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Ndongo FA, Kana R, Nono MT, Noah JPYA, Ndzie P, Tejiokem MC, Biheng EH, Ndie J, Nkoa TA, Ketchaji A, Ngako JN, Penda CI, Bissek ACZK, Ndombo POK, Hawa HM, Msellati P, Lallemant M, Faye A. Association between mental disorders with detectable viral load and poor adherence to antiretroviral therapy among adolescents infected with Human Immunodeficiency Virus on follow-up at Chantal Biya Foundation, Cameroon. J Epidemiol Popul Health 2024; 72:202193. [PMID: 38523399 DOI: 10.1016/j.jeph.2024.202193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 10/11/2023] [Accepted: 10/30/2023] [Indexed: 03/26/2024]
Abstract
INTRODUCTION Perinatally HIV-Infected Adolescents (HIVIA) are more likely to have mental health problems than their uninfected peers. In resource-limited settings, mental health disorders are rarely taken into account in the care offered to HIVIA and have an impact on their routine follow-up. The objective of this study was to assess the baseline socio-demographic factors and mental health conditions associated with detectable viral load or poor ART adherence in HIVIA on ART followed at the Mother and Child Centre of the Chantal Biya Foundation in Yaoundé (CME-FCB), Cameroon. METHODS A cross-sectional study was conducted in HIVIA aged 10 to 19 years, followed at CME-FCB during the period from December 2021 to March 2022. Sociodemographic, clinical, and mental characteristics were collected using a structured questionnaire administered face-to-face by trained healthcare providers. The primary outcome was viral load ≥ 40 copies/mL in HIVIA on ART for at least six months. The secondary outcome was poor ART adherence, defined as ≥ 1 missed dose of antiretroviral therapy within the last past three days. The main exposure variables were mental health disorders, including the level of anxiety, depression and low self-esteem. RESULTS In total, 302 adolescents were interviewed, 159 (52.7 %) were girls and median age was 15.2 years (IQR: 12.0-17.5). Having missed at least 1 dose of ART drugs during the last 3 days before screening concerned 53 (35.0 %) cases. Of the 247 adolescents with an available viral load (VL) in the last 12 months prior to screening, 33 (26.7 %) had a VL ≥ 40 copies/mL. Among participating adolescents, 29.1 % presented with high or very high anxiety, 26.5 % with severe depression, 36.4 % with history of suicidal ideation, and 20.5 % low self-esteem. Low self-esteem was strongly associated with a higher risk of poor ART adherence (adjusted odds ratio(aOR) (95 % confidence interval (95 %CI)): 2.2 (1.1-4.3); p = 0.022). Living with the father (aOR (95 %CI): 0.6 (0.3-1.1); p = 0.085) or in a household with a televisor (aOR (95 %CI): 0.5 (0.2-1.1); p = 0.069) were slightly associated with a lower risk of poor adherence to ART. Having both parents alive (aOR (95 %CI): 0.4 (0.2-0.9); p = 0.031) or receiving ART with efavirenz or dolutegravir (aOR (95 %CI): 0.5 (0.2-0.9); p = 0.047) was strongly associated with a lower likelihood of having a detectable VL. Moreover, detectable viral load was slightly less frequent in adolescents whose household was equipped with a television (p = 0.084) or who were completely disclosed for HIV status (p = 0.070). CONCLUSION This study found that co-morbid low self-esteem had higher odds of poor ART adherence in HIVIA. Moreover, both poor ART adherence, and detectable viral load were associated with impaired life conditions in HIVIA.
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Affiliation(s)
- Francis Ateba Ndongo
- University of Garoua, Cameroon; Centre Mère-enfant, Fondation Chantal Biya, Yaounde, Cameroon; Ministry of Public Health, Yaounde, Cameroun.
| | - Rogacien Kana
- Media Convergence Consulting Office, Yaounde, Cameroon
| | - Marius Tchassep Nono
- Action for Youths and Family, Douala, Cameroon; University of Douala, Douala, Cameroon
| | | | | | | | | | - Justin Ndie
- Ministry of Public Health, Yaounde, Cameroun
| | | | | | | | | | | | | | | | - Philippe Msellati
- Research Institute for Sustainable Development (IRD), Abidjan, Côte d'Ivoire
| | - Marc Lallemant
- Programs for HIV Prevention and Treatment (PHPT) Foundation - Research Institute for Sustainable Development (IRD), Paris, France
| | - Albert Faye
- Hôpital Universitaire Robert Debré, Paris, France
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Bekker A, Salvadori N, Rabie H, du Toit S, Than-In-At K, Groenewald M, Cressey R, Nielsen J, Capparelli EV, Lallemant M, Cotton MF, Cressey TR. Paediatric abacavir-lamivudine fixed-dose dispersible tablets and ritonavir-boosted lopinavir granules in neonates exposed to HIV (PETITE study): an open-label, two-stage, single-arm, phase 1/2, pharmacokinetic and safety trial. Lancet HIV 2024; 11:e86-e95. [PMID: 38296364 DOI: 10.1016/s2352-3018(23)00289-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/16/2023] [Accepted: 10/26/2023] [Indexed: 02/08/2024]
Abstract
BACKGROUND Existing solid antiretroviral fixed-dose combination formulations are preferred over liquid formulations in children, but their suitability for neonates is unknown. We evaluated the pharmacokinetics and safety of paediatric abacavir-lamivudine fixed-dose dispersible tablets and ritonavir-boosted lopinavir granules in neonates. METHODS In this open-label, two-stage, single-arm, phase 1/2, pharmacokinetic and safety trial, generic abacavir- lamivudine (120:60 mg) double-scored dispersible tablets and lopinavir boosted with ritonavir (40:10 mg) granules were studied. Neonates exposed to HIV (≥37 weeks gestational age) of no more than 3 days of age with birthweights of 2000-4000 g were identified through routine care in a tertiary hospital in Cape Town, South Africa. In stage 1, the pharmacokinetics and safety of two single doses were assessed to select the multidose strategy for stage 2. Neonates received a single dose of abacavir-lamivudine (30:15 mg, a quarter of a tablet) and lopinavir boosted with ritonavir (40:10 mg - one sachet) orally between 3 days and 14 days of age, and a second dose of a quarter tablet of abacavir-lamivudine and lopinavir boosted with ritonavir (80:20 mg, two sachets) 10-14 days later in stage 1. The multidose strategy selected in stage 2 was a quarter of the abacavir-lamivudine (30:15 mg) fixed-dose dispersible tablet once per day and two sachets of the lopinavir boosted with ritonavir (80:20 mg) granules twice per day from birth to age 28 days. In both stages two intensive pharmacokinetic visits were done, one at less than 14 days of life (pharmacokinetics 1) and another 10-14 days later (pharmacokinetics 2). Safety visits were done 1-2 weeks after each pharmacokinetic visit. Primary objectives were to assess pharmacokinetics and safety of abacavir, lamivudine, and lopinavir. Pharmacokinetic endpoints were area under the concentration time curve (AUC), maximum concentration, and concentration at end of dosing interval in all participants with at least one evaluable pharmacokinetic visit. Safety endpoints included grade 3 or worse adverse events, and grade 3 or worse treatment-related adverse events, occurring between study drug initiation and end of study. This completed trial is registered with the Pan African Clinical Trials Registry (PACTR202007806554538). FINDINGS Between Aug 18, 2021, and Aug 18, 2022, 24 neonates were enrolled into the trial and received study drugs. Eight neonates completed stage 1, meeting interim pharmacokinetic and safety criteria. In stage 2, 16 neonates received study drugs. Geometric mean abacavir and lamivudine exposures (AUC0-24) were higher at 6-14 days (51·7 mg × h/L for abacavir and 17·2 mg × h/L for lamivudine) than at 19-24 days of age (25·0 mg × h/L and 11·3 mg × h/L), whereas they were similar for lopinavir over this period (AUC 0-12 58·5 mg × h/L vs 46·4 mg × h/L). Abacavir geometric mean AUC0-24 crossed the upper reference range at pharmacokinetics 1, but rapidly decreased. Lamivudine and lopinavir AUC0-tau were within range. No grade 2 or worse adverse events were related to study drugs. One neonate had a grade 1 prolonged corrected QT interval using the Fridericia method that spontaneously resolved. INTERPRETATION Abacavir-lamivudine dispersible tablets and ritonavir-boosted lopinavir granules in neonates were safe and provided drug exposures similar to those in young infants. Although further safety data are needed, this regimen presents a new option for HIV prevention and treatment from birth. Accelerating neonatal pharmacokinetic studies of novel antiretroviral therapies is essential for neonates to also benefit from state-of-the-art treatments. FUNDING Unitaid.
