Adverse events associated with nevirapine and efavirenz-based first-line antiretroviral therapy

Shubber, Zara; Calmy, Alexandra; Andrieux-Meyer, Isabelle; Vitória, Marco; Renaud-Théry, Françoise; Shaffer, Nathan; Hargreaves, Sally; Mills, Edward J.; Ford, Nathan

doi:10.1097/qad.0b013e32835f1db0

Cited by 151 publications

(116 citation statements)

References 40 publications

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“…In the ARROW trial, a nonrandomized comparison of NNRTI‐ based regimens showed favourable short‐term VL suppression with EFV; however, long‐term suppression depended on age, and was better with EFV in children aged < 10 years, and with NVP in those aged > 10 years 79. A recent systematic review and meta‐analysis which included data on nearly 4000 children showed a lower frequency of severe adverse events and treatment discontinuations with EFV than NVP, although EFV use was associated with higher rates of CNS adverse events 80. Overall, these data support the use of EFV as the preferred NNRTI in children aged > 3 years.…”

Section: Which Art Regimen To Start As First‐line Therapymentioning

confidence: 87%

Paediatric European Network for Treatment of AIDS (PENTA) guidelines for treatment of paediatric HIV‐1 infection 2015: optimizing health in preparation for adult life

et al. 2015

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The 2015 Paediatric European Network for Treatment of AIDS (PENTA) guidelines provide practical recommendations on the management of HIV‐1 infection in children in Europe and are an update to those published in 2009. Aims of treatment have progressed significantly over the last decade, moving far beyond limitation of short‐term morbidity and mortality to optimizing health status for adult life and minimizing the impact of chronic HIV infection on immune system development and health in general. Additionally, there is a greater need for increased awareness and minimization of long‐term drug toxicity. The main updates to the previous guidelines include: an increase in the number of indications for antiretroviral therapy (ART) at all ages (higher CD4 thresholds for consideration of ART initiation and additional clinical indications), revised guidance on first‐ and second‐line ART recommendations, including more recently available drug classes, expanded guidance on management of coinfections (including tuberculosis, hepatitis B and hepatitis C) and additional emphasis on the needs of adolescents as they approach transition to adult services. There is a new section on the current ART ‘pipeline’ of drug development, a comprehensive summary table of currently recommended ART with dosing recommendations. Differences between PENTA and current US and World Health Organization guidelines are highlighted and explained.

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Section: Which Art Regimen To Start As First‐line Therapymentioning

confidence: 87%

Paediatric European Network for Treatment of AIDS (PENTA) guidelines for treatment of paediatric HIV‐1 infection 2015: optimizing health in preparation for adult life

et al. 2015

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“…Since NVP and EFV are the only two choices for NNRTIs, it is not surprising that all the cases with TDR were found to contain resistance to NNRTIs. Due to severe adverse effects (hepatotoxicity and allergic reaction), NVP is no longer recommended as a first-line ART drug [45]. Despite neuropsychiatric side effects [46], ART regimens containing EFV demonstrated sustained antiretroviral activity with continued immunologic recovery in the treatment of naïve HIV patients [478].…”

Section: Discussionmentioning

confidence: 99%

No Difference in Prevalence of Transmitted Drug Resistance between Injection Drug Users and Non-Injection Drug Users: A Cross-Sectional Study among Antiretroviral Treatment-Naïve HIV Patients

et al. 2018

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Objectives: The epidemiological evidence is inconsistent about whether HIV-positive injection drug users (IDUs) are at higher risk of developing antiretroviral resistance than any other HIV-positive populations. This study aims to investigate and compare transmitted drug resistance (TDR) between IDUs and non-IDUs in Lingshan County, an HIV-hit region in Guangxi, China, where IDU and heterosexual transmission were the two dominant transmission routes and roughly equally contributed to the local HIV transmission. Methods: A cross-sectional study was conducted among newly diagnosed and antiretroviral-treatment (ART)-naïve HIV-1 patients from Lingshan County. The pol gene of HIV-1 from the individuals was sequenced followed by genotyping and TDR analysis. Results: Two dominant transmission routes, heterosexual contact and IDU, accounted for 49.2 and 45.9% of 183 HIV-1 infection cases, respectively. Three genotypes, including CRF08_BC (70.6%), CRF01_AE (24.4%), and CRF07_BC (5.0%), and three unique recombinant forms (1.6%), were identified. There was a significant difference in genotype distribution among the different transmission routes (F = 21.814, p < 0.001). The overall TDR prevalence was 5.5%. There were no significant differences in TDR prevalence among the different transmission routes (F = 1.420, p = 0.439). Conclusions: Injection drug use has little impact on TDR prevalence compared with other routes of transmission.

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“…These reactions mostly occur during the first 18 weeks of treatment [55]. Nevertheless, only a minority of patients develop potentially life-threatening conditions, such as SJS or TEN [57,58]. As occurs with abacavir, rechallenge with nevirapine is associated with allergy reactions characterized by greater severity and a decreased lag period [57,59].…”

Section: Nevirapinementioning

confidence: 99%

HLA and Delayed Drug-Induced Hypersensitivity

Sousa‐Pinto¹,

Correia²,

Gomes³

et al. 2016

Int Arch Allergy Immunol

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Delayed drug allergy reactions (DDAR) are potentially fatal. Certain human leukocyte antigen (HLA) alleles have been associated with delayed allergy reactions following the administration of particular drugs. Examples are HLA-B*57:01 (abacavir), HLA-B*15:02/HLA-A*31:01 (carbamazepine), and HLA-B*58:01 (allopurinol). Based on the identification of these associations, it may now be possible to prevent certain allergy reactions that were, until recently, considered unpredictable. In this review, we will focus on the pharmacogenetics of the best-studied associations between specific HLA alleles and delayed allergy reactions and describe the pathogenesis models proposed so far. Finally, we will evaluate the genetic screening strategies available and discuss the clinical relevance of a better understanding of the immunogenetics and mechanisms involved in DDAR.

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Adverse events associated with nevirapine and efavirenz-based first-line antiretroviral therapy

Abstract: Compared to NVP, EFV is associated with a lower frequency of severe adverse events, in particular treatment discontinuations. This finding supports a move toward EFV-based therapy as the preferred first-line treatment regimen for HIV treatment within a public health approach.

Cited by 151 publications

References 40 publications

Paediatric European Network for Treatment of AIDS (PENTA) guidelines for treatment of paediatric HIV‐1 infection 2015: optimizing health in preparation for adult life

Paediatric European Network for Treatment of AIDS (PENTA) guidelines for treatment of paediatric HIV‐1 infection 2015: optimizing health in preparation for adult life

No Difference in Prevalence of Transmitted Drug Resistance between Injection Drug Users and Non-Injection Drug Users: A Cross-Sectional Study among Antiretroviral Treatment-Naïve HIV Patients

HLA and Delayed Drug-Induced Hypersensitivity

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