Efavirenz works in kids with both HIV and TB
Children coinfected with HIV and tuberculosis appear to suppress both infections when treated with standard TB regimens and an efavirenz-based HIV regimen, researchers said here at the International AIDS Conference.
Although the patients treated with efavirenz (Sustiva) had more extensive disease at baseline, at the end of 1 year 80% of them were alive, which was comparable to the 87% survival rate among the children treated with a nevirapine-based (Viramune) regimen, said Janneke van Dijk, MD, a clinical researcher at Macha Hospital, Choma, Zambia.
Mortality rates also were comparable; eight children on nevirapine died, compared with 10 on efavirenz (P=0.21).
Treating the children with nevirapine requires more intensive dosing, and that can result in more adverse events, van Dijk told MedPage Today at her poster presentation.
For the anti-tuberculosis portion of the treatment, children were given rifampin using a dosing schedule based on their weight, with treatment ranging from 300 mg for children less than 9 kg (20 lbs.) to 600 mg for children 40 kg to 60 kg (about 90 to 130 lbs.).
Clinicians are concerned about coadministration of antiretrovirals and rifampin because rifampin is a potent inducer of the cytochrome P450 system, which may reduce antiretroviral serum levels and therefore the drugs' effectiveness, van Dijk explained.
For her study, she enrolled 69 children on an HIV nevirapine-based therapy and 45 children on an efavirenz-based therapy plus anti-tuberculous therapy. All the children received nucleoside reverse transcriptase inhibitor backbone antiretroviral therapy as well, she said. The children in the nevirapine arm did not have tuberculosis infection.
Van Dijk said that the choice of the backbone drugs did not appear to make a difference in outcomes.
"Our idea is to overcome recommendations that contraindicate efavirenz in children less than 3 years of age," she said. "That's why we did this study."
In commenting on the study, Geoffrey Forster, MD, staff physician at Mutare Provincial Hospital in Zimbabwe, said, "I am already doing this. I am trying to convince my colleagues that this type of treatment with efavirenz can be safely accomplished in young children who weigh less than 4 kg (about 10 lbs.). This will help."
He noted that his hospital is currently treating 1,500 children infected with HIV.
Forster told MedPage Today that he is using the efavirenz-based regimen in children about 2 years of age who also have tuberculosis coinfection. "The alternative is that you have to ratchet up nevirapine dosage and that can lead to side effects," he said while reviewing the poster at the meeting. "Even after that, you still may not have nevirapine at therapeutic levels."
Van Dijk noted, "Given limited treatment options in resource-limited settings, efavirenz-based regimens should be considered for young HIV-infected children with tuberculosis."
The study was funded through the President's Emergency Plan for AIDS Relief.
Van Dijk and Forster had no disclosures.
Primary source: International AIDS Conference
Source reference:
Van Dijk, J er al "MOPE041 - Effectiveness of EFV-based ART regimens in young children requiring TB/HIV co-treatment: a possible treatment option for resource-limited settings" IAC 2012; Abstract.
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