Abstract
Efavirenz-based first-line regimens have been widely used for children ≥3 years of age starting antiretroviral therapy, despite possible resistance with prior exposure to non-nucleoside reverse transcriptase inhibitors for prevention of mother-to-child transmission (PMTCT). We used logistic regression to examine the association between PMTCT exposure and viral failure (VF) defined as two consecutive viral loads (VL)>1000 copies/ml between 6–18 months on ART. Children with previous nevirapine exposure for PMTCT were not at higher risk of VF compared to unexposed children (adjusted Odds Ratio (aOR): 0.79; 95% CI:0.56, 1.11).
Highlights
While prevention of mother to child HIV transmission (PMTCT) has greatly reduced the number of new pediatric HIV infections, there are still 1.8 million children
Our study showed no evidence of an increased risk of viral failure (VF) among children who were exposed to PMTCT starting EFV-based antiretroviral therapy (ART) at 3 years of age
Our results concur with the NEVEREST III randomized clinical trial (RCT) which randomized PMTCT-exposed children to an EFV-based regimen or to continue lopinavir/ritonavirbased ART [9]
Summary
While prevention of mother to child HIV transmission (PMTCT) has greatly reduced the number of new pediatric HIV infections, there are still 1.8 million children 3 years) and adults for several years due to its advantages for long term maintenance, once daily dosing, simplification of co-treatment for tuberculosis and preserving alternative drugs for second-line [9]
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