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Lamivudine monotherapy as a holding regimen for HIV-positive children

Gabriela Patten1, Jonathan Bernheimer2, Lee Fairlie3

  • 1Centre for Infectious Disease Epidemiology & Research, University of Cape Town, Cape Town, South Africa.

Plos One
|October 12, 2018
PubMed

Insights

Lamivudine monotherapy (LM) in HIV-positive children on combination antiretroviral therapy (cART) often leads to immune decline. Restricted use is advised, especially for children with low CD4 counts, due to limited treatment options.

Area of Science:

  • Pediatric infectious diseases
  • HIV/AIDS management
  • Pharmacological outcomes in children

Background:

  • Resource-limited settings often use lamivudine monotherapy (LM) for HIV-positive children failing combination antiretroviral therapy (cART).
  • LM is employed to mitigate drug resistance and manage adherence issues or restricted access to second- or third-line regimens.
  • This study investigates the characteristics and outcomes of children managed with LM.

Purpose of the Study:

  • To characterize children initiated on lamivudine monotherapy (LM) for HIV treatment failure.
  • To evaluate the immunologic and virologic outcomes of children on LM and after resuming combination antiretroviral therapy (cART).

Main Methods:

  • Analysis of data from 5 IeDEA-SA cohorts, including 228 children under 16 years at cART start.
  • Assessment of immunologic outcomes (CD4 counts) during LM (for >90 days) and after resuming cART.
  • Evaluation of virologic outcomes (viral load) after resuming cART.

Main Results:

  • Children on LM experienced a median CD4 count decline of 46.5 cells/μL over 6 months, with 46% dropping below 500 cells/μL.
  • 8% experienced WHO stage 3 or 4 events, and 3 deaths occurred during LM.
  • Upon resuming cART, children gained an average of 15.65 CD4 cells/μL per month, with 66.6% achieving viral suppression (<1000 copies/mL) within 6 months.

Conclusions:

  • Lamivudine monotherapy (LM) is associated with significant immune decline in HIV-positive children.
  • LM should be avoided in children with low CD4 counts but may be a necessary option when treatment alternatives are limited.
  • Improved treatment options and adherence strategies are crucial for managing children with virologic failure on cART.
Abstract

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