401. Optimization of antiretroviral therapy in HIV-infected children and adolescents: systematic review and meta-analysis to inform 2015 WHO guidelines
Session: Poster Abstract Session: HIV Engagement in Care and the Care Cascade
Thursday, October 8, 2015
Room: Poster Hall
Background: Evidence-based guidance for treating pediatric HIV is critical to scale up treatment and reduce related morbidity and mortality. Our objective was to synthesize data from randomized trials that compare antiretroviral therapy (ART) strategies among pediatric HIV patients. This review is an update of the Cochrane review published in 2012, which was restricted to children aged <3 years; this review has no such age restriction.

Methods: The Cochrane HIV/AIDS Review Group Trials register, the Cochrane library, PubMed, EMBASE and CENTRAL were searched in February 2015. Titles, abstracts, and full-text articles were screened using a priori criteria. Study-level effects were synthesized by meta-analysis. 

Results: Of 910 records identified in the published literature since 2012, no additional trials were found. Three additional trials were included from conference proceedings and one additional trial was included from the pre-2012 literature. Study authors were contacted for unpublished data, as needed. In children aged >3 years, there was no difference in the hazard for treatment failure between NNRTI (non-nucleoside reverse transcriptase inhibitor) and PI (protease inhibitor)–based regimens (HR 0.99, 95% CI 0.36–2.73). In addition, there was no difference in efficacy and toxicity between abacavir (ABC) and zidovudine (AZT) among ART-naïve children. Children initially virologically suppressed on a ritonavir-boosted lopinavir (LPV/r)-based regimen who were switched to an NNRTI—either nevirapine (NVP) or efavirenz EFV)—were less likely to develop virological failure (>50 copies/mL), compared with children staying on LPV/r (NVP: HR 0.62, 95% CI 0.41–0.92; EFV: HR 0.58, 95% CI 0.36–0.95).

Conclusion: Among children aged >3 years, PIs appear comparable to NNRTIs in children in terms of efficacy. There was no difference in efficacy or toxicity between ABC or AZT. Substitution of LPV/r with either NVP or EFV remains an alternative to continuing LPV/r among young children. These findings support existing WHO recommendations from 2013.

Brian Chang, BA, BS1, Mohsin Ali, MPhil1, Nandita Sugandhi, MD2, Andrew Prendergast, DPhil3 and Martina Penazzato, MD, PhD4, (1)Icahn School of Medicine at Mount Sinai, New York, NY, (2)Clinton Health Access Initiative, Boston, MA, (3)Centre for Paediatrics, Blizard Institute, Queen Mary University of London, London, United Kingdom, (4)World Health Organization, Geneva, Switzerland


B. Chang, None

M. Ali, None

N. Sugandhi, None

A. Prendergast, None

M. Penazzato, None

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