title: Virologic response in children treated with abacavir-compared with stavudine-based antiretroviral treatment: a South African multi-cohort analysis.
abstract: BACKGROUND
  Initiation criteria and pediatric antiretroviral treatment regimens have changed over the past few years in South Africa. We reported worse early virological outcomes associated with the use of abacavir (ABC)-based regimens at 1 large site: here, we expand this analysis to multiple sites in the IeDEA-Southern Africa collaboration.
  
  
  METHODS
  Data for 9543 antiretroviral treatment-naïve children <16 years at treatment initiation started on either stavudine/lamivudine (d4T/3TC) or ABC/3TC with efavirenz (EFV) or ritonavir-boosted lopinavir (LPV/r) treated at 6 clinics in Johannesburg and Cape Town, South Africa, were analyzed with χ tests and logistic regression to evaluate viral suppression at 6 and 12 months.
  
  
  RESULTS
  Prevalence of viral suppression at 6 months in 2174 children started on a d4T-based LPV/r regimen was greater (70%) than among 438 children started on an ABC-based LPV/r regimen (54%, P < 0.0001). Among 3189 children started on a d4T-based EFV regimen, a higher proportion (86%) achieved suppression at 6 months compared with 391 children started on ABC-containing EFV regimens (78%, P < 0.0001). Relative benefit of d4T versus ABC on 6-month suppression remained in multivariate analysis after adjustment for pretreatment characteristics, cohort and year of program [LPV/r: odds ratio = 0.57 (confidence interval: 0.46-0.72); EFV: odds ratio = 0.46 (confidence interval: 0.32-0.65)].
  
  
  CONCLUSIONS
  This expanded analysis is consistent with our previous report of worse virological outcomes after ABC was introduced as part of first-line antiretroviral treatment in South Africa. Whether due to the drug itself or coincident with other changes over time, continued monitoring and analyses must clarify causes and prevent suboptimal long-term outcomes.
authors.affiliation: From the *Empilweni Services and Research Unit, Department of Paediatrics and Child Health, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand; †School of Public Health and Family Medicine, University of Cape Town, Cape Town; ‡Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; §Wits Reproductive Health and HIV Institute (Harriet Shezi Children's Clinic, Chris Hani Baragwanath Hospital, Soweto), Faculty of Health Sciences, University of Witwatersrand, Johannesburg; ¶Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, The University of Cape Town, Cape Town; ‖Tygerberg Academic Hospital, University of Stellenbosch, Stellenbosch; **Gugulethu Community Health Centre and Desmond Tutu HIV Centre, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town; ††Médecins Sans Frontières South Africa and Khayelitsha ART Programme, Khayelitsha, Cape Town, South Africa; and ‡‡Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
authors.forename: Karl-Günter
authors.initials: KG
authors.lastname: Technau
authors.forename: Michael
authors.initials: M
authors.lastname: Schomaker
authors.forename: Louise
authors.initials: L
authors.lastname: Kuhn
authors.forename: Harry
authors.initials: H
authors.lastname: Moultrie
authors.forename: Ashraf
authors.initials: A
authors.lastname: Coovadia
authors.forename: Brian
authors.initials: B
authors.lastname: Eley
authors.forename: Helena
authors.initials: H
authors.lastname: Rabie
authors.forename: Robin
authors.initials: R
authors.lastname: Wood
authors.forename: Vivian
authors.initials: V
authors.lastname: Cox
authors.forename: Luisa Salazar
authors.initials: LS
authors.lastname: Vizcaya
authors.forename: Evans
authors.initials: E
authors.lastname: Muchiri
authors.forename: Mary-Ann
authors.initials: MA
authors.lastname: Davies
mesh_terms: D000293:Adolescent; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D002648:Child; D015331:Cohort Studies; D015224:Dideoxynucleosides / Q000627:therapeutic use*; D005260:Female; D006678:HIV / Q000302:isolation & purification*; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000821:virology; D006801:Humans; D008297:Male; D013019:South Africa / Q000453:epidemiology; D018119:Stavudine / Q000627:therapeutic use*; D016896:Treatment Outcome; D019562:Viral Load; D000099227:Abacavir
chemical_list: D019380:Anti-HIV Agents; D015224:Dideoxynucleosides; D018119:Stavudine; D000099227:Abacavir