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Chiappini E, Lisi C, Giacomet V, Erba P, Bernardi S, Zangari P, Di Biagio A, Taramasso L, Giaquinto C, Rampon O, Gabiano C, Garazzino S, Tagliabue C, Esposito S, Bruzzese E, Badolato R, Zanaboni D, Cellini M, Dedoni M, Mazza A, Pession A, Giannini AM, Salvini F, Dodi I, Carloni I, Cazzato S, Tovo PA, de Martino M, Galli L. Off-label use of combined antiretroviral therapy, analysis of data collected by the Italian Register for HIV-1 infection in paediatrics in a large cohort of children. BMC Infect Dis 2022; 22:55. [PMID: 35033018 PMCID: PMC8760752 DOI: 10.1186/s12879-022-07026-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 12/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early start of highly active antiretroviral therapy (HAART) in perinatally HIV-1 infected children is the optimal strategy to prevent immunological and clinical deterioration. To date, according to EMA, only 35% of antiretroviral drugs are licenced in children < 2 years of age and 60% in those aged 2-12 years, due to the lack of adequate paediatric clinical studies on pharmacokinetics, pharmacodynamics and drug safety in children. METHODS An observational retrospective study investigating the rate and the outcomes of off-label prescription of HAART was conducted on 225 perinatally HIV-1 infected children enrolled in the Italian Register for HIV Infection in Children and followed-up from 2001 to 2018. RESULTS 22.2% (50/225) of included children were receiving an off-label HAART regimen at last check. Only 26% (13/50) of off-label children had an undetectable viral load (VL) before the commencing of the regimen and the 52.0% (26/50) had a CD4 + T lymphocyte percentage > 25%. At last check, during the off label regimen, the 80% (40/50) of patients had an undetectable VL, and 90% (45/50) of them displayed CD4 + T lymphocyte percentage > 25%. The most widely used off-label drugs were: dolutegravir/abacavir/lamivudine (16%; 8/50), emtricitbine/tenofovir disoproxil (22%; 11/50), lopinavir/ritonavir (20%; 10/50) and elvitegravir/cobicistat/emtricitabine/ tenofovir alafenamide (10%; 10/50). At logistic regression analysis, detectable VL before starting the current HAART regimen was a risk factor for receiving an off-label therapy (OR: 2.41; 95% CI 1.13-5.19; p = 0.024). Moreover, children < 2 years of age were at increased risk for receiving off-label HAART with respect to older children (OR: 3.24; 95% CI 1063-7.3; p = 0.001). Even if our safety data regarding off-label regimens where poor, no adverse event was reported. CONCLUSION The prescription of an off-label HAART regimen in perinatally HIV-1 infected children was common, in particular in children with detectable VL despite previous HAART and in younger children, especially those receiving their first regimen. Our data suggest similar proportions of virological and immunological successes at last check among children receiving off-label or on-label HAART. Larger studies are needed to better clarify efficacy and safety of off-label HAART regimens in children, in order to allow the enlargement of on-label prescription in children.
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Affiliation(s)
- Elena Chiappini
- Paediatric Infectious Diseases Unit, Department of Health Sciences, Anna Meyer Children's University Hospital, University of Florence, Viale Pieraccini, 24, 50100, Florence, Italy.
