Even among children with HIV who have not received nevirapine, treatment outcomes were better with ritonavir-boosted lopinavir, according to study findings published online.
The findings, published by researchers from the Dartmouth-Hitchcock Medical Center in Lebanon, N.H., may pose some important questions for policymakers, according to Paul Palumbo, MD, and other researchers from Dartmouth.
Palumbo and colleagues looked at data on about 300 children in Africa and India who were randomly assigned to zidovudine and lamivudine plus either the nevirapine or ritonavir-boosted lopinavir regimen.
The researchers said, in the nevirapine group, 19 of 32 children had resistance at the time their regimen failure, and the time to toxicity and death was shorter in the nevirapine groups.
“Factors that may have contributed to the suboptimal results with nevirapine include elevated viral load at baseline, selection for nevirapine resistance, background regimen of nucleoside reverse-transcriptase inhibitors and the standard ramp-up dosing strategy,” the researchers wrote.
They said these findings could challenge the recommended first-line of treatment for ART, which is currently nevirapine.
Disclosure: The study was supported by a grant from the NIH. Dr. Violari reports receiving lecture fees from Abbott, consulting fees from Tibotec and trial drugs from GlaxoSmithKline.