Switching to Efavirenz Versus Remaining on Ritonavir-boosted Lopinavir in Human Immunodeficiency Virus-infected Children Exposed to Nevirapine: Long-term Outcomes of a Randomized Trial.
Identifieur interne : 000E36 ( PubMed/Corpus ); précédent : 000E35; suivant : 000E37Switching to Efavirenz Versus Remaining on Ritonavir-boosted Lopinavir in Human Immunodeficiency Virus-infected Children Exposed to Nevirapine: Long-term Outcomes of a Randomized Trial.
Auteurs : Pamela M. Murnane ; Renate Strehlau ; Stephanie Shiau ; Faeezah Patel ; Ndileke Mbete ; Gillian Hunt ; Elaine J. Abrams ; Ashraf Coovadia ; Louise KuhnSource :
- Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [ 1537-6591 ] ; 2017.
Abstract
We previously demonstrated the noninferiority of switching to efavirenz (EFV) versus remaining on ritonavir-boosted lopinavir (LPV/r) for virologic control in children infected with human immunodeficiency virus (HIV) and exposed to nevirapine (NVP) for prevention of mother-to-child transmission. Here we assess outcomes up to 4 years post-randomization.
DOI: 10.1093/cid/cix335
PubMed: 28419200
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pubmed:28419200Le document en format XML
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<author><name sortKey="Murnane, Pamela M" sort="Murnane, Pamela M" uniqKey="Murnane P" first="Pamela M" last="Murnane">Pamela M. Murnane</name>
<affiliation><nlm:affiliation>Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York.</nlm:affiliation>
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<author><name sortKey="Strehlau, Renate" sort="Strehlau, Renate" uniqKey="Strehlau R" first="Renate" last="Strehlau">Renate Strehlau</name>
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<author><name sortKey="Mbete, Ndileke" sort="Mbete, Ndileke" uniqKey="Mbete N" first="Ndileke" last="Mbete">Ndileke Mbete</name>
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<author><name sortKey="Coovadia, Ashraf" sort="Coovadia, Ashraf" uniqKey="Coovadia A" first="Ashraf" last="Coovadia">Ashraf Coovadia</name>
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<sourceDesc><biblStruct><analytic><title xml:lang="en">Switching to Efavirenz Versus Remaining on Ritonavir-boosted Lopinavir in Human Immunodeficiency Virus-infected Children Exposed to Nevirapine: Long-term Outcomes of a Randomized Trial.</title>
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<author><name sortKey="Shiau, Stephanie" sort="Shiau, Stephanie" uniqKey="Shiau S" first="Stephanie" last="Shiau">Stephanie Shiau</name>
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<author><name sortKey="Patel, Faeezah" sort="Patel, Faeezah" uniqKey="Patel F" first="Faeezah" last="Patel">Faeezah Patel</name>
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<author><name sortKey="Hunt, Gillian" sort="Hunt, Gillian" uniqKey="Hunt G" first="Gillian" last="Hunt">Gillian Hunt</name>
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<front><div type="abstract" xml:lang="en">We previously demonstrated the noninferiority of switching to efavirenz (EFV) versus remaining on ritonavir-boosted lopinavir (LPV/r) for virologic control in children infected with human immunodeficiency virus (HIV) and exposed to nevirapine (NVP) for prevention of mother-to-child transmission. Here we assess outcomes up to 4 years post-randomization.</div>
</front>
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<pubmed><MedlineCitation Status="In-Process" Owner="NLM"><PMID Version="1">28419200</PMID>
<DateCreated><Year>2017</Year>
<Month>04</Month>
<Day>18</Day>
</DateCreated>
<DateRevised><Year>2017</Year>
<Month>08</Month>
<Day>25</Day>
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<Issue>3</Issue>
<PubDate><Year>2017</Year>
<Month>Aug</Month>
<Day>01</Day>
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<Title>Clinical infectious diseases : an official publication of the Infectious Diseases Society of America</Title>
<ISOAbbreviation>Clin. Infect. Dis.</ISOAbbreviation>
</Journal>
<ArticleTitle>Switching to Efavirenz Versus Remaining on Ritonavir-boosted Lopinavir in Human Immunodeficiency Virus-infected Children Exposed to Nevirapine: Long-term Outcomes of a Randomized Trial.</ArticleTitle>
<Pagination><MedlinePgn>477-485</MedlinePgn>
</Pagination>
<ELocationID EIdType="doi" ValidYN="Y">10.1093/cid/cix335</ELocationID>
<Abstract><AbstractText Label="Background" NlmCategory="UNASSIGNED">We previously demonstrated the noninferiority of switching to efavirenz (EFV) versus remaining on ritonavir-boosted lopinavir (LPV/r) for virologic control in children infected with human immunodeficiency virus (HIV) and exposed to nevirapine (NVP) for prevention of mother-to-child transmission. Here we assess outcomes up to 4 years post-randomization.</AbstractText>
