Association Between Efavirenz-Based Compared With Nevirapine-Based Antiretroviral Regimens and Virological Failure in HIV-Infected Children

Patterns of HIV Treatment Adherence do not Differ Between Male and Female Adolescents in Botswana

“…In our prior study, gender-specific differences in treatment outcomes were seen among patients on nevirapine, prompting this evaluation. Of note, however, similar findings were not seen among patients on efavirenz (2). We thought that, if males had longer gaps between doses than females, the lack of gender-specific outcomes among patients on efavirenz might be explained by increased permissiveness of efavirenz to longer treatment gaps.…”

“…Since then, urbanization has been ongoing in Botswana, and providers at the study clinic have noted a subjective reduction in the prevalence of boys attributing poor adherence to trips to rural areas (2). Thus, cultural evolution could have extinguished gender-specific differences.…”

“…Adherence to once- or twice-daily ART was monitored with MEMS for 2 years during the study period of October 2012–January 2016 in an ongoing prospective study of 10–<20 year-old males and females taking ART at the Botswana-Baylor Children’s Clinical Centre of Excellence, the same clinic in which the earlier study showed gender-specific outcome differences (2). Institutional review boards at the University of Botswana, Botswana Ministry of Health, University of Pennsylvania, and Baylor College of Medicine approved this study.…”

“…In a previously published comparative effectiveness study from our tertiary pediatric HIV referral clinic in Botswana, rates of virologic failure (confirmed HIV viral load ≥400 copies/mL) among 156 boys on nevirapine were higher than those among 227 girls on nevirapine at 1, 2, and 5 years after treatment initiation [18.0 % (95 % CI 12.3–24.9 %), 24.4 % (95 % CI 17.9–31.9 %), and 30.1 % (95 % CI 23.1–38.0 %) vs 6.3 % (95 % CI 3.2–11.0 %), 10.3 % (95 % CI 6.2–15.8 %), and 14.3 % (95 % CI 9.5–20.4 %), respectively, although the interaction between drug regimen and sex was not statistically significant with p = 0.25] (2). Behavioral patterns that are more common in one gender than the other could drive adherence differences that are important to treatment outcomes.…”

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

“…As seen in adult studies 77, two recent retrospective paediatric cohort studies, in resource‐limited and resource‐rich settings, comparing EFV and NVP showed that EFV was associated with superior virological outcomes 78 73, although in the UK/Ireland CHIPS cohort, the benefit of EFV‐based regimens over NVP‐based regimens in terms of virological failure was very modest after 2 years of therapy 73. 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.…”