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Antiretroviral treatment for children with peripartum nevirapine exposure

Paul Palumbo1, Jane C Lindsey, Michael D Hughes

  • 1Department of Medicine, Dartmouth Medical School, Lebanon, NH 03765, USA. paul.e.palumbo@dartmouth.edu

The New England Journal of Medicine
|October 15, 2010
PubMed

Insights

For children with HIV exposed to nevirapine prophylaxis, zidovudine and lamivudine plus ritonavir-boosted lopinavir showed better outcomes than nevirapine. New prevention and treatment strategies are needed.

Area of Science:

  • Pediatric infectious diseases
  • HIV/AIDS treatment and prevention
  • Antiretroviral therapy

Background:

  • Single-dose nevirapine is standard for preventing mother-to-child HIV transmission in resource-limited settings.
  • Nevirapine resistance is common in children receiving prophylaxis.
  • Optimal treatment for children with prior nevirapine exposure is unknown.

Purpose of the Study:

  • To compare the efficacy of two antiretroviral regimens in HIV-infected children with prior exposure to single-dose nevirapine.
  • To evaluate virologic failure and treatment discontinuation rates.
  • To inform treatment guidelines for this vulnerable population.

Main Methods:

  • A randomized trial was conducted in six African countries involving HIV-infected children aged 6-36 months.
  • Children received initial therapy with zidovudine and lamivudine plus either nevirapine or ritonavir-boosted lopinavir.
  • The primary endpoint was virologic failure or treatment discontinuation by week 24; enrollment was terminated early.

Main Results:

  • 164 children were enrolled, with a median CD4+ count of 19% and 56% having WHO stage 3 or 4 disease.
  • Higher rates of virologic failure or discontinuation occurred with nevirapine compared to ritonavir-boosted lopinavir (39.6% vs. 21.7%).
  • Baseline nevirapine resistance (12%) predicted treatment failure; adverse events were similar between groups.

Conclusions:

  • Ritonavir-boosted lopinavir combined with zidovudine and lamivudine demonstrated superior outcomes compared to nevirapine in HIV-infected children with prior nevirapine exposure.
  • The findings highlight the urgent need for alternative strategies for both HIV prevention and treatment in resource-limited settings.
  • Current nevirapine use for both prophylaxis and treatment necessitates re-evaluation of global HIV management protocols.
Abstract

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