title: Choice of antiretroviral drugs for postexposure prophylaxis for children: a systematic review.
abstract: BACKGROUND
  This systematic review aimed to assess the safety and efficacy of antiretroviral options for postexposure prophylaxis (PEP). Recognizing the limited data on the safety and efficacy of antiretroviral drugs for PEP in children, this review was extended to include consideration of data on the use of antiretroviral drugs for treatment of infants and children living with human immunodeficiency virus.
  
  
  METHODS
  The PEP literature was assessed to identify studies reporting safety and completion rates for children given PEP, and this information was complemented by safety and efficacy data for drugs used in antiretroviral therapy. The proportion of patients experiencing each outcome was calculated and data were pooled using random-effects meta-analysis.
  
  
  RESULTS
  Three prospective cohort studies reported outcomes of children given zidovudine (ZDV) plus lamivudine (3TC) as a 2-drug PEP regimen. The proportion of children completing the full 28-day course of PEP was 64.0% (95% confidence interval [CI], 41.2%-86.8%), whereas the proportion discontinuing due to adverse events was 4.5% (95% CI, .4%-8.6%). One randomized trial compared abacavir (ABC) plus lamivudine (3TC) and ZDV+3TC as part of a dual or triple first-line antiretroviral therapy regimen; this study showed better efficacy in the ABC-containing combinations and no difference in the time to first serious adverse event. Three randomized trials compared lopinavir/ritonavir (LPV/r) to nevirapine (NVP) for antiretroviral therapy and showed a lower risk of treatment discontinuations associated with LPV/r vs NVP (hazard ratio, 0.56 [95% CI, .41-.75]) but no difference in drug-related adverse events. The overall quality of the evidence was rated as very low.
  
  
  CONCLUSIONS
  This review supports ZDV+3TC+LPV/r as the preferred 3-drug regimen for PEP in children.
authors.affiliation: Department of HIV/AIDS, World Health Organization, Geneva, Switzerland.
authors.forename: Martina
authors.initials: M
authors.lastname: Penazzato
authors.affiliation: Division of HIV/AIDS Prevention, US Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Ken
authors.initials: K
authors.lastname: Dominguez
authors.affiliation: Division of Paediatric Infectious Diseases, Department of Pediatrics and Child Health, Stellenbosch University and Tygerberg Children's Hospital, Cape Town, South Africa.
authors.forename: Mark
authors.initials: M
authors.lastname: Cotton
authors.affiliation: Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda.
authors.forename: Linda
authors.initials: L
authors.lastname: Barlow-Mosha
authors.affiliation: Department of HIV/AIDS, World Health Organization, Geneva, Switzerland.
authors.forename: Nathan
authors.initials: N
authors.lastname: Ford
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D015224:Dideoxynucleosides / Q000627:therapeutic use; D004338:Drug Combinations; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D007223:Infant; D018445:Infectious Disease Transmission, Vertical; D019259:Lamivudine / Q000009:adverse effects / Q000627:therapeutic use; D061466:Lopinavir / Q000627:therapeutic use; D019829:Nevirapine / Q000009:adverse effects / Q000627:therapeutic use; D056990:Post-Exposure Prophylaxis; D011247:Pregnancy; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D019438:Ritonavir / Q000627:therapeutic use; D015215:Zidovudine / Q000009:adverse effects / Q000627:therapeutic use; D000099227:Abacavir
chemical_list: D019380:Anti-HIV Agents; D015224:Dideoxynucleosides; D004338:Drug Combinations; D019259:Lamivudine; D061466:Lopinavir; D019829:Nevirapine; D019438:Ritonavir; D015215:Zidovudine; C492871:abacavir, lamivudine drug combination; D000099227:Abacavir; C109078:lamivudine, zidovudine drug combination
keywords: antiretroviral; children; postexposure prophylaxis; safety; tolerability