=29369"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/tags?post=29369"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}