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Affiliation(s)
- Adrie Bekker
- Family Centre for Research with Ubuntu, Stellenbosch University, Cape Town, South Africa
| | - Nicolas Salvadori
- AMS-PHPT Research Collaboration, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand; Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
| | - Helena Rabie
- Family Centre for Research with Ubuntu, Stellenbosch University, Cape Town, South Africa
| | - Samantha du Toit
- Family Centre for Research with Ubuntu, Stellenbosch University, Cape Town, South Africa
| | - Kanchana Than-In-At
- AMS-PHPT Research Collaboration, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Marisa Groenewald
- Family Centre for Research with Ubuntu, Stellenbosch University, Cape Town, South Africa
| | - Ratchada Cressey
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - James Nielsen
- Hassenfield Children's Hospital at NYU Langone, New York, NY, USA
| | - Edmund V Capparelli
- Department of Pediatrics and Skaggs School of Pharmacy and Pharmaceutical Science, University of California San Diego, San Diego, CA, USA
| | - Marc Lallemant
- AMS-PHPT Research Collaboration, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Mark F Cotton
- Family Centre for Research with Ubuntu, Stellenbosch University, Cape Town, South Africa
| | - Tim R Cressey
- AMS-PHPT Research Collaboration, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand; Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand.
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Donà D, Minotti C, Masini T, Penazzato M, Van Der Zalm MM, Judd A, Giaquinto C, Lallemant M. COVID-19 and MIS-C treatment in children-results from an international survey. Eur J Pediatr 2023; 182:5087-5093. [PMID: 37672062 PMCID: PMC10640428 DOI: 10.1007/s00431-023-05179-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/07/2023]
Abstract
Children have been mostly excluded from COVID-19 clinical trials, and, as a result, most medicines approved for COVID-19 have no pediatric indication. In addition, access to COVID-19 therapeutics remains limited. Collecting physicians' experiences with off-label use of therapeutics is important to inform global prioritization processes and better target pediatric research and development. A standardized questionnaire was designed to explore the use of therapeutics used to treat COVID-19 and multisystem inflammatory syndrome in children (MIS-C) in pediatric patients globally. Seventy-three physicians from 29 countries participated. For COVID-19, steroids were used by 75.6% of respondents; remdesivir and monoclonal antibodies were prescribed by 48.6% and 27.1% of respondents, respectively. For MIS-C, steroids were prescribed by 79.1% of respondents and intravenous immunoglobulins by 69.6%. The use of these products depended on their pediatric approval and the limited availability of antivirals and most monoclonal antibodies in Africa, South America, Southeast Asia, and Eastern Europe. Off-label prescription resulted widespread due to the paucity of clinical trials in young children at the time of the survey; though, based on our survey results, it was generally safe and led to clinical benefits. Conclusion: This survey provides a snapshot of current practice for treating pediatric COVID-19 worldwide, informing global prioritization efforts to better target pediatric research and development for COVID-19 therapeutics. Off-label use of such medicines is widespread for the paucity of clinical trials under 12 years and 40 kg, though appears to be safe and generally results in clinical benefits, even in young children. However, access to care, including medicine availability, differs widely globally. Clinical development of COVID-19 antivirals and monoclonal antibodies requires acceleration to ensure pediatric indication and allow worldwide availability of therapeutics that will enable more equitable access to COVID-19 treatment. What is Known: • Children have been mostly excluded from COVID-19 clinical trials, and, as a result, most medicines approved for COVID-19 have no pediatric indication. • Access to care differs widely globally, so because of the diversity of national healthcare systems; the unequal availability of medicines for COVID-19 treatment represents an obstacle to the pediatric population's universal right to health care. What is New: • Off-label COVID-19 drug prescription is widespread due to the lack of clinical trials in children younger than 12 years and weighing less than 40 kg, but relatively safe and generally leading to clinical benefit. • The application of the GAP-f framework to COVID-19 medicines is crucial, ensuring widespread access to all safe and effective drugs, enabling the rapid development of age-appropriate formulations, and developing specific access plans (including stability, storage, packaging, and labeling) for distribution in low- and middle-income countries (LMICs). Antivirals and monoclonal antibodies may benefit from the acceleration to reach widespread and equal diffusion.
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Affiliation(s)
- Daniele Donà
- Department of Women's and Children's Health, University of Padua, Padua, Italy
- Division of Pediatric Infectious Diseases, Department of Women's and Children's Health, Padova University - Hospital, Padova, Italy
| | - Chiara Minotti
- Department of Women's and Children's Health, University of Padua, Padua, Italy.
- Division of Pediatric Infectious Diseases, Department of Women's and Children's Health, Padova University - Hospital, Padova, Italy.
| | - Tiziana Masini
- WHO Research for Health Department, World Health Organization, Geneva, Switzerland
| | - Martina Penazzato
- WHO Research for Health Department, World Health Organization, Geneva, Switzerland
| | - Marieke M Van Der Zalm
- Desmond Tutu TB Centre, Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Ali Judd
- MRC Clinical Trials Unit at UCL, University College London, London, UK
| | - Carlo Giaquinto
- Department of Women's and Children's Health, University of Padua, Padua, Italy
- Division of Pediatric Infectious Diseases, Department of Women's and Children's Health, Padova University - Hospital, Padova, Italy
| | - Marc Lallemant
- Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
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Barbieri E, Minotti C, Cavagnis S, Giaquinto C, Cappello B, Penazzato M, Lallemant M. Paediatric medicine issues and gaps from healthcare workers point of view: survey results and a narrative review from the global accelerator for paediatric formulations project. Front Pharmacol 2023; 14:1200848. [PMID: 37529704 PMCID: PMC10390094 DOI: 10.3389/fphar.2023.1200848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/29/2023] [Indexed: 08/03/2023] Open
Abstract
The WHO Model List of Essential Medicines for Children (EMLc) has not been systematically revised in the last few years. We conducted a survey addressed to healthcare professionals prescribing, preparing, or administering medicines to children and a narrative review to identify problematic paediatric formulations or missing medicines in all therapeutic fields to inform the review of the EMLc in 2023. A total of 285 physicians (63%), 28 nurses (6%) and 142 pharmacists (31%), mostly working in the hospital setting, reported at least one problematic medicine. 290 medicines were reported as missing (completely or the child-appropriate formulation). The top three most mentioned were ciprofloxacin together with phenobarbital and omeprazole. 387 medicines were reported as problematic (34% were oral liquid formulations, 34% tablets, 18% parenteral preparations. Mostly of the products were antibacterials (27%), cardiovascular medicines (11%) and antivirals (11%). The obtained responses show the perspective of healthcare workers working around the world, particularly in the European region (25%), in the African region (24%), and in the Region of the Americas (19%), with limited representation from Northern Africa and the Middle East. Our results need to be analysed with the outputs of other ongoing works before specific products can enter the WHO-hosted Global Accelerator for Paediatric formulations network prioritisation process. Efforts to develop appropriate formulations for children should be accelerated so that the uncertainties associated with off-label drug preparation and use are minimised, and therapeutic benefits are optimised.
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Affiliation(s)
- Elisa Barbieri
- Division of Pediatric Infectious Diseases, Department of Women’s and Children’s Health, University of Padova, Padova, Italy
- Penta—Child Health Research, Padova, Italy
| | - Chiara Minotti
- Division of Pediatric Infectious Diseases, Department of Women’s and Children’s Health, University of Padova, Padova, Italy
| | | | - Carlo Giaquinto
- Division of Pediatric Infectious Diseases, Department of Women’s and Children’s Health, University of Padova, Padova, Italy
- Penta—Child Health Research, Padova, Italy
| | - Bernadette Cappello
- Department of Health Products Policy and Standards, World Health Organization, Geneva, Switzerland
| | - Martina Penazzato
- WHO Research for Health Department, World Health Organization, Geneva, Switzerland
| | - Marc Lallemant
- Penta—Child Health Research, Padova, Italy
- Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
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Ruel T, Penazzato M, Zech JM, Archary M, Cressey TR, Goga A, Harwell J, Landovitz RJ, Lain MG, Lallemant M, Namusoke-Magongo E, Mukui I, Permar SR, Prendergast AJ, Shapiro R, Abrams EJ. Novel Approaches to Postnatal Prophylaxis to Eliminate Vertical Transmission of HIV. Glob Health Sci Pract 2023; 11:e2200401. [PMID: 37116934 PMCID: PMC10141432 DOI: 10.9745/ghsp-d-22-00401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 03/01/2023] [Indexed: 04/03/2023]
Abstract
Despite progress in providing antiretroviral therapy to pregnant women living with HIV, a substantial number of vertical transmissions continue to occur. Novel approaches leveraging modern potent, safe, and well-tolerated antiretroviral drugs are urgently needed.
