Different Antiretroviral Drugs Found Effective in Children

Delaying switch to second-line drugs does not seem to impact long-term viral load outcomes

THURSDAY, Feb. 3 (HealthDay News) -- Protease inhibitors (PIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs) appear to be equally effective as part of first-line treatment for HIV-infected children, and delaying the switch to second-line drugs has minimal impact on long-term viral load outcomes, according to a study published online Feb. 1 in The Lancet Infectious Diseases.

In the PENPACT-1 study, the researchers randomized 266 children from 68 clinics across 13 countries to begin treatment with two nucleoside reverse transcriptase inhibitors (NRTIs) plus one of four options: a PI and then switch to second-line antiretroviral therapy (ART) when viral load increased to 1,000 copies per mL; a PI and then delay switching until viral load reached 30,000 copies per mL; an NNRTI and switch at 1,000 copies per mL; or an NNRTI and switch at 30,000 copies per mL.

The investigators found that the proportion of children with viral load less than 400 copies per mL was similar between PI and NNRTI-based ART after four years of treatment. The investigators also found no difference in viral load between those who switched to second-line treatment at 1,000 copies per mL and those who switched at 30,000 copies per mL. The level of drug resistance to PIs and NNRTIs was similar between the early and delayed switch groups. Compared to those on PI-based ART, children starting with NNRTI-based treatment were more likely to develop resistance to NRTIs over five years if switching treatment was delayed until viral load levels reached 30,000 copies per mL.

"Delaying switching until viral-load levels are 30,000 copies per mL results in accumulation of more NRTI resistance mutations with NNRTI-combination therapy compared with switching at 1,000 copies per mL; conversely, for children on ART based on PIs, the absence of a difference in the NRTI and PI resistance suggests that delayed switching might be reasonable in circumstances and settings where future drug options are limited," the authors write.

Several authors disclosed financial relationships with pharmaceutical companies.

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