TUESDAY, Sept. 7 (HealthDay News) -- For HIV-infected children
in the developing world, treatment choices have been limited by
concerns over the possible development of resistance to drugs they
received as infants during failed attempts to prevent their
infection in the first place.
But a new U.S. National Institutes of Health-funded study
suggests there may be a way to administer one particularly cheap
and practical HIV drug -- nevirapine -- safely and effectively to
many of these children.
The finding was detailed by study co-author Louise Kuhn, a
professor of epidemiology at the Mailman School of Public Health at
Columbia University in New York City, and Dr. Lynne Mofenson, chief
of the pediatric, adolescent and maternal AIDS branch of the Eunice
Kennedy Shriver National Institute of Child Health and Human
Development, during a recent teleconference.
The study itself will be published in the Sept. 8 issue of the
Journal of the American Medical Association.
Mofenson noted that globally 430,000 infants become infected
with HIV. About 90 percent of these children live in sub-Saharan
To tackle this immense problem, public health officials often
turn to nevirapine. A single dose of the drug given at birth to the
newborn of an HIV-infected mother can reduce the risk of HIV
transmission by as much as 50 percent, Mofenson explained.
However, those infants who go on to become infected run the risk
of developing a nevirapine-resistant strain of virus. And
resistance testing, though available, is far too expensive to be
considered a practical screening tool in the developing world.
So, about three years ago the World Health Organization
recommended that HIV-infected children who had first been given
nevirapine not be given the effective and cost-effective treatment
again in favor of a costly protease inhibitor cocktail that is
difficult to store and transport.
In this latest study, the researchers focused on the treatment
of 195 children infected with HIV who were cared for at one
hospital in Johannesburg, South Africa, between 2005 and 2009.
For these children, nevirapine at birth had failed to prevent
As a result, each child was placed on a protease inhibitor
regimen, which involved three drugs: ritonavir-boosted lopinavir,
stavudine and lamivudine. All the children fared well on this
cocktail, having maintained a desirably low viral load for a
minimum of three months over the course of their first year of
At the launch of the study, about half the children were
randomly switched to a nevirapine treatment: namely, replacing
ritonavir with nevirapine in the drug cocktail. The other children
stayed with their standard protease inhibitor regimen. Blood
samples were taken at 4, 12, 24, 36 and 52 weeks.
The authors found that children who had fared well (for an
average of nine months) under a non-nevirapine protease-inhibitor
drug regimen appeared to fare even better once they switched to a
"Those children who changed to nevirapine were actually more likely to maintain the virus below 50 copies per milliliter (ml) in the blood, which is the lowest detectable limit that we use to measure the amount of virus in the blood," explained Kuhn.
Among the nevirapine group, 66 percent of the children remained
below this threshold. For the standard treatment group, just 42
percent achieved that goal.
However, they cautioned that about one in five of the children
who switched to nevirapine did not fare well, with viral loads
rising beyond 1,000 copies/ml.
Nevertheless, with a majority of children reacting well to the
switch, Kuhn and her colleagues suggest the approach could cut
costs and improve treatment, so long as viral loads are
"What this shows is that this is a unique and innovative, but also reasonable, alternative strategy, and it will allow us to treat many more children," Mofenson said. "Because compared with the protease inhibitors we use now, nevirapine is much less expensive -- about $55 a year per child compared to about $280 a year for the PIs."
"So this will allow us to treat five times as many children for the same price," she noted. "Which is why this is so critical."
Kuhn added that nevirapine offers other crucial pluses.
"Our group is very, very encouraged by these results, because the biggest factor in HIV treatment is adherence," she explained. "The drugs don't work if you don't take them. And here the big problem is that it's very, very difficult for parents to get their children to take what we currently offer them two times a day because they are really horrible, foul-tasting drugs."
"So if we can move to something like nevirapine - which has a kind of a sweet taste that children don't really mind so much -- it would be very helpful," she said.
Dr. Geoffrey A. Weinberg, a pediatric infectious disease expert
at Golisano Children's Hospital at the University of Rochester
Medical Center in New York, agreed that a nevirapine treatment
option would be helpful.
"The important message is that many children will do better with anti-HIV therapy based on nevirapine," he said.
For more on nevirapine, visit the
U.S. Department of Health and Human Services.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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