A New Treatment Option for HIV in Kids

Efavirenz-based antiretroviral therapy may effectively treat HIV in children who achieved viral suppression

/ Author:  / Reviewed by: Jennifer Gershman, PharmD, CPh

(RxWiki News) In the fight against human immunodeficiency virus (HIV), one treatment may be safer than previously thought.

A new study from Columbia University found that HIV-infected children in South Africa who had already achieved viral suppression with one antiretroviral treatment (ritonavir-boosted lopinavir-based therapy) may be able to safely switch to the recommended treatment (efavirenz-based therapy) without risking viral rebound or failure.

"There is little guidance available as to what clinicians ought to do when confronted with a child older than 3 years who has begun treatment with ritonavir-boosted lopinavir," wrote study author Louise Kuhn, PhD, an epidemiologist at Columbia, and colleagues. "This study provides evidence to support the safety and efficacy of switching to efavirenz, the recommended drug for children older than 3 years, among children with viral suppression."

HIV is a virus that gradually attacks the immune system. Unlike some other viruses, the body cannot get rid of HIV.

The HIV virus is transmitted via the bodily fluids of an infected person. Although the most common way for someone to become infected is during sex, HIV can also be passed from mother to child during pregnancy, birth or breastfeeding.

If left untreated, HIV can eventually lead to acquired immunodeficiency syndrome (AIDS). AIDS is the last stage of HIV infection, in which the body can no longer defend itself against disease.

While there is currently no cure for HIV or AIDS, with early diagnosis and effective antiretroviral treatment, patients with HIV can lead relatively normal lives.

For infants and young children, ritonavir-boosted lopinavir-based therapy is the first-line treatment option for HIV infection. For adults and older children, however, efavirenz-based therapy is recommended.

For this study, Dr. Kuhn looked at 300 HIV-infected children age 3 or older who were previously exposed to nevirapine for the prevention of mother-to-child HIV transmission and who had achieved viral suppression while on ritonavir-boosted lopinavir-based therapy.

Nevirapine (brand name Viramune) is a prescription drug used to prevent and treat HIV infection. There have recently been concerns about potential reduced effectiveness of efavirenz-based therapy in children previously exposed to nevirapine.

The children in this study were randomly assigned to either switch to efavirenz-based therapy or to continue ritonavir-boosted lopinavir-based therapy. A follow-up was conducted after 48 weeks.

Dr. Kuhn and team found that switching to efavirenz-based therapy did not result in significantly higher rates of viral rebound or viral failure compared to continuing ritonavir-boosted lopinavir-based therapy.

According to Dr. Kuhn and team, the implementation of antiretroviral treatment programs in the South African region has rapidly transformed childhood HIV infection from a fatal disease into a chronic condition.

This study was published Nov. 3 in the journal JAMA.

The Eunice Kennedy Shriver National Institute of Child Health and Human Development funded this research. No conflicts of interest were disclosed.

Review Date: 
November 2, 2015
Last Updated:
November 3, 2015