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Choice of antiretroviral drugs for postexposure prophylaxis for children: a systematic review.
- Source :
-
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2015 Jun 01; Vol. 60 Suppl 3, pp. S177-81. - Publication Year :
- 2015
-
Abstract
- Background: This systematic review aimed to assess the safety and efficacy of antiretroviral options for postexposure prophylaxis (PEP). Recognizing the limited data on the safety and efficacy of antiretroviral drugs for PEP in children, this review was extended to include consideration of data on the use of antiretroviral drugs for treatment of infants and children living with human immunodeficiency virus.<br />Methods: The PEP literature was assessed to identify studies reporting safety and completion rates for children given PEP, and this information was complemented by safety and efficacy data for drugs used in antiretroviral therapy. The proportion of patients experiencing each outcome was calculated and data were pooled using random-effects meta-analysis.<br />Results: Three prospective cohort studies reported outcomes of children given zidovudine (ZDV) plus lamivudine (3TC) as a 2-drug PEP regimen. The proportion of children completing the full 28-day course of PEP was 64.0% (95% confidence interval [CI], 41.2%-86.8%), whereas the proportion discontinuing due to adverse events was 4.5% (95% CI, .4%-8.6%). One randomized trial compared abacavir (ABC) plus lamivudine (3TC) and ZDV+3TC as part of a dual or triple first-line antiretroviral therapy regimen; this study showed better efficacy in the ABC-containing combinations and no difference in the time to first serious adverse event. Three randomized trials compared lopinavir/ritonavir (LPV/r) to nevirapine (NVP) for antiretroviral therapy and showed a lower risk of treatment discontinuations associated with LPV/r vs NVP (hazard ratio, 0.56 [95% CI, .41-.75]) but no difference in drug-related adverse events. The overall quality of the evidence was rated as very low.<br />Conclusions: This review supports ZDV+3TC+LPV/r as the preferred 3-drug regimen for PEP in children.<br /> (© The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.)
- Subjects :
- Child
Child, Preschool
Cohort Studies
Dideoxynucleosides therapeutic use
Drug Combinations
Female
HIV Infections transmission
Humans
Infant
Infectious Disease Transmission, Vertical
Lamivudine adverse effects
Lamivudine therapeutic use
Lopinavir therapeutic use
Nevirapine adverse effects
Nevirapine therapeutic use
Pregnancy
Prospective Studies
Randomized Controlled Trials as Topic
Ritonavir therapeutic use
Zidovudine adverse effects
Zidovudine therapeutic use
Anti-HIV Agents therapeutic use
HIV Infections prevention & control
Post-Exposure Prophylaxis
Subjects
Details
- Language :
- English
- ISSN :
- 1537-6591
- Volume :
- 60 Suppl 3
- Database :
- MEDLINE
- Journal :
- Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
- Publication Type :
- Academic Journal
- Accession number :
- 25972500
- Full Text :
- https://doi.org/10.1093/cid/civ110