Second- and Third-line Antiretroviral Therapy for Children and Adolescents: A Scoping Review.
|Abstract||The World Health Organization identified a need for evidence to inform revision of second- and third-line antiretroviral therapy (ART) options in children failing ART. We performed an in-depth scoping review of all available literature on second-line and subsequent ART regimens in children younger than 18 years.|
Efavirenz or nevirapine in three-drug combination therapy with two nucleoside or nucleotide-reverse transcriptase inhibitors for initial treatment of HIV infection in antiretroviral-naïve individuals.
|Journal Title||the pediatric infectious disease journal|
|Publication Year Start||2017-01-01|
PMID- 28403052 OWN - NLM STAT- MEDLINE DA - 20170413 DCOM- 20170420 LR - 20170420 IS - 1532-0987 (Electronic) IS - 0891-3668 (Linking) VI - 36 IP - 5 DP - 2017 May TI - Second- and Third-line Antiretroviral Therapy for Children and Adolescents: A Scoping Review. PG - 492-499 LID - 10.1097/INF.0000000000001481 [doi] AB - BACKGROUND: The World Health Organization identified a need for evidence to inform revision of second- and third-line antiretroviral therapy (ART) options in children failing ART. We performed an in-depth scoping review of all available literature on second-line and subsequent ART regimens in children younger than 18 years. METHODS: We comprehensively searched, without language or date limitations, the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, the World Health Organization's International Clinical Trials Registry Platform and ClinicalTrials.gov. RESULTS: The search retrieved 1982 records. Eighteen studies provided efficacy data: 1 randomized controlled trial, 7 phase II trials, 5 prospective and 5 retrospective cohorts. Five studies evaluated regimens in children failing first-line ART, 4 in children with multidrug resistance and 9 in children with variable treatment experience. Only 10/18 studies reported week 48 or month 12 outcomes. The overall proportion of children with virologic suppression defined by study at week 48 was 61.8%. Although the randomized controlled trial had low risk of bias, outcomes were similar between groups because of highly active optimized background regimens. All phase II and prospective studies were judged to have moderate to high risk of bias. No study compared currently recommended lopinavir-based second-line regimens for nonnucleoside reverse transcriptase inhibitor failures to other non-nonnucleoside reverse transcriptase inhibitor regimens head-to-head. CONCLUSIONS: We found no evidence comparing current World Health Organization-recommended second- and third-line ART regimens with regimens including drugs of interest: raltegravir, darunavir, etravirine and atazanavir. Randomized controlled trials or prospective cohort studies with comparator arms, and bridging studies, ideally conducted in resource-limited settings, are required to guide future recommendations. FAU - Lazarus, Erica AU - Lazarus E AD - From the *Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; daggerFAMCRU, Children's' Infectious Diseases Clinical Research Unit, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa; double daggerWorld Health Organization, HIV Department, Treatment and Care Unit, Geneva, Switzerland; and section signCentre for Evidence-based Health Care, Department of Interdisciplinary Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa. FAU - Nicol, Simone AU - Nicol S FAU - Frigati, Lisa AU - Frigati L FAU - Penazzato, Martina AU - Penazzato M FAU - Cotton, Mark F AU - Cotton MF FAU - Centeno-Tablante, Elizabeth AU - Centeno-Tablante E FAU - Violari, Avy AU - Violari A FAU - Nicol, Liesl AU - Nicol L LA - eng PT - Journal Article PT - Review PL - United States TA - Pediatr Infect Dis J JT - The Pediatric infectious disease journal JID - 8701858 RN - 0 (Anti-HIV Agents) RN - 0 (Pyridazines) RN - 0C50HW4FO1 (etravirine) RN - 43Y000U234 (Raltegravir Potassium) RN - 4MT4VIE29P (Atazanavir Sulfate) RN - YO603Y8113 (Darunavir) SB - IM MH - Adolescent MH - Anti-HIV Agents/*therapeutic use MH - *Antiretroviral Therapy, Highly Active MH - Atazanavir Sulfate/therapeutic use MH - Child MH - Child, Preschool MH - Clinical Trials, Phase II as Topic MH - Cohort Studies MH - Darunavir/therapeutic use MH - Drug Administration Schedule MH - Female MH - HIV Infections/*drug therapy/virology MH - Humans MH - Male MH - Practice Guidelines as Topic MH - Pyridazines/therapeutic use MH - Raltegravir Potassium/therapeutic use MH - Viral Load/drug effects EDAT- 2017/04/14 06:00 MHDA- 2017/04/21 06:00 CRDT- 2017/04/14 06:00 AID - 10.1097/INF.0000000000001481 [doi] AID - 00006454-201705000-00012 [pii] PST - ppublish SO - Pediatr Infect Dis J. 2017 May;36(5):492-499. doi: 10.1097/INF.0000000000001481.
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