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2011 NIAID Year In Review

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Modified Treatment Strategy Improves Outcomes of HIV Infection Transmitted From Mother to Child

Young children have fewer antiretroviral options available to them to treat HIV than adults because of difficulties in formulating these drugs into liquid or powder forms. The regimens available for infants may be even more limited because one of the cornerstones of these regimens, nevirapine, is often used as part of a maternal and infant regimen to prevent mother-to-child transmission of HIV. While the use of ART does prevent HIV transmission to many infants, those who do become infected are likely to have HIV strains resistant to the antiretroviral medications their mothers received, including nevirapine.

In an NIAID-supported clinical trial involving HIV-infected children ages 6 to 36 months old in six African countries, children were treated with three antiretroviral drugs, including zidovudine, lamivudine, and either nevirapine or ritonavir-boosted lopinavir. In the first cohort of children who had previously received nevirapine for HIV prevention, the researchers found that a lower percentage of children who received lopinavir in comparison to nevirapine experienced treatment failure after 24 weeks: 22 percent compared to 40 percent, respectively.1

These findings were subsequently replicated in another group of children who did not receive nevirapine for prevention of mother-to-children transmission of HIV. Similar to the results in the nevirapine-exposed cohort, the researchers found that a lower percentage of children who received lopinavir in comparison to nevirapine experienced treatment failure: 19 percent compared to 40 percent, respectively.2 Because infants infected with HIV should start antiretroviral therapy as soon as possible, these findings are essential in helping to determine the best antiretroviral regimen for them.

References:

  1. Palumbo P, Lindsey JC, Hughes MD, Cotton MF, Bobat R, Meyers T, Bwakura-Dangarembizi M, Chi BH, Musoke P, Kamthunzi P, Schimana W, Purdue L, Eshleman SH, Abrams EJ, Millar L, Petzold E, Mofenson LM, Jean-Philippe P, Violari A. Antiretroviral treatment for children with peripartum nevirapine exposure. N Engl J Med. 2010 Oct 14;363(16):1510-20.
  2. Palumbo P, Violari A, Lindsey J, Hughes M, Jean-Philippe P, Mofenson L, Bwakura-Dangarembizi M, Kamthunzi P, Eshleman S, Purdue L, and IMPAACT P1060 Team. NVP- vs LPV/r-based ART among HIV+ infants in resource-limited settings: The IMPAACT P1060 trial. Paper presented at: 18th Conference on Retroviruses and Opportunistic Infections; 2011 Feb 27 -- March 2; Boston, MA.

Last Updated December 28, 2012

Last Reviewed December 28, 2012