<AbstractText Label="Methods" NlmCategory="UNASSIGNED">From 2010-2013, 298 NVP-exposed HIV-infected children ≥3 years of age were randomized to switch to EFV or remain on LPV/r in Johannesburg, South Africa (Clinicaltrials.gov NCT01146873). After trial completion, participants were invited to enroll into observational follow-up. We compared HIV RNA levels, CD4 counts and percentages, lipids, and growth across groups through four years post-randomization.</AbstractText>
<AbstractText Label="Results" NlmCategory="UNASSIGNED">HIV RNA levels 51-1000 copies/mL were less frequently observed in the EFV group than the LPV/r group (odds ratio [OR] 0.67, 95% confidence interval [CI]: 0.51-0.88, P = .004), as was HIV RNA >1000 copies/mL (OR 0.52 95% CI: 0.28-0.98, P = .04). The probability of confirmed HIV RNA >1000 copies/mL by 48 months was 0.07 and 0.12 in the EFV and LPV/r groups, respectively (P = .21). Children randomized to EFV had a reduced risk of elevated total cholesterol (OR 0.45 95% CI: 0.27-0.75, P = .002) and a reduced risk of abnormal triglycerides (OR 0.42, 95% CI 0.29-0.62, P < .001).</AbstractText>
<AbstractText Label="Conclusions" NlmCategory="UNASSIGNED">Our results indicate that the benefits of switching virologically suppressed NVP-exposed HIV-infected children ≥3 years of age from LPV/r to EFV are sustained long-term. This approach has several advantages, including improved palatability, reduced metabolic toxicity, simplified cotreatment for tuberculosis, and preservation of second line options.</AbstractText>
<AbstractText Label="Clinical Trials Registration" NlmCategory="UNASSIGNED">NCT01146873.</AbstractText>
</Abstract>
<AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Murnane</LastName>
<ForeName>Pamela M</ForeName>
<Initials>PM</Initials>
<AffiliationInfo><Affiliation>Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Strehlau</LastName>
<ForeName>Renate</ForeName>
<Initials>R</Initials>
<AffiliationInfo><Affiliation>Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.</Affiliation>
</AffiliationInfo>
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<Author ValidYN="Y"><LastName>Shiau</LastName>
<ForeName>Stephanie</ForeName>
<Initials>S</Initials>
<AffiliationInfo><Affiliation>Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.</Affiliation>
</AffiliationInfo>
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<Author ValidYN="Y"><LastName>Patel</LastName>
<ForeName>Faeezah</ForeName>
<Initials>F</Initials>
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</AffiliationInfo>
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<Author ValidYN="Y"><LastName>Mbete</LastName>
<ForeName>Ndileke</ForeName>
<Initials>N</Initials>
<AffiliationInfo><Affiliation>Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.</Affiliation>
</AffiliationInfo>
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<Author ValidYN="Y"><LastName>Hunt</LastName>
<ForeName>Gillian</ForeName>
<Initials>G</Initials>
<AffiliationInfo><Affiliation>Centre for HIV and STIs, National Institute for Communicable Diseases, Johannesburg, South Africa.</Affiliation>
</AffiliationInfo>
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<Author ValidYN="Y"><LastName>Abrams</LastName>
<ForeName>Elaine J</ForeName>
<Initials>EJ</Initials>
<AffiliationInfo><Affiliation>Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>ICAP, Mailman School of Public Health.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>Department of Pediatrics, College of Physicians & Surgeons, Columbia University, New York, New York.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Coovadia</LastName>
<ForeName>Ashraf</ForeName>
<Initials>A</Initials>
<AffiliationInfo><Affiliation>Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Kuhn</LastName>
<ForeName>Louise</ForeName>
<Initials>L</Initials>
<AffiliationInfo><Affiliation>Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.</Affiliation>
</AffiliationInfo>
</Author>
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<Language>eng</Language>
<PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType>
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<MedlineJournalInfo><Country>United States</Country>
<MedlineTA>Clin Infect Dis</MedlineTA>
<NlmUniqueID>9203213</NlmUniqueID>
<ISSNLinking>1058-4838</ISSNLinking>
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<KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">HIV infections</Keyword>
<Keyword MajorTopicYN="N">antiretroviral therapy</Keyword>
<Keyword MajorTopicYN="N">efavirenz</Keyword>
<Keyword MajorTopicYN="N">lopinavir-ritonavir</Keyword>
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