Study finds less-used regimen for treating children in Africa with HIV is more effective

(Press-News.org) Philadelphia, April 30, 2013 — Researchers from The Children's Hospital of Philadelphia and the Perelman School of Medicine at The University of Pennsylvania, along with colleagues at the Botswana-Baylor Children's Clinical Centre of Excellence, conducted the first large-scale comparison of first-line treatments for HIV-positive children, finding that initial treatment with efavirenz was more effective than nevirapine in suppressing the virus in children ages 3 to 16. However, the less effective nevirapine is currently used much more often in countries with a high prevalence of HIV. The results of the study of more than 800 children are published today in the Journal of the American Medical Association (JAMA).

There are more than 3 million HIV-positive children in the world, and more than 90 percent of them live in sub-Saharan Africa. Currently, the World Health Organization (WHO) recommends both efavirenz and nevirapine for first-line pediatric use in resource-limited settings such as sub-Saharan Africa. Lead author Elizabeth Lowenthal, MD, MSCE of The Children's Hospital of Philadelphia, says this study has the potential to change the standard of care in the parts of the world where most HIV-infected children live.

"Because nevirapine costs less than efavirenz and is more widely available in pediatric formulations, it is currently the more frequent choice for initial treatment in these children. However, our study suggests that efavirenz produces better outcomes," said Dr. Lowenthal.

Senior author Robert Gross, MD, MSCE, an associate professor of Infectious Diseases and Epidemiology at Penn Medicine, adds, "Given this evidence, it is very reasonable to adjust pediatric HIV treatment guidelines. However, as we move towards such changes, more work should be done to make efavirenz a more financially viable option for children on anti-retroviral therapy in these resource-limited settings."

Previous studies favoring efavirenz over nevirapine in adults have resulted in treatment guidelines for adults in many countries, including a few in resource-limited settings, to recommend the use of efavirenz over nevirapine. "In these low-resource settings, Non-Government Organizations typically work with countries' medical programs to forecast their HIV-related drug needs and lobby companies to lower prices for bulk purchases," explained Lowenthal. "Through such programs, drugs that were once more expensive can become cost-effective."

Doctors Lowenthal and Gross applaud the work that the government of Botswana has done to both bring high-quality HIV treatment to its citizens and to facilitate the generation of knowledge to help improve treatment options. "Botswana has been extremely supportive of clinical trials and epidemiological studies, and is very forward thinking in its willingness to inform the world. For such a small country, the amount of research that comes out of Botswana on HIV and tuberculosis is tremendous, which has not only benefitted their public health, but public health for all."

### To read the full study, "Association Between Efavirenz-Based Compared With Nevirapine-Based Antiretroviral Regimens and Virological Failure in HIV-Infected Children" visit http://media.jamanetwork.com.

About The Children's Hospital of Philadelphia The Children's Hospital of Philadelphia was founded in 1855 as the nation's first pediatric hospital. Through its long-standing commitment to providing exceptional patient care, training new generations of pediatric healthcare professionals and pioneering major research initiatives, Children's Hospital has fostered many discoveries that have benefited children worldwide. Its pediatric research program receives the highest amount of National Institutes of Health funding among all U.S. children's hospitals. In addition, its unique family-centered care and public service programs have brought the 516-bed hospital recognition as a leading advocate for children and adolescents. For more information, visit http://www.chop.edu.

About Penn Medicine Penn Medicine is one of the world's leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System, which together form a $4.3 billion enterprise. END