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Affiliation(s)
- Theodore Ruel
- University of California, San Francisco, San Francisco, CA, USA
| | | | - Jennifer M. Zech
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, NY, USA
| | | | - Tim R. Cressey
- AMS-IRD Research Collaboration, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Ameena Goga
- HIV and other Infectious Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Paediatrics and Child Health, University of Pretoria, South Africa
| | | | - Raphael J. Landovitz
- UCLA Center for Clinical AIDS Research and Education, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | | | - Marc Lallemant
- AMS-PHPT Research Collaboration, Chiang Mai University, Chiang Mia, Thailand
- Penta Foundation Italy, Padova, Italy
| | | | - Irene Mukui
- Drugs for Neglected Diseases Initiative, Nairobi, Kenya
| | - Sallie R. Permar
- Department of Pediatrics, Weill Cornell Medicine, New York, NY, USA
| | - Andrew J. Prendergast
- Queen Mary University of London, London, United Kingdom
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Roger Shapiro
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Elaine J. Abrams
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, NY, USA
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Ndongo FA, Kana R, Nono MT, Noah JPYA, Ndzie P, Tejiokem MC, Biheng EH, Ndie J, Nkoa TA, Ketchaji A, Pamen JB, Penda CI, Bissek ACZK, Ndombo POK, Hawa HM, Lallemant M, Faye A. [Problèmes de santé mentale chez les adolescents camerounais infectés par le VIH par voie verticale]. Rev Epidemiol Sante Publique 2023; 71:101422. [PMID: 36706703 DOI: 10.1016/j.respe.2022.101422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 12/07/2022] [Accepted: 12/16/2022] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Adolescents living with HIV are more likely to experience mental health challenges compared to their peers who do not have HIV. However, there is a lack of data regarding the mental health of adolescents living with HIV in Cameroon. Understanding risk factors and protective factors that influence mental health amongst adolescents is critical for effective programming. The purpose of this study was to estimate the prevalence and the factors associated with depression in adolescents infected with HIV and receiving ART in a Cameroonian referral hospital. METHODS This was a cross-sectional study which enrolled adolescents perinatally infected with HIV, aged 10-19 years, on antiretroviral treatment and cared for at "Centre Mère et Enfant de la Fondation Chantal Biya", Yaounde, Cameroon. Structured questionnaires, including validated French versions of the Coopersmith Child Depression Inventory (CDI), the Multidimensional Anxiety Scale for Children (MASC) and the Coopersmith Self Esteem Inventory (SEI), were administered to the study participants by the healthcare providers. RESULTS All in all, 302 adolescents were recruited in the study at a median age of 15.2 years (interquartile range : 12.0 - 17.5), including 159 (52.7 %) girls. Both parents had died for 57 (18.9 %) adolescents ; only the father was alive for 64 (21.2 %) ; only the mother was alive for 48 (15.9 %), both parents were alive for 133 (44.0 %). This study found prevalence of 26.5 % for severe depression, 36.4 % for suicidal ideation, 29.1 % for high/very high anxiety, and 20.5 % for low self-esteem. No factor was found significantly associated with severe depression but there was a trend towards decreased risk of severe depression among adolescents whose mother was alive [OR= 0.4 (0.1-1.0), p = 0.084]. CONCLUSION This study found that elevated depression, anxiety, and low self-esteem symptoms were prevalent among Cameroonian adolescents perinatally infected with HIV. Services and systems should go beyond clinical management of HIV and address the psychosocial and mental health of adolescents. The indicators of mental health among adolescents infected with HIV should be included in HIV program reporting.
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Affiliation(s)
- Francis Ateba Ndongo
- University of Garoua, Cameroon; Centre Mère-enfant, Fondation Chantal Biya, Yaounde, Cameroon; Ministry of Public Health, Yaounde, Cameroun.
| | - Rogacien Kana
- Media Convergence Consulting Office, Yaounde, Cameroon
| | | | | | | | | | | | - Justin Ndie
- Ministry of Public Health, Yaounde, Cameroun
| | | | | | | | | | | | | | | | - Marc Lallemant
- Programs for HIV Prevention and Treatment (PHPT) Foundation -Research Institute for Sustainable Development (IRD), Paris, France
| | - Albert Faye
- Hôpital Universitaire Robert Debré, Paris, France
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Tresch C, Lallemant M, Mottet N, Ramanah R. Placental preservation after surgery of an advanced ovarian pregnancy. J Gynecol Obstet Hum Reprod 2022; 51:102469. [DOI: 10.1016/j.jogoh.2022.102469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 09/02/2022] [Indexed: 11/15/2022]
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Bekker A, Rabie H, Salvadori N, du Toit S, Than-in-at K, Groenewald M, Andrieux-Meyer I, Kumar M, Cressey R, Nielsen J, Capparelli E, Lallemant M, Cotton MF, Cressey TR. Pharmacokinetics and Safety of the Abacavir/Lamivudine/Lopinavir/Ritonavir Fixed-Dose Granule Formulation (4-in-1) in Neonates: PETITE Study. J Acquir Immune Defic Syndr 2022; 89:324-331. [PMID: 34855626 PMCID: PMC8826609 DOI: 10.1097/qai.0000000000002871] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/15/2021] [Indexed: 12/03/2022]
Abstract
BACKGROUND Antiretroviral options for neonates (younger than 28 days) should be expanded. We evaluated the pharmacokinetics, safety, and acceptability of the "4-in-1" fixed-dose pediatric granule formulation of abacavir/lamivudine/lopinavir/ritonavir (30/15/40/10 mg) in neonates. METHODS The PETITE study is an ongoing phase I/II, open-label, single-arm, 2-stage trial conducted in South Africa. In stage 1, term neonates exposed to HIV on standard antiretroviral prophylaxis (nevirapine ± zidovudine) received single dose(s) of the 4-in-1 formulation, followed by intensive pharmacokinetic sampling and safety assessments. At each PK visit, blood was drawn after an observed dose at 1, 2, 4, 8, and 12 hours postdose. In this study, we have reported the planned interim pharmacokinetic and safety analysis after completion of the single-dose administration. RESULTS Sixteen neonates, with a median (range) birth weight of 3130 g (2790-3590 g), completed 24 pharmacokinetic visits. The 4-in-1 formulation imposed relatively high doses of abacavir [8.6 mg/kg (6.6-11.4)] and lamivudine [4.3 mg/kg (3.3-5.7)] but lower doses of lopinavir [11.5 mg/kg (8.8-15.2)]. The geometric means (GM, 90% CI) AUC0-12 of abacavir, lamivudine, and lopinavir were 29.87 (26.29-33.93), 12.61 (10.72-14.83), and 3.49 (2.13-5.72) µg.h/mL, respectively. Lopinavir GM AUC0-12 was below the predefined target (20-100 µg.h/mL), and ritonavir concentrations were only detectable in 4 of the 120 (3%) samples. No adverse events were related to study drugs. No neonate had difficulty swallowing the 4-in-1 formulation. CONCLUSIONS The high doses of abacavir and lamivudine (in mg/kg) and AUCs were safe, and the formulation was well tolerated; however, lopinavir/ritonavir exposures were extremely low, preventing its use in neonates use in neonates. Alternative pediatric solid antiretroviral formulations must be studied in neonates.
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Affiliation(s)
- Adrie Bekker
- Department of Pediatrics and Child Health, Family Centre for Research with Ubuntu, Stellenbosch University, Cape Town, South Africa
| | - Helena Rabie
- Department of Pediatrics and Child Health, Family Centre for Research with Ubuntu, Stellenbosch University, Cape Town, South Africa
| | - Nicolas Salvadori
- AMS-PHPT Research Collaboration, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
- MIVEGEC, University of Montpellier, CNRS, IRD, Montpellier, France
| | - Samantha du Toit
- Department of Pediatrics and Child Health, Family Centre for Research with Ubuntu, Stellenbosch University, Cape Town, South Africa
| | - Kanchana Than-in-at
- AMS-PHPT Research Collaboration, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Marisa Groenewald
- Department of Pediatrics and Child Health, Family Centre for Research with Ubuntu, Stellenbosch University, Cape Town, South Africa
| | | | | | - Ratchada Cressey
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - James Nielsen
- Hassenfield Children's Hospital at NYU Langone, New York, NY
| | | | - Marc Lallemant
- AMS-PHPT Research Collaboration, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Mark F. Cotton
- Department of Pediatrics and Child Health, Family Centre for Research with Ubuntu, Stellenbosch University, Cape Town, South Africa
| | - Tim R. Cressey
- AMS-PHPT Research Collaboration, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
- MIVEGEC, University of Montpellier, CNRS, IRD, Montpellier, France
- Department of Molecular & Clinical Pharmacology, University of Liverpool, Liverpool, United Kingdom
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Nallet C, Puyraveau M, Lallemant M, Ramanah R, Simon A, Krausz M, Riethmuller D, Mottet N. 432 Mid-cavity vacuum-assisted delivery: Description of a large cohort of 1097 women, and development of a clinical risk score of failure. Eur J Obstet Gynecol Reprod Biol 2022. [DOI: 10.1016/j.ejogrb.2021.11.363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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10
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Morin S, Lallemant M, Garcia-Prats A, Lewis L, Watkins M, Giaquinto C, Valentin M, Penazzato M, Reeder JC. Pediatric COVID-19 Therapeutics: Seizing the Right Research and Development Opportunities to Accelerate Access for Children. Pediatr Infect Dis J 2022; 41:e1-e5. [PMID: 34784302 PMCID: PMC8658058 DOI: 10.1097/inf.0000000000003331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2021] [Indexed: 11/30/2022]
Abstract
Children, although at lower risk of poor outcomes from COVID-19 relative to adults, still stand to benefit from therapeutic interventions. Understanding of COVID-19 clinical presentation and prognosis in children is essential to optimize therapeutic trials design. This perspective illustrates how to collectively accelerate pediatric COVID-19 therapeutic research and development, based on the experience of the Global Accelerator for Paediatric Formulations.
