Nevirapine Reuse in Children With HIV May Be Safe

Switch from protease inhibitor-based regimen safe for most children
By Lindsey Marcellin
HealthDay Reporter

WEDNESDAY, Sept. 8 (HealthDay News) -- After achieving viral suppression with protease inhibitor-based therapy, most children infected with HIV at birth despite being given nevirapine may safely be switched back to nevirapine-based therapy without fear of drug resistance, according to a study published in the Sept. 8 issue of the Journal of the American Medical Association.

Ashraf Coovadia, of the Rahima Moosa Mother and Child Hospital in Johannesburg, South Africa, and colleagues conducted a randomized trial of 195 HIV-positive children exposed to nevirapine at birth. Current recommendations are for these children to receive the more expensive ritonavir-boosted lopinavir-based therapy because of fears of nevirapine resistance from previous nevirapine exposure. About half of the children were continued on their usual ritonavir-boosted lopinavir-based therapy with the remainder being switched to nevirapine.

The researchers found that plasma viremia greater than 50 copies/mL was significantly less frequent in the switch group than in the control group. Twenty percent of the switch group, however, experienced breakthrough viremia greater than 1,000 copies/mL; this was strongly related to pretreatment nonnucleoside reverse transcriptase inhibitor mutations and occurred in only 2 percent of the children who maintained their original regimen. In the switch group, poor drug adherence and drug resistance before treatment were associated with confirmed viremia greater than 1,000 copies/mL.

"Our results suggest that a majority of nevirapine-exposed children who are successfully treated with initial regimens based on ritonavir-boosted lopinavir and achieve viral suppression could benefit from the switch strategy, which would allow reductions in costs of pediatric treatment programs," the authors write. "However, switching should only be undertaken with adequate virologic monitoring."

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