| | - Catiuscia Lisi
- Paediatric Infectious Diseases Unit, Department of Health Sciences, Anna Meyer Children's University Hospital, University of Florence, Viale Pieraccini, 24, 50100, Florence, Italy
| | - Vania Giacomet
- Paediatric Infectious Diseases Unit, Department of Paediatrics, ASST FBF SACCO, University of Milan, Milan, Italy
| | - Paola Erba
- Paediatric Infectious Diseases Unit, Department of Paediatrics, ASST FBF SACCO, University of Milan, Milan, Italy
| | - Stefania Bernardi
- Academic Department of Pediatrics (DPUO), Research Unit of Clinical Immunology and Vaccinology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Paola Zangari
- Academic Department of Pediatrics (DPUO), Research Unit of Clinical Immunology and Vaccinology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Antonio Di Biagio
- Infectious Disease Unit, Ospedale Policlinico San Martino, University of Genova, Genova, Italy
| | - Lucia Taramasso
- Infectious Disease Unit, Ospedale Policlinico San Martino, University of Genova, Genova, Italy
| | - Carlo Giaquinto
- Department of Women and Child Health, University of Padova, Padova, Italy
| | - Osvalda Rampon
- Department of Women and Child Health, University of Padova, Padova, Italy
| | - Clara Gabiano
- Paediatric Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Silvia Garazzino
- Paediatric Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Claudia Tagliabue
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Susanna Esposito
- Paediatric Clinic, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy
| | - Eugenia Bruzzese
- Department of Translational Medical Sciences, Section of Paediatrics, University of Naples Federico II, Naples, Italy
| | - Raffaele Badolato
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Domenico Zanaboni
- Department On Internal Medicine and Therapeutics, IRCCS Policlinico "S. Matteo" Foundation, University of Pavia, Pavia, Italy
| | - Monica Cellini
- Department of Medical and Surgical Sciences, Section of Paediatric Hemato-Oncology, University of Modena and Reggio Emilia, Modena, Italy
| | - Maurizio Dedoni
- Department of Paediatrics, Ospedale Microcitemico, Cagliari, Italy
| | - Antonio Mazza
- Paediatric Unit, "S. Chiara" Hospital, Trento, Italy
| | - Andrea Pession
- Andrea Pession, Paediatric Unit, IRCCS Azienda Ospedaliero-Universitaria, Bologna, Italy
| | - Anna Maria Giannini
- Paediatric Infectious Diseases Unit, University Hospital Policlinico Giovanni XXIII, Bari, Italy
| | - Filippo Salvini
- Department of Paediatrics, University of Milan, Niguarda Hospital, Milan, Italy
| | - Icilio Dodi
- Paediatric Clinic, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy
| | - Ines Carloni
- Department of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy
| | | | - Pier Angelo Tovo
- Paediatric Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Maurizio de Martino
- Paediatric Infectious Diseases Unit, Department of Health Sciences, Anna Meyer Children's University Hospital, University of Florence, Viale Pieraccini, 24, 50100, Florence, Italy
| | - Luisa Galli
- Paediatric Infectious Diseases Unit, Department of Health Sciences, Anna Meyer Children's University Hospital, University of Florence, Viale Pieraccini, 24, 50100, Florence, Italy
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Dakshina S, Olaru ID, Khan P, Raman L, McHugh G, Bwakura-Dangarembizi M, Nathoo K, Munyati S, Mujuru H, Ferrand RA. Evaluation of weight-based prescription of antiretroviral therapy in children. HIV Med 2019; 20:248-253. [PMID: 30632659 PMCID: PMC6590156 DOI: 10.1111/hiv.12702] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2018] [Indexed: 11/30/2022]
Abstract
Objectives The aim of the study was to investigate the extent of and factors associated with incorrect dosing of antiretroviral therapy (ART) in HIV‐infected children in Harare, Zimbabwe. Methods All children aged 0–10 years and children aged 11–17 years who weighed < 35 kg and taking ART were recruited from the paediatric HIV clinic at Harare Hospital. Their current doses of ART drugs were compared against doses recommended by the national guidelines. Results Among 309 children recruited [55% male; median age 7 years (interquartile range (IQR) 5–10 years)], the median CD4 count was 899 cells/μL and the median duration of their current ART regimen was 11.2 months (IQR 4.9–17.1 months). Overall, 110 (35.6%) children were prescribed incorrect doses of at least one drug component within their ART regimen; 64 (20.7%) under‐dosed and 49 (15.9%) over‐dosed on at least one drug. Children receiving a higher than recommended dose of at least one drug were younger compared with correctly dosed children (median 6 versus 7 years, respectively; P = 0.001), had been on their current ART regimen for a shorter time (median 7.2 versus 13 months, respectively; P = 0.003) and were less likely to be receiving a three‐drug fixed‐dose combination (FDC; 42.9 versus 63.3%, respectively; P = 0.009). Those who were under‐dosed were also less likely to be on a three‐drug FDC (25 versus 63.3%, respectively; P < 0.001). Conclusions Over a third of children were prescribed incorrect doses of ART. Children taking triple‐drug FDCs were likely to be correctly dosed. Our study highlights the importance of weight monitoring at each clinical contact, training of health care providers on paediatric drug dosing and the need for wider availability of FDCs for children.