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Affiliation(s)
| | - Marc Lallemant
- Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Anthony Garcia-Prats
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Linda Lewis
- Department of Women and Child Health, University of Padova, Padova, Italy
| | - Melynda Watkins
- Department of Women and Child Health, University of Padova, Padova, Italy
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11
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Cressey TR, Abbassi M, Lallemant M, Indolfi G, Al-Nahari M, Farid S, Penazzato M, Easterbrook P, El-Sayed MH. Effective and Safe Daclatasvir Drug Exposures Predicted in Children Using Adult Formulations. Pediatr Infect Dis J 2021. [PMID: 34321444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
BACKGROUND Sofosbuvir (SOF)/daclatasvir (DCV) is the direct-acting antiviral regimen of choice in many low- and middle-income countries for curative treatment of chronic hepatitis C virus (HCV) infection in adults, but data on the use of DCV in children are lacking. We performed a population pharmacokinetic (PK) analysis to predict DCV exposure in children treated with available adult formulations. METHODS DCV concentration data from HCV-infected adolescents receiving SOF/DCV [400/60 mg, once daily (OD)] who participated in a PK study in Egypt were used for model development. PK parameters were estimated using a population approach. Monte Carlo simulations were run for virtual children weighing 10 to <35 kg receiving 60 or 30 mg OD, and DCV exposures were compared with adults ranges. RESULTS Seventeen HCV-infected adolescents (13 males) provided 151 DCV concentrations. Median (range) age was 14 (11-18) years and weight 50 (32-63) kg. In these adolescents receiving 60 mg DCV, median (interquartile range) DCV area under the concentration time curve 0 to 24 hours, maximum concentrations, and minimum concentrations were 11,130 (8140-14,690) ng·h/mL, 1030 (790-1220) ng/mL and 130 (110-220) ng/mL, respectively, compared with 10,343 (7661-14,095) ng·h/mL, 1132 (876-1518) ng/mL and 110 (55.7-192) ng/mL predicted in children 10 to <35 kg receiving 30 mg. The proportion of children with DCV exposures above the adult range rapidly increased for children <30 kg using 60 mg OD, similarly for children 10-14 kg using 30 mg. CONCLUSIONS DCV 30 mg OD was predicted to achieve effective and safe exposures in children 14 to <35 kg, perhaps down to 10 kg. These results should be validated clinically. Low-cost available adult DCV formulations together with approved pediatric doses of SOF would expand global access to HCV treatment for children.
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Affiliation(s)
- Tim R Cressey
- From the AMS-PHPT Research Collaboration, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand.,MIVEGEC, University of Montpellier, CNRS, IRD, Montpellier, France.,Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, United Kingdom
| | - Maggie Abbassi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Marc Lallemant
- From the AMS-PHPT Research Collaboration, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand.,PENTA Foundation, Padova, Italy
| | | | - Mogeb Al-Nahari
- Department of Clinical Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Samar Farid
- Department of Clinical Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Martina Penazzato
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Philippa Easterbrook
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Manal H El-Sayed
- Pediatric Department, Ain Shams University.,Faculty of Medicine, Ain Shams University Research Institute Clinical Research Center (MASRI-CRC), Cairo, Egypt
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Ngo-Giang-Huong N, Leroi C, Fusco D, Cressey TR, Wangsaeng N, Salvadori N, Kongyai N, Sirirungsi W, Lallemant M, Auewarakul P, Khamduang W, Jourdain G. Lack of Association between Adverse Pregnancy Outcomes and Zika Antibodies among Pregnant Women in Thailand between 1997 and 2015. Viruses 2021; 13:1423. [PMID: 34452289 PMCID: PMC8402824 DOI: 10.3390/v13081423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/05/2021] [Accepted: 07/10/2021] [Indexed: 01/28/2023] Open
Abstract
Data about Zika virus infection and adverse pregnancy outcomes in Southeast Asia are scarce. We conducted an unmatched case-control study of Zika virus (ZIKV) serology in pregnant women enrolled in human immunodeficiency virus (HIV) or hepatitis B virus (HBV) perinatal prevention trials between 1997 and 2015 in Thailand. Case and control groups included women with and without adverse pregnancy outcomes. Plasma samples collected during the last trimester of pregnancy were tested for ZIKV IgG/IgM and Dengue IgG/IgM (Euroimmun, AG, Germany). Case newborn plasma samples were tested for ZIKV IgM and ZIKV RNA (Viasure, Spain). The case group included women with stillbirth (n = 22) or whose infants had microcephaly (n = 4), a head circumference below the first percentile (n = 14), neurological disorders (n = 36), or had died within 10 days after birth (n = 11). No women in the case group were positive for ZIKV IgM, and none of their live-born neonates were positive for ZIKV IgM or ZIKV RNA. The overall ZIKV IgG prevalence was 29%, 24% in the case and 34% in the control groups (Fisher's exact test; p = 0.13), while the dengue IgG seroprevalence was 90%. Neither neonatal ZIKV infections nor ZIKV-related adverse pregnancy outcomes were observed in these women with HIV and/or HBV during the 18-year study period.
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Affiliation(s)
- Nicole Ngo-Giang-Huong
- Maladies Infectieuses et Vecteurs: Écologie, Génétique, Évolution et Contrôle (MIVEGEC), Agropolis University Montpellier, Centre National de la Recherche Scientifique (CNRS), Institut de Recherche Pour le Développement (IRD), 34394 Montpellier, France; (T.R.C.); (N.W.); (N.S.); (G.J.)
- Associated Medical Sciences (AMS)-PHPT Research Collaboration, Chiang Mai 50200, Thailand; (C.L.); (W.S.); (M.L.)
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, 110 Inthawaroros Road, Sripoom, Muang, Chiang Mai 50200, Thailand;
| | - Charline Leroi
- Associated Medical Sciences (AMS)-PHPT Research Collaboration, Chiang Mai 50200, Thailand; (C.L.); (W.S.); (M.L.)
| | - Dahlene Fusco
- Department of Medicine, Tulane University, 1430 Tulane Avenue, New Orleans, LA 70112, USA;
| | - Tim R. Cressey
- Maladies Infectieuses et Vecteurs: Écologie, Génétique, Évolution et Contrôle (MIVEGEC), Agropolis University Montpellier, Centre National de la Recherche Scientifique (CNRS), Institut de Recherche Pour le Développement (IRD), 34394 Montpellier, France; (T.R.C.); (N.W.); (N.S.); (G.J.)
- Associated Medical Sciences (AMS)-PHPT Research Collaboration, Chiang Mai 50200, Thailand; (C.L.); (W.S.); (M.L.)
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, 110 Inthawaroros Road, Sripoom, Muang, Chiang Mai 50200, Thailand;
| | - Nantawan Wangsaeng
- Maladies Infectieuses et Vecteurs: Écologie, Génétique, Évolution et Contrôle (MIVEGEC), Agropolis University Montpellier, Centre National de la Recherche Scientifique (CNRS), Institut de Recherche Pour le Développement (IRD), 34394 Montpellier, France; (T.R.C.); (N.W.); (N.S.); (G.J.)
- Associated Medical Sciences (AMS)-PHPT Research Collaboration, Chiang Mai 50200, Thailand; (C.L.); (W.S.); (M.L.)
| | - Nicolas Salvadori
- Maladies Infectieuses et Vecteurs: Écologie, Génétique, Évolution et Contrôle (MIVEGEC), Agropolis University Montpellier, Centre National de la Recherche Scientifique (CNRS), Institut de Recherche Pour le Développement (IRD), 34394 Montpellier, France; (T.R.C.); (N.W.); (N.S.); (G.J.)
- Associated Medical Sciences (AMS)-PHPT Research Collaboration, Chiang Mai 50200, Thailand; (C.L.); (W.S.); (M.L.)
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, 110 Inthawaroros Road, Sripoom, Muang, Chiang Mai 50200, Thailand;
| | - Natedao Kongyai
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, 110 Inthawaroros Road, Sripoom, Muang, Chiang Mai 50200, Thailand;
| | - Wasna Sirirungsi
- Associated Medical Sciences (AMS)-PHPT Research Collaboration, Chiang Mai 50200, Thailand; (C.L.); (W.S.); (M.L.)
