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Pediatric Infectious Disease Journal:
doi: 10.1097/INF.0b013e31828e8c09
HIV Reports

Use of Nucleoside Reverse Transcriptase Inhibitor–only Regimens in HIV-infected Children and Adolescents

Neely, Michael MD, MSc, FCP*; Rutstein, Richard MD; Del Bianco, Gabriela MD; Heresi, Gloria MD; Barton, Theresa MD§; Wiznia, Andrew MD; Wiegand, Ryan MS; Wheeling, Travis MPH**; Bohannon, Beverly MS; Dominguez, Kenneth RN; for the LEGACY Consortium

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Abstract

Objective: In adults, nucleoside reverse transcriptase inhibitor–only antiretroviral regimens (NOARs) with ≥3 nucleoside reverse transcriptase inhibitors are less potent than highly active antiretroviral therapy (HAART). Published pediatric experience with NOARs is limited; thus, we wished to better define the virological, immunological and toxicological effects of NOARs in children and adolescents.

Methods: We analyzed data from NOAR-treated participants in LEGACY, a multicenter observational cohort study of HIV-infected children and adolescents. NOAR-treated case-participants were matched to participants without prior NOAR who initiated HAART during the same year for comparison.

Results: Of 575 participants with data from time of HIV diagnosis through 2006, 67 (12%) received NOARs for at least 24 weeks; most (46%) received the fixed dose combination of zidovudine/lamivudine/abacavir. NOAR use peaked in 2001 to 2002. NOAR-treated participants were significantly older and more treatment experienced than HAART-treated participants. Virologic outcomes, including the percentage of participants with a plasma HIV RNA viral load <400 copies/mL at week 24 (47% versus 34%) and the mean 24-week change in log10 plasma HIV RNA viral load from baseline (−0.63 versus −1.02), were similar between NOAR- and HAART-treated participants, but virologic rebound was more likely in NOAR-treated participants (77% versus 54%, P = 0.02). Increase in CD4 percentage points from baseline to 24 weeks was negligible in NOAR-treated participants compared with HAART-treated participants (0.95% versus 10.1%, P < 0.001). Anemia and leukopenia were more commonly reported with NOARs than HAART.

Discussion: Week 24 virologic outcomes were similar between NOAR- and HAART-treated participants, but NOAR durability was poorer and their use was associated with less immunologic reconstitution. NOARs should play a limited role in pediatric and adolescent antiretroviral therapy.

© 2013 by Lippincott Williams & Wilkins, Inc.

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