Technau K.-G., Lazarus E., Kuhn L., Abrams E.J., Sorour G., Strehlau R., Reubenson G., Davies M.-A., Coovadia A.
Department of Paediatrics and Child Health, Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Cnr Fuel and Oudtshoorn St, Coronationville, Johannesburg, Gauteng, South Africa; Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, South Africa; Gertrude H. Sergievsky Center, Department of Epidemiology, Mailman School of Public Health, New York, NY, United States; Mailman School of Public Health, Department of Pediatrics, Columbia University, New York, NY, United States; School of Public Health and Family Medicine, University of Cape Town, South Africa
Technau, K.-G., Department of Paediatrics and Child Health, Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Cnr Fuel and Oudtshoorn St, Coronationville, Johannesburg, Gauteng, South Africa; Lazarus, E., Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, South Africa; Kuhn, L., Gertrude H. Sergievsky Center, Department of Epidemiology, Mailman School of Public Health, New York, NY, United States; Abrams, E.J., Mailman School of Public Health, Department of Pediatrics, Columbia University, New York, NY, United States; Sorour, G., Department of Paediatrics and Child Health, Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Cnr Fuel and Oudtshoorn St, Coronationville, Johannesburg, Gauteng, South Africa; Strehlau, R., Department of Paediatrics and Child Health, Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Cnr Fuel and Oudtshoorn St, Coronationville, Johannesburg, Gauteng, South Africa; Reubenson, G., Department of Paediatrics and Child Health, Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Cnr Fuel and Oudtshoorn St, Coronationville, Johannesburg, Gauteng, South Africa; Davies, M.-A., School of Public Health and Family Medicine, University of Cape Town, South Africa; Coovadia, A., Department of Paediatrics and Child Health, Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Cnr Fuel and Oudtshoorn St, Coronationville, Johannesburg, Gauteng, South Africa
BACKGROUND: Concerns about stavudine (d4T) toxicity have led to increased use of abacavir (ABC) in first-line pediatric antiretroviral treatment (ART) regimens. Field experience with ABC in ART-naïve children is limited. METHODS: Deidentified demographic, clinical and laboratory data on HIV-infected children initiating ART between 2004 and 2011 in a large pediatric HIV treatment program in Johannesburg, South Africa, were used to compare viral suppression at 6 and 12 months by initial treatment regimen, time to suppression (<400 copies/mL) and rebound (>1000 copies/mL after initial suppression). Adjusted logistic regression was used to investigate confounders and calendar effects. RESULTS: Two thousand thirty-six children initiated either d4T/3TC-or ABC/3TC-based first-line regimens in combination with either boosted lopinavir (LPV/r) or efavirenz (EFV). 1634 received d4T regimens (LPV/r n = 672; EFV n = 962) and 402 ABC regimens (LPV/r n = 192; EFV n = 210). At 6 and 12 months on ART, viral suppression rate was poorer in ABC versus d4T groups within both the LPV/r and EFV groups (P < 0.0001 for all points). In ABC groups, time to suppression was significantly slower (log-rank P < 0.0001 and P = 0.0092 for LPV/r-and EFV-based, respectively) and time to rebound after suppression significantly faster (log-rank P = 0.014 and P = 0.0001 for LPV/r-and EFV-based, respectively). Logistic regression confirmed the worse outcomes in the ABC groups even after adjustment for confounders. CONCLUSION: Data from this urban pediatric ART service program show significantly poorer virological performance of ABC compared with d4T-based regimens, a signal that urgently warrants further investigation. Copyright © 2013 Lippincott Williams &Wilkins.