A retrospective case-cohort study comparing treatment outcomes in abacavir versus stavudine containing first line antiretroviral treatment regimens in children <3yrs old, at a paediatric programme based in Soweto, South Africa
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Date
Authors
Cassim, Haseena
Otwombe, Kennedy
Lazarus, Erica
Liberty, Afaaf
Gray, Glenda E.
Greeff, Oppel Bernhardt Wilhelm
Violari, Avy
Journal Title
Journal ISSN
Volume Title
Publisher
Public Library of Science
Abstract
INTRODUCTION
The current World Health Organization guideline for first line antiretroviral therapy (ART) in
HIV-infected children recommends the use of abacavir and lamivudine as nucleoside backbones
and no longer includes stavudine. We compared treatment outcomes with abacavir
(ABC) versus stavudine (d4T) in a cohort of HIV-1 infected children 6 and 12 months after
antiretroviral therapy was initiated.
METHODS
This was a retrospective case-cohort study, using programmatic data from children enrolled
in the Paediatric Wellness Programme at the Perinatal HIV Research Unit in Soweto, South
Africa between 2005 and 2013. Children on abacavir/stavudine who had initiated ART at
age <3 years with a regimen including lamivudine and lopinavir/ritonavir and had at least
one 6 or 12 month viral load result were eligible. All ABC cases identified were matched for
age at ART initiation and gender to eligible d4T controls (1:2). Outcomes analysed at 6 and
12 months post ART initiation included virological failure, mortality, immunological failure
and anthropometry. Chi-square tests compared categorical measures while Kruskal-Wallis
compared continuous measures.
RESULTS
We identified 57 eligible ABC cases and selected 114 matched d4T controls. Overall, 57%
were females and 89% started treatment at age <1year. The median age at ART initiation was 3.11 (IQR: 1.98±6.05) months. There was no difference in the proportion of children virologically suppressed between the groups at 6 (ABC 54.5% vs. d4T 67.0%, p = 0.125)
and 12 (ABC 66.7% vs. d4T 71.6%, p = 0.53) months post ART-initiation. The proportion of
children with adherence levels >90% for ABC and d4T were similar too (95% in ABC vs.
86% in d4T, p = 0.10). The proportion of children who died over 12 months was 3.5% in the
ABC and 7.9% in the d4T group (p = 0.27). Similarly, the anthropometric measures were
comparable.
CONCLUSIONS
It is reassuring that in the short term, in this group of patients, the treatment outcomes were
similar.
Description
S1 Table. Outcomes at 6 and 12 months for those with viral loads above 100 000 copies/ml.
S2 Table. Outcomes at 6 and 12 months for those with viral loads above 100 000 copies/ml.
S1 File. Supporting data.
S2 Table. Outcomes at 6 and 12 months for those with viral loads above 100 000 copies/ml.
S1 File. Supporting data.
Keywords
Children, Antiretroviral therapy (ART), Human immunodeficiency virus (HIV), Therapy, Infants, Growth, Abacavir (ABC), Stavudine (d4T), World Health Organization (WHO)
Sustainable Development Goals
Citation
Cassim, H., Otwombe, K., Lazarus, E., Liberty, A., Gray, G.E., Greeff, O.B.W. & Violari, A. (2017) A retrospective case-cohort study comparing
treatment outcomes in abacavir versus stavudine
containing first line antiretroviral treatment
regimens in children <3yrs old, at a paediatric
programme based in Soweto, South Africa. PLoS
ONE 12(7): e0180645. https://DOI.org/ 10.1371/journal.pone.0180645.