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Affiliation(s)
- S Dakshina
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - I D Olaru
- Biomedical Research and Training Institute, Harare, Zimbabwe.,Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
| | - P Khan
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.,Interactive Research and Development, Karachi, Pakistan
| | - L Raman
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - G McHugh
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - M Bwakura-Dangarembizi
- Department of Paediatrics and Child Health College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - K Nathoo
- Department of Paediatrics and Child Health College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - S Munyati
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - H Mujuru
- Department of Paediatrics and Child Health College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - R A Ferrand
- Biomedical Research and Training Institute, Harare, Zimbabwe.,Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
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Rojas Sánchez P, Prieto L, Jiménez De Ory S, Fernández Cooke E, Navarro ML, Ramos JT, Holguín Á. Impact of lopinavir-ritonavir exposure in HIV-1 infected children and adolescents in Madrid, Spain during 2000-2014. PLoS One 2017; 12:e0173168. [PMID: 28350802 PMCID: PMC5369685 DOI: 10.1371/journal.pone.0173168] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 02/16/2017] [Indexed: 01/18/2023] Open
Abstract
Background The most-used protease-inhibitor in children is Lopinavir-ritonavir (LPV/r), which provides durable suppression of viral load and increases CD4+T-counts. This study describes the virological outcome of the HIV-1-infected paediatric population exposed to LPV/r during 15 years in Spain. Methodology Patients from the Madrid Cohort of HIV-1-infected-children and adolescents exposed to LPV/r as different line therapy during 2000–2014 were selected. The baseline epidemiological-clinical features, viral suppression, changes in CD4+T-CD8+T cell counts and drug susceptibility were recorded before and during LPV/r exposure. Drug resistance mutations (DRM) were identified in viruses from samples collected until 2011. We predicted drug susceptibility to 19 antiretrovirals among those carrying DRM using the Stanford′s HIVdb Algorithm. Results A total of 199 (37.3%) of the 534 patients from the cohort were exposed to LPV/r during 2000–2014 in first (group 1), second (group 2) or more line-therapies (group 3). Patients were mainly Spaniards (81.9%), perinatally infected (96.5%) with subtype-B (65.3%) and HIV-diagnosed before year 2000 (67.8%). The mean age at first LPV/r exposure was 9.7 years. After protease-inhibitor exposure, viral suppression was higher in groups 1 and 2 than in group 3. Viral suppression occurred in 87.5%, 68.6% and 64.8% patients from groups 1, 2 and 3, respectively. Among the 64 patients with available resistance data during LPV/r treatment, 27(42.3%) carried DRM to protease-inhibitor, 28 (58.3%) to reverse-transcriptase-inhibitors and 21 (43.7%) to non-reverse-transcriptase-inhibitors. Darunavir/ritonavir, atazanavir-ritonavir and tipranavir/ritonavir presented the highest susceptibility and nelfinavir the lowest. Conclusions A better lymphocyte recovering occurred when protease-inhibitor was taken as part of a first-line regimen and a higher number of patients reached viral suppression. The least compromised antiretrovirals for rescue antiretroviral regimens, according to DRM in the LPV/r-exposed-paediatric cohort, were mainly the new protease inhibitors.
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Affiliation(s)
- Patricia Rojas Sánchez
- HIV-1 Molecular Epidemiology Laboratory, Microbiology and Parasitology Department, Hospital RamÓn y Cajal-IRYCIS and CIBER-ESP, Madrid, Spain
| | - Luis Prieto
- Infectious Diseases Department, Hospital Universitario de Getafe, Madrid, Spain
| | - Santiago Jiménez De Ory
- Molecular Inmuno-Biology Laboratory, Hospital Universitario Gregorio Marañón-IISGM and CIBER-BBN, Madrid, Spain
| | - Elisa Fernández Cooke
- Infectious Diseases Department, Hospital Universitario Doce de Octubre, Madrid, Spain
| | - Maria Luisa Navarro
- Infectious Diseases Unit, Paediatric Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - José Tomas Ramos
- Infectious Diseases Department, Hospital Clínico Universitario and Universidad Complutense, Madrid, Spain
| | - África Holguín
- HIV-1 Molecular Epidemiology Laboratory, Microbiology and Parasitology Department, Hospital RamÓn y Cajal-IRYCIS and CIBER-ESP, Madrid, Spain
- * E-mail:
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