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, 110 Inthawaroros Road, Sripoom, Muang, Chiang Mai 50200, Thailand;
| | - Marc Lallemant
- Associated Medical Sciences (AMS)-PHPT Research Collaboration, Chiang Mai 50200, Thailand; (C.L.); (W.S.); (M.L.)
| | - Prasert Auewarakul
- Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok 10700, Thailand;
| | - Woottichai Khamduang
- Associated Medical Sciences (AMS)-PHPT Research Collaboration, Chiang Mai 50200, Thailand; (C.L.); (W.S.); (M.L.)
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, 110 Inthawaroros Road, Sripoom, Muang, Chiang Mai 50200, Thailand;
| | - Gonzague Jourdain
- Maladies Infectieuses et Vecteurs: Écologie, Génétique, Évolution et Contrôle (MIVEGEC), Agropolis University Montpellier, Centre National de la Recherche Scientifique (CNRS), Institut de Recherche Pour le Développement (IRD), 34394 Montpellier, France; (T.R.C.); (N.W.); (N.S.); (G.J.)
- Associated Medical Sciences (AMS)-PHPT Research Collaboration, Chiang Mai 50200, Thailand; (C.L.); (W.S.); (M.L.)
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, 110 Inthawaroros Road, Sripoom, Muang, Chiang Mai 50200, Thailand;
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13
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Tikiso T, McIlleron H, Burger D, Gibb D, Rabie H, Lee J, Lallemant M, Cotton MF, Archary M, Hennig S, Denti P. Abacavir pharmacokinetics in African children living with HIV: A pooled analysis describing the effects of age, malnutrition and common concomitant medications. Br J Clin Pharmacol 2021; 88:403-415. [PMID: 34260082 PMCID: PMC9292832 DOI: 10.1111/bcp.14984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 06/29/2021] [Accepted: 07/03/2021] [Indexed: 11/29/2022] Open
Abstract
Aims Abacavir is part of WHO‐recommended regimens to treat HIV in children under 15 years of age. In a pooled analysis across four studies, we describe abacavir population pharmacokinetics to investigate the influence of age, concomitant medications, malnutrition and formulation. Methods A total of 230 HIV‐infected African children were included, with median (range) age of 2.1 (0.1–12.8) years and weight of 9.8 (2.5–30.0) kg. The population pharmacokinetics of abacavir was described using nonlinear mixed‐effects modelling. Results Abacavir pharmacokinetics was best described by a two‐compartment model with first‐order elimination, and absorption described by transit compartments. Clearance was predicted around 54% of its mature value at birth and 90% at 10 months. The estimated typical clearance at steady state was 10.7 L/h in a child weighing 9.8 kg co‐treated with lopinavir/ritonavir, and was 12% higher in children receiving efavirenz. During coadministration of rifampicin‐based antituberculosis treatment and super‐boosted lopinavir in a 1:1 ratio with ritonavir, abacavir exposure decreased by 29.4%. Malnourished children living with HIV had higher abacavir exposure initially, but this effect waned with nutritional rehabilitation. An additional 18.4% reduction in clearance after the first abacavir dose was described, suggesting induction of clearance with time on lopinavir/ritonavir‐based therapy. Finally, absorption of the fixed dose combination tablet was 24% slower than the abacavir liquid formulation. Conclusion In this pooled analysis we found that children on lopinavir/ritonavir or efavirenz had similar abacavir exposures, while concomitant TB treatment and super‐boosted lopinavir gave significantly reduced abacavir concentrations.
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Affiliation(s)
- Tjokosela Tikiso
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Helen McIlleron
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa.,Wellcome Centre for Infectious Diseases Research in Africa (CIDRI-Africa), Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - David Burger
- Department of Pharmacy, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Diana Gibb
- MRC Clinical Trials Unit at University College London, London, UK
| | - Helena Rabie
- Department of Paediatrics and Child Health and Family Centre for Research with Ubuntu (FAM-CRU), Stellenbosch University and Tygerberg Children's Hospital, Cape Town, South Africa
| | - Janice Lee
- Drugs for Neglected Diseases initiative, Geneva, Switzerland
| | - Marc Lallemant
- Drugs for Neglected Diseases initiative, Geneva, Switzerland
| | - Mark F Cotton
- Department of Paediatrics and Child Health and Family Centre for Research with Ubuntu (FAM-CRU), Stellenbosch University and Tygerberg Children's Hospital, Cape Town, South Africa
| | - Moherndran Archary
- Department of Paediatrics and Child Health at King Edward VIII Hospital affiliated to the Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa
| | - Stefanie Hennig
- Certara, Inc., Princeton, New Jersey, USA.,School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Paolo Denti
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
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14
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Benelmir S, Lallemant M, Manfredelli S, Ramanah R. [How do I perform … a laparoscopic diaphragmatic endometriosis resection]. ACTA ACUST UNITED AC 2021; 49:792-794. [PMID: 33516937 DOI: 10.1016/j.gofs.2021.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Indexed: 11/28/2022]
Affiliation(s)
- S Benelmir
- Pôle mère-femme, service de gynécologie-obstétrique, centre hospitalier universitaire Besançon, 3 Boulevard Alexandre Fleming, 25000Besançon, France
| | - M Lallemant
- Pôle mère-femme, service de gynécologie-obstétrique, centre hospitalier universitaire Besançon, 3 Boulevard Alexandre Fleming, 25000Besançon, France; Laboratoire de nanomédecine, imagerie et thérapeutiques, INSERM EA 4662, Université de Franche-Comté, 19, rue Ambroise Paré, 25000 Besançon, France
| | - S Manfredelli
- Service de chirurgie digestive, centre hospitalier universitaire Besançon, 3, boulevard Alexandre Fleming, 25000 Besançon, France
| | - R Ramanah
- Pôle mère-femme, service de gynécologie-obstétrique, centre hospitalier universitaire Besançon, 3 Boulevard Alexandre Fleming, 25000Besançon, France; Laboratoire de nanomédecine, imagerie et thérapeutiques, INSERM EA 4662, Université de Franche-Comté, 19, rue Ambroise Paré, 25000 Besançon, France.
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15
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Lallemant M, Tresch C, Puyraveau M, Delplanque S, Cosson M, Ramanah R. Evaluating the morbidity and long-term efficacy of laparoscopic sacrocolpopexy with and without robotic assistance for pelvic organ prolapse. J Robot Surg 2020; 15:785-792. [PMID: 33247428 DOI: 10.1007/s11701-020-01177-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 11/12/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of our study was to compare the morbidity and long-term efficacy after laparoscopic sacrocolpopexy with and without robotic assistance. METHODS We conducted a retrospective chart review of all laparoscopic or robotic sacrocolpopexies for POP-Q stage 2-4 vaginal prolapse performed between September 2015 and October 2018 in 2 Gynecologic Surgery Departments of France. Patients were separated into two groups: a laparoscopic sacrocolpopexy group (LS) and a robotic-assisted sacrocolpopexy group (RAS). The primary outcome measure was reoperation procedures for recurrent pelvic organ prolapse (POP). RESULTS Two hundred and fourteen patients were included, 160 patients (75%) in the LS group and 54 patients (25%) in the RAS group. After a mean follow-up of 32.8 months, reoperation rate for recurrent POP and the recurrent POP rate were greater in the RAS group (9.2% versus 1.2%, p = 0.01 and 25.9% versus 7.5%, p = 0.0003, respectively). No significant difference was found in terms of immediate intraoperative (3.1% versus 1.8%, p = 1) and postoperative complications (1.9% versus 1.8%, p = 1). On comparing the 2 groups by bivariate analysis, RAS significantly increased the odds of reoperation for POP recurrence (OR = 7.8 CI 95% [1.5-41.6], p = 0.02) and the odds of global reoperation (OR = 3.8 CI 95% [1.4-10.4], p = 0.0095). Similarly, multivariate logistic analysis showed that RAS increased the risks of global reoperation (OR = 3.8 CI 95% [1.3-10.6], p = 0.01) after controlling high-grade prolapse. CONCLUSION Robotic sacrocolpopexy does not appear to give long-term clinical benefits. Recurrent POP and reoperation procedures seem to be more frequent in case of robotic-assisted surgery.
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Affiliation(s)
- M Lallemant
- Department of Gynecologic Surgery, Besancon University Medical Centre, 3 Alexander Fleming Boulevard, 25000, Besançon, France. .,Nanomedicine Imaging and Therapeutics Laboratory, INSERM EA 4662, University of Franche-Comte, Besançon, France.
| | - C Tresch
- Department of Gynecologic Surgery, Besancon University Medical Centre, 3 Alexander Fleming Boulevard, 25000, Besançon, France
| | - M Puyraveau
- Methodology department, uMETh, Inserm CIC 1431, Besancon University Medical Centre, Besançon, France
| | - S Delplanque
- Department of Gynecologic Surgery, Jeanne de Flandre, University Medical Centre, Lille, France
| | - M Cosson
- Department of Gynecologic Surgery, Jeanne de Flandre, University Medical Centre, Lille, France
| | - R Ramanah
- Department of Gynecologic Surgery, Besancon University Medical Centre, 3 Alexander Fleming Boulevard, 25000, Besançon, France.,Nanomedicine Imaging and Therapeutics Laboratory, INSERM EA 4662, University of Franche-Comte, Besançon, France
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16
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Mazellier S, Lallemant M, Tholozan AS, Terzibachian JJ, Ramanah R. [Buttock abscess: A late complication of prosthetic surgery for stress urinary incontinence]. ACTA ACUST UNITED AC 2020; 48:466-468. [PMID: 32092490 DOI: 10.1016/j.gofs.2020.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Indexed: 10/25/2022]
Affiliation(s)
- S Mazellier
- Service de gynécologie-obstétrique, centre hospitalier de Trevenans hôpital Nord Franche-Comté, 100, route de Moval, 90400 Trevenans France.
| | - M Lallemant
- Service de gynécologie-obstétrique, pôle mère-femme, centre hospitalier universitaire de Besançon, 3, boulevard Alexandre-Fleming 25000 Besançon France
| | - A-S Tholozan
- Service de gynécologie-obstétrique, pôle mère-femme, centre hospitalier universitaire de Besançon, 3, boulevard Alexandre-Fleming 25000 Besançon France
| | - J-J Terzibachian
- Service de gynécologie-obstétrique, centre hospitalier de Trevenans hôpital Nord Franche-Comté, 100, route de Moval, 90400 Trevenans France
| | - R Ramanah
- Service de gynécologie-obstétrique, pôle mère-femme, centre hospitalier universitaire de Besançon, 3, boulevard Alexandre-Fleming 25000 Besançon France
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Kawilapat S, Salvadori N, Ngo-Giang-Huong N, Decker L, Kanjanavanit S, Puangsombat A, Preedisripipat K, Lertpienthum N, Akarathum N, Mekmullica J, Srirompotong U, Lallemant M, Le Coeur S, Traisathit P, Leroi C, Jourdain G. Incidence and risk factors of loss to follow-up among HIV-infected children in an antiretroviral treatment program. PLoS One 2019; 14:e0222082. [PMID: 31527875 PMCID: PMC6748564 DOI: 10.1371/journal.pone.0222082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 08/21/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction The success of antiretroviral treatment (ART) programs can be compromised by high rates of patient loss to follow-up (LTFU). We assessed the incidence and risk factors of LTFU in a large cohort of HIV-infected children receiving ART in Thailand. Methods All children participating in a multicenter cohort (NCT00433030) between 1999 and 2014 were included. The date of LTFU was 9 months after the last contact date. ART interruption was defined as ART discontinuation for more than 7 days followed by resumption of treatment. Baseline and time-dependent risk factors associated with LTFU were identified using Fine and Gray competing risk regression models with death or referral to another hospital as competing events. Results Of 873 children who were followed during a median of 8.6 years (interquartile range 4.5–10.6), 196 were LTFU, 73 died, and 195 referred. The cumulative incidence of LTFU was 2.9% at 1 year, 7.3% at 5 years and 22.2% at 10 years. Children aged 13 years and more had a 3-fold higher risk (95% confidence interval 2.06–4.78) of LTFU than those younger. Children who had interrupted ART within the previous year had a 2.5-fold higher risk (1.12–5.91) than those who had not. The risk of LTFU was lower in children stunted (height-for-age Z-scores <-2 SD) (0.42–0.96) or underweight (weight-for-age Z-scores <-2 SD) (0.24–0.97). Conclusion Adolescence, ART interruption and absence of growth deficit were associated with LTFU. These may be warnings that should draw clinicians’ attention and possibly trigger specific interventions. Children with no significant growth retardation may also be at risk of LTFU.
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Affiliation(s)
- Suttipong Kawilapat
- Institut de recherche pour le développement (IRD, France), U174 –PHPT, Chiang Mai, Thailand
- Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
- Graduate Program in Applied Statistics, Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
| | - Nicolas Salvadori
- Institut de recherche pour le développement (IRD, France), U174 –PHPT, Chiang Mai, Thailand
- Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Nicole Ngo-Giang-Huong
- Institut de recherche pour le développement (IRD, France), U174 –PHPT, Chiang Mai, Thailand
- Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Luc Decker
- Institut de recherche pour le développement (IRD, France), U174 –PHPT, Chiang Mai, Thailand
- Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | | | | | | | | | | | | | | | - Marc Lallemant
- Institut de recherche pour le développement (IRD, France), U174 –PHPT, Chiang Mai, Thailand
- Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Sophie Le Coeur
- Institut de recherche pour le développement (IRD, France), U174 –PHPT, Chiang Mai, Thailand
- Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
- Institut National d'Etudes Démographiques (INED), Paris, France
| | - Patrinee Traisathit
- Institut de recherche pour le développement (IRD, France), U174 –PHPT, Chiang Mai, Thailand
- Data Science Research Center, Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
| | - Charline Leroi
- Institut de recherche pour le développement (IRD, France), U174 –PHPT, Chiang Mai, Thailand
- Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Gonzague Jourdain
- Institut de recherche pour le développement (IRD, France), U174 –PHPT, Chiang Mai, Thailand
- Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
- * E-mail:
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Nebot Giralt A, Nöstlinger C, Lee J, Salami O, Lallemant M, Onyango-Ouma W, Nyamongo I, Marchal B. Understanding acceptance of and adherence to a new formulation of paediatric antiretroviral treatment in the form of pellets (LPV/r)-A realist evaluation. PLoS One 2019; 14:e0220408. [PMID: 31433803 PMCID: PMC6703671 DOI: 10.1371/journal.pone.0220408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 07/14/2019] [Indexed: 11/24/2022] Open
Abstract
Background Improving access to paediatric HIV treatment requires large-scale antiretroviral treatment programmes and medication adapted to infants and children’s needs. The World Health Organisation recommends lopinavir/ritonavir plus two nucleoside reverse transcriptase inhibitors as first-line treatment for all HIV-infected children younger than three years, usually given as a syrup. A pellet formulation (i.e. tiny cylinders of compressed medication put in capsules) was developed to overcome the syrup formulation’s disadvantages such as bitterness, toxicity and cold storage. This study assessed multi-level factors influencing caregivers’ acceptance of and adherence to lopinavir/ritonavir pellets as well as their underlying mechanisms. Methods A realist evaluation (a theory-driven evaluation method considering the social context and mechanisms of change), embedded in a clinical trial was carried out in three hospital settings in Kenya. Data were collected through document review, observations (n = 34) in home and clinic settings and semi-structured interviews (n = 44) with caregivers and providers. Data analysis was based on realist principles. Results High levels of treatment initiation and adherence were observed. Taste masking, neutral packaging and easy storage made the new formulation highly acceptable. Caregivers developed individual strategies to deliver the treatment, particularly to overcome specific problems e.g. in case of just-weaned babies or food shortage. A refined program theory emerged from the triangulated findings showing that ease of administration combined with increased self-efficacy and competences of the caregivers, and effective provider support contributed to high levels of adherence. Conclusions Formulating combined antiretroviral treatment in the form of pellets is clearly a more acceptable solution for infants and children and their caregivers compared to the syrup. Further research in non-trial settings may shed light on factors related to providers, services and the health system that contribute to better adherence of such formulations.
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Affiliation(s)
| | | | - Janice Lee
- Drugs for Neglected Diseases Initiative, Geneva, Switzerland
| | | | - Marc Lallemant
- Drugs for Neglected Diseases Initiative, Geneva, Switzerland
| | - Washington Onyango-Ouma
- Institute of Anthropology, Gender and African Studies, University of Nairobi, Museum Hill, Nairobi, Kenya
| | - Isaac Nyamongo
- Institute of Anthropology, Gender and African Studies, University of Nairobi, Museum Hill, Nairobi, Kenya
| | - Bruno Marchal
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- * E-mail:
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Traisathit P, Urien S, Le Coeur S, Srirojana S, Akarathum N, Kanjanavanit S, Ngampiyaskul C, Krikajornkitti S, Ngo-Giang-Huong N, Lallemant M, Jourdain G. Impact of antiretroviral treatment on height evolution of HIV infected children. BMC Pediatr 2019; 19:287. [PMID: 31421667 PMCID: PMC6697969 DOI: 10.1186/s12887-019-1663-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 08/07/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Antiretroviral treatment (ART) has been shown to have a beneficial effect on the weight evolution but its effect on height remains unclear. We described patterns of height evolution and identified predictors of catch-up growth in HIV-infected children on ART. METHODS To describe the height evolution from birth to adulthood, we developed a nonlinear mixed effect model using data from perinatally HIV-infected children who initiated ART from 1999 to 2013 in a prospective cohort study in Thailand. The main covariates of interest were: sex, ART regimen (dual nucleoside reverse-transcriptase inhibitor, non-nucleoside reverse transcriptase inhibitor (NNRTI)-, or protease inhibitor (PI)-based), baseline CD4 percentage, HIV-RNA load and CDC HIV Classification stage and occurrence of AIDS-defining events. RESULTS A total 477 children (43% boys) contributed 18,596 height measurements over a median duration of 6.3 years on ART (interquartile range, 3.0 to 8.3). At ART initiation, median age was 6.2 years (1.8 to 9.6), 16% of children were underweight (weight-for-age z-score < - 2), 49% presented stunting (height-for-age z-score < - 2), and 7% wasting (weight-for-height z-score < - 2). The most frequent regimen at ART initiation was NNRTI-based (79%). A model with 4 components, birth length and 3 exponential functions of age accounting for the 3 growth phases was developed and show that the height-growth velocity was inversely associated with the age at ART initiation, the adult height was significantly lower in those who had experienced at least one AIDS-defining event while, as expected, the model found that adult height in females was lower than in males. Age at ART initiation, type of ART regimen, CDC stage, CD4 percentages, and HIV-RNA load were not associated with the final height. CONCLUSIONS The younger the children at ART initiation, the greater the effect on height-growth velocity, supporting the World Health Organization's recommendation to start ART as early as possible. However, final adult height was not linked to the age at ART initiation.
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Affiliation(s)
- Patrinee Traisathit
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
| | - Saïk Urien
- Pediatric and perinatal pharmacology, Université de Paris, Paris, France.,Unité de Recherche Clinique Necker Cochin, AP-HP, Hôpital Tarnier, Paris, France.,CIC1419 INSERM, Cochin-Necker, Paris, France
| | - Sophie Le Coeur
- Institut de recherche pour le développement (IRD) UMI 174-PHPT, Marseille, France.,Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand.,Institut d'Etudes Démographiques, Paris, France
| | | | | | | | | | | | - Nicole Ngo-Giang-Huong
- Institut de recherche pour le développement (IRD) UMI 174-PHPT, Marseille, France.,Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand.,Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Marc Lallemant
- Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Gonzague Jourdain
- Institut de recherche pour le développement (IRD) UMI 174-PHPT, Marseille, France. .,Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand. .,Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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20
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Lallemant M, Porté C, Laroche J, Andreoletti JB, Gay C. [Functional or aesthetic labia minora reduction: Complications, revision surgeries and results - a comparative study]. ACTA ACUST UNITED AC 2019; 47:330-336. [PMID: 30771515 DOI: 10.1016/j.gofs.2019.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate and compare the complications, the rate of revision surgeries and the long-term patient postoperative satisfaction level for the two main indications of labia minora reduction: aesthetic or functional. METHODS A comparative, retrospective and multicentered study was carried out in Belfort and Montbéliard hospitals between January 2010 and January 2017. Ninety-two primary labia minora reductions for labia minora hypertrophy have been listed. Each patient has been requested to fill in a questionnaire about the main indication of labiaplasty, any potential complication, a revision surgery and her level of the satisfaction. Patients who had agreed to respond were divided into two groups: a "functional indication" group (FI) and an "aesthetic indication" group (AI). RESULTS Thirty-seven patients (40%) answered the survey: 19 (51%) have been included in the FI group and the remaining 18 (49%) in the AI group. The mean postoperative follow-up duration was 3.2 years. We identified 13 patients (35%) who encountered a postoperative complication. It predominates in the FI group (53% versus 17%, P=0.04). Seven patients (19%) were treated by revision surgeries. All of them belonged to the IF group. Whatever the indication of the labiaplasty, 86% of the patients have been satisfied by the outcomes. CONCLUSION A labia minora reduction is a highly appreciated surgical treatment on the long term whatever the initial surgical indication. However, postoperative complications and revision surgeries are not negligible especially when the main indication is functional.
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Affiliation(s)
- M Lallemant
- Service de chirurgie gynécologique, hôpital Nord Franche-Comté, 100, route de Moval, 90400 Trevenans, France.
| | - C Porté
- Service de chirurgie gynécologique, hôpital Nord Franche-Comté, 100, route de Moval, 90400 Trevenans, France.
| | - J Laroche
- Service de chirurgie gynécologique, hôpital Nord Franche-Comté, 100, route de Moval, 90400 Trevenans, France.
| | - J B Andreoletti
- Service de chirurgie plastique, hôpital Nord Franche-Comté, 100, route de Moval, 90400 Trevenans, France.
| | - C Gay
- Service de chirurgie gynécologique, hôpital Nord Franche-Comté, 100, route de Moval, 90400 Trevenans, France.
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Rabie H, Denti P, Lee J, Masango M, Coovadia A, Pillay S, Liberty A, Simon F, McIlleron H, Cotton MF, Lallemant M. Lopinavir-ritonavir super-boosting in young HIV-infected children on rifampicin-based tuberculosis therapy compared with lopinavir-ritonavir without rifampicin: a pharmacokinetic modelling and clinical study. Lancet HIV 2018; 6:S2352-3018(18)30293-5. [PMID: 30529029 DOI: 10.1016/s2352-3018(18)30293-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 10/08/2018] [Accepted: 10/12/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Rifampicin reduces lopinavir concentrations in HIV and tuberculosis co-treated patients. We hypothesised that adding ritonavir to co-formulated lopinavir-ritonavir (4:1) to achieve a one-to-one ratio would overcome this drug-drug interaction in young children. METHODS We did a prospective, open-label, one-group, one-sequence study at five sites in three South African provinces. We included HIV-infected children with tuberculosis, a bodyweight of 3-15 kg, and a post-conceptional age of more than 42 weeks. Children received the standard four-to-one ratio of lopinavir-ritonavir in the absence of rifampicin-based anti-tuberculosis treatment, whereas super-boosting of lopinavir-ritonavir with additional ritonavir was given orally twice a day to achieve a one-to-one ratio during rifampicin treatment. The primary outcome was the comparison of the proportion of children with predicted lopinavir morning minimum concentrations (Cmin) of more than 1·0 mg/L during super-boosting with the proportion of more than 1·0 mg/L during standard lopinavir-ritonavir treatment without rifampicin. Lopinavir concentrations were determined before and at 1, 2, 4, 6, and 10 h after the morning dose during the second and the last month of tuberculosis co-treatment, and 4-6 weeks after stopping rifampicin. A non-linear mixed-effects model was implemented to interpret the data and Monte Carlo simulations were used to compare the percentage of lopinavir with morning Cmin values of less than 1·0 mg/L for the two dosing schemes. A non-inferiority margin of 10% was used. This study is registered with ClinicalTrials.gov, number NCT02348177. FINDINGS Between Jan 30, 2013, and Nov 9, 2015, 96 children with a median age of 18·2 months (IQR 9·6-26·8) were enrolled. Of these 96 children, 80 (83%) completed the first three pharmacokinetic evaluations. Tuberculosis therapy was started before antiretrovirals in 70 (73%) children. The model-predicted percentage of morning Cmin of less than 1·0 mg/L after tuberculosis treatment without super-boosting was 8·8% (95% CI 0·6-19·8) versus 7·6% (0·4-16·2) during super-boosting and tuberculosis treatment. The difference of -1·1% (95% CI -6·9 to 3·2), at a non-inferiority margin of 10%, confirmed the non-inferiority of lopinavir trough concentrations during rifampicin co-treatment. 19 serious adverse events were reported in 12 participants. Three deaths and a temporary treatment interruption due to jaundice were unrelated to study treatment. INTERPRETATION Lopinavir exposure with ritonavir super-boosting in a one-to-one ratio during rifampicin-based tuberculosis treatment was non-inferior to the exposure with lopinavir-ritonavir without rifampicin. Safe and effective, field application of super-boosting is limited by poor acceptability. Access to better adapted solid formulations will most likely facilitate public health implementation of this strategy. FUNDING DNDi, French Development Agency, UBS Optimus Foundation, and Unitaid.
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Affiliation(s)
- Helena Rabie
- Department of Pediatrics and Child Health and Family Clinical Research Unit, University of Stellenbosch, Cape Town, South Africa.
| | - Paolo Denti
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Janice Lee
- Drugs for Neglected Diseases Initiative, Geneva, Switzerland
| | - Mhleli Masango
- Shandukani Research Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Ashraf Coovadia
- Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Sandy Pillay
- Enhancing Care Foundation-Durban International Clinical Research, Wentworth Hospital, Durban, South Africa
| | - Afaaf Liberty
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - François Simon
- Drugs for Neglected Diseases Initiative, Geneva, Switzerland
| | - Helen McIlleron
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Mark F Cotton
- Department of Pediatrics and Child Health and Family Clinical Research Unit, University of Stellenbosch, Cape Town, South Africa
| | - Marc Lallemant
- Drugs for Neglected Diseases Initiative, Geneva, Switzerland
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Traisathit P, Delory T, Ngo-Giang-Huong N, Somsamai R, Techakunakorn P, Theansavettrakul S, Kanjanavanit S, Mekmullica J, Ngampiyaskul C, Na-Rajsima S, Lallemant M, Cressey TR, Jourdain G, Collins IJ, Le Coeur S. Brief Report: AIDS-Defining Events and Deaths in HIV-Infected Children and Adolescents on Antiretrovirals: A 14-Year Study in Thailand. J Acquir Immune Defic Syndr 2018; 77:17-22. [PMID: 29040162 PMCID: PMC6047734 DOI: 10.1097/qai.0000000000001571] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Data are scarce on the long-term clinical outcomes of perinatally HIV-infected children and adolescents receiving antiretroviral therapy (ART) in low/middle-income countries. We assessed the incidence of mortality before (early) and after (late) 6 months of ART and of the composite outcome of new/recurrent AIDS-defining event or death >6 months after ART start (late AIDS/death) and their associated factors. METHODS Study population was perinatally HIV-infected children (≤18 years) initiating ART within the Program for HIV Prevention and Treatment observational cohort (NCT00433030). Factors associated with late AIDS/death were assessed using competing risk regression models accounting for lost to-follow-up and included baseline and time-updated variables. RESULTS Among 619 children, "early" mortality incidence was 99 deaths per 1000 person-years of follow-up [95% confidence interval (CI): 69 to 142] and "late" mortality 6 per 1000 person-years of follow-up (95% CI: 4 to 9). Of the 553 children alive >6 months after ART initiation, median age at ART initiation was 6.4 years, CD4% 8.2%, and HIV-RNA load 5.1 log10 copies/mL. Thirty-eight (7%) children developed late AIDS/death after median time of 3.3 years: 24 died and 24 experienced new/recurrent AIDS-defining events (10 subsequently died). Factors independently associated with late AIDS/death were current age ≥13 years (adjusted subdistribution hazard ratio 4.9; 95% CI: 2.4 to 10.1), HIV-RNA load always ≥400 copies/mL (12.3; 95% CI: 4.0 to 37.6), BMI-z-score always <-2 SD (13.7; 95% CI: 3.4 to 55.7), and hemoglobin <8 g/dL at least once (4.6; 95% CI: 2.0 to 10.5). CONCLUSIONS After the initial 6 months of ART, being an adolescent, persistent viremia, poor nutritional status, and severe anemia were associated with poor clinical outcomes. This supports the need for novel interventions that target children, particularly adolescents with poor growth and uncontrolled viremia.
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Affiliation(s)
- Patrinee Traisathit
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
- Institut de recherche pour le développement (IRD) UMI 174-PHPT, Marseille, France
- Center of Excellence in Bioresources for Agriculture, Industry and Medicine, Chiang Mai University, Thailand
| | - Tristan Delory
- Institut de recherche pour le développement (IRD) UMI 174-PHPT, Marseille, France
- APHP, Service de maladies infectieuses et tropicales, hôpital Saint Louis, F-75010, Paris, France
| | - Nicole Ngo-Giang-Huong
- Institut de recherche pour le développement (IRD) UMI 174-PHPT, Marseille, France
- Department of Medical Technology, Faculty of Associated Medical Science, Chiang Mai University, Chiang Mai, Thailand
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | | | | | | | | | | | | | - Marc Lallemant
- Institut de recherche pour le développement (IRD) UMI 174-PHPT, Marseille, France
- Department of Medical Technology, Faculty of Associated Medical Science, Chiang Mai University, Chiang Mai, Thailand
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Tim R Cressey
- Institut de recherche pour le développement (IRD) UMI 174-PHPT, Marseille, France
- Department of Medical Technology, Faculty of Associated Medical Science, Chiang Mai University, Chiang Mai, Thailand
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Molecular & Clinical Pharmacology, University of Liverpool, UK
| | - Gonzague Jourdain
- Institut de recherche pour le développement (IRD) UMI 174-PHPT, Marseille, France
- Department of Medical Technology, Faculty of Associated Medical Science, Chiang Mai University, Chiang Mai, Thailand
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Intira Jeannie Collins
- MRC Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, UK
| | - Sophie Le Coeur
- Institut de recherche pour le développement (IRD) UMI 174-PHPT, Marseille, France
- Department of Medical Technology, Faculty of Associated Medical Science, Chiang Mai University, Chiang Mai, Thailand
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Institut national d’études démographiques (INED), F-75020 Paris, France
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Balasubramanian R, Fowler MG, Dominguez K, Lockman S, Tookey PA, Huong NNG, Nesheim S, Hughes MD, Lallemant M, Tosswill J, Shaffer N, Sherman G, Palumbo P, Shapiro DE. Time to first positive HIV-1 DNA PCR may differ with antiretroviral regimen in infants infected with non-B subtype HIV-1. AIDS 2017; 31:2465-2474. [PMID: 28926397 PMCID: PMC5710822 DOI: 10.1097/qad.0000000000001640] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the association of type and timing of prophylactic maternal and infant antiretroviral regimen with time to first positive HIV-1 DNA PCR test, in nonbreastfed HIV-infected infants, from populations infected predominantly with HIV-1 non-B subtype virus. DESIGN Analysis of combined data on nonbreastfed HIV-infected infants from prospective cohorts in Botswana, Thailand, and the United Kingdom (N = 405). METHODS Parametric models appropriate for interval-censored outcomes estimated the time to first positive PCR according to maternal or infant antiretroviral regimen category and timing of maternal antiretroviral initiation, with adjustment for covariates. RESULTS Maternal antiretroviral regimens included: no antiretrovirals (n = 138), single-nucleoside analog reverse transcriptase inhibitor (n = 165), single-dose nevirapine with zidovudine (n = 66), and combination prophylaxis with 3 or more antiretrovirals [combination antiretroviral therapy (cART), n = 36]. Type of maternal/infant antiretroviral regimen and timing of maternal antiretroviral initiation were each significantly associated with time to first positive PCR (multivariate P < 0.0001). The probability of a positive test with no antiretrovirals compared with the other regimen/timing groups was significantly lower at 1 day after birth, but did not differ significantly after age 14 days. In a subgroup of 143 infants testing negative at birth, infant cART was significantly associated with longer time to first positive test (multivariate P = 0.04). CONCLUSION Time to first positive HIV-1 DNA PCR in HIV-1-infected nonbreastfed infants (non-B HIV subtype) may differ according to maternal/infant antiretroviral regimen and may be longer with infant cART, which may have implications for scheduling infant HIV PCR-diagnostic testing and confirming final infant HIV status.
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Affiliation(s)
- Raji Balasubramanian
- aDepartment of Biostatistics and Epidemiology, University of Massachusetts-Amherst, Amherst, Massachusetts bDepartment of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland cDivision of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia dDivision of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Boston eDepartment of Immunology and Infectious Diseases, Harvard University, T. H. Chan School of Public Health, Boston, Massachusetts, USA fBotswana Harvard AIDS Institute Partnership, Gaborone, Botswana gUniversity College Institute of Child Health, London, UK hInstitut de recherche pour le développement (IRD) UMI 174-PHPT, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand iDepartment of Biostatistics, Harvard University T. H. Chan School of Public Health, Boston, Massachusetts, USA jVirus Reference Department, National Infection Service, Public Health England, London, UK kDepartment of HIV/AIDS, World Health Organization, Geneva, Switzerland lDepartment of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand and National Institute for Communicable Diseases, Johannesburg, South Africa mSection of Infectious Diseases and International Health, Geisel School of Medicine at Dartmouth, 1 Medical Center Dr, Lebanon, New Hampshire nCenter for Biostatistics in AIDS Research, Harvard University T. H. Chan School of Public Health. Boston, Massachusetts, USA
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Cressey TR, Punyawudho B, Le Coeur S, Jourdain G, Saenjum C, Capparelli E, Jittayanun K, Phanomcheong S, Luvira A, Borkird T, Puangsombat A, Aarons L, Sukrakanchana PO, Urien S, Lallemant M. Assessment of Nevirapine Prophylactic and Therapeutic Dosing Regimens for Neonates. J Acquir Immune Defic Syndr 2017; 75:554-560. [PMID: 28489732 PMCID: PMC5508655 DOI: 10.1097/qai.0000000000001447] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Nevirapine (NVP) is a key component of antiretroviral prophylaxis and treatment for neonates. We evaluated current World Health Organization (WHO) weight-band NVP prophylactic dosing recommendations and investigated optimal therapeutic NVP dosing for neonates. METