Related Experiment Video

Updated: Feb 18, 2026

Rapid Screening of HIV Reverse Transcriptase and Integrase Inhibitors
05:46

Rapid Screening of HIV Reverse Transcriptase and Integrase Inhibitors

Published on: April 9, 2014

18.5K

Discontinuation of Efavirenz in Paediatric Patients: Why do Children Switch?

Elke Wynberg1, Eleri Williams2,3, Gareth Tudor-Williams2,4

  • 1The Family Clinic, Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London, UK. elke.wynberg@stcatz.ox.ac.uk.

Clinical Drug Investigation
|November 29, 2017
PubMed

Insights

Nearly two-thirds of children switched efavirenz treatment due to virological failure or side effects, with most adverse events affecting the central nervous system (CNS). Alternative regimens are recommended for pediatric HIV treatment.

Area of Science:

  • Pediatric HIV/AIDS
  • Antiretroviral Therapy (ART)
  • Pharmacovigilance

Background:

  • Efavirenz is a widely used first-line antiretroviral therapy (ART) for HIV in children and adults.
  • Central nervous system (CNS) adverse effects and treatment discontinuation are significant concerns with efavirenz in adults, but data in children are limited.

Purpose of the Study:

  • To describe the single-center pediatric experience with efavirenz-based ART.
  • To analyze reasons for efavirenz discontinuation in children and adolescents with perinatally acquired HIV.

Main Methods:

  • Retrospective case-note audit of children and adolescents (≤18 years) receiving efavirenz.
  • Data collected on treatment initiation, adverse events, virological failure, and regimen switches.

Main Results:

  • 59% of 51 children switched from efavirenz, with 29% due to virological failure and 30% due to adverse effects.
  • Central nervous system (CNS) adverse effects (sleep disturbance, mood changes, psychosis) were most common, reported by 19.6% of those experiencing side effects.
  • Other adverse events included gynaecomastia, hypercholesterolaemia, and Stevens-Johnson syndrome.

Conclusions:

  • Almost two-thirds of the pediatric cohort switched from efavirenz, driven equally by virological failure and toxicity.
  • CNS adverse effects were the predominant side effects observed.
  • First-line ART regimens with better tolerability and higher genetic barriers to resistance are preferred for pediatric HIV management.
Abstract

More Related Videos

An Affordable HIV-1 Drug Resistance Monitoring Method for Resource Limited Settings19:57

An Affordable HIV-1 Drug Resistance Monitoring Method for Resource Limited Settings

Published on: March 30, 2014

19.4K
Quantitative Structure-Activity Relationship, Activity Prediction, and Molecular Dynamics of Non-nucleotide Reverse Transcriptase Inhibitors10:29

Quantitative Structure-Activity Relationship, Activity Prediction, and Molecular Dynamics of Non-nucleotide Reverse Transcriptase Inhibitors

Published on: May 9, 2025

2.4K

Related Concept Videos

Pharmacokinetics in Pediatric Patients: Drug Excretion01:26

Pharmacokinetics in Pediatric Patients: Drug Excretion

In pediatric medicine, understanding the renal function and drug elimination nuances is crucial for administering safe and effective treatments. Newborns, in particular, display markedly slower renal functions than adults, profoundly affecting how drugs are cleared from their bodies. This slower drug clearance requires clinicians to extend the dosing intervals for many medications to prevent drug accumulation and toxicity while ensuring therapeutic efficacy.One key area where these adjustments...
284
Pharmacokinetics in Pediatric Patients: Drug Metabolism01:24

Pharmacokinetics in Pediatric Patients: Drug Metabolism

In pediatric care, understanding the nuances of hepatic drug metabolism is crucial, as it significantly differs from that of adults. This divergence is primarily due to the developmental stage of drug-metabolizing enzymes, which affects how medications are processed in the body. In neonates, for instance, the activity of Phase I enzymes—critical for the initial breakdown of drugs—is markedly reduced, functioning at just 20–40% of the levels seen in adults. This reduction poses...
257
Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption01:23

Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption

Understanding the physiological differences in the pediatric population is crucial for effective pharmacotherapy. Neonates, infants, and children exhibit significant variations in gastric pH, gastric emptying time, intestinal transit time, and biliary function. These variations profoundly affect oral drug absorption, necessitating a nuanced approach to pediatric dosing.Neonates present with a unique physiological profile, having a gastric pH greater than 4 and faster and more irregular gastric...
324
Pharmacokinetics in Pediatric Patients: Drug Distribution01:17

Pharmacokinetics in Pediatric Patients: Drug Distribution

Drug distribution in the pediatric population exhibits unique challenges and considerations due to the physiological differences between children, particularly neonates and infants, and adults. A crucial aspect of pediatric pharmacology is understanding how these differences impact the pharmacokinetics of various drugs, necessitating age-specific dosing strategies to ensure efficacy and safety.Neonates and infants have a higher total body water content, ~75%–90% of their body weight,...
337
Drug Dosing: Infants and Children01:29

Drug Dosing: Infants and Children

Pediatric patient dosages diverge from adults due to disparities in body surface area, total body water, and extracellular fluid per kilogram of body weight. The dosing regimen considers the variations in pharmacokinetics and pharmacology across distinct age groups, encompassing preterm newborns, infants, young children, older children, and adolescents. Calculation of pediatric patient doses is predicated on determining body surface area, which exhibits a superior correlation with the child's...
341
Factors Affecting Drug Response: Overview01:21

Factors Affecting Drug Response: Overview

When it comes to infants and young children, they are typically administered smaller doses of medication in comparison to adults. This is primarily because their organ functions still need to fully develop, meaning their bodies are not as efficient at metabolizing or eliminating drugs. Additionally, their blood-brain barrier is more permeable than in adults. As a result, high concentrations of drugs can easily penetrate the central nervous system (CNS), potentially leading to neurological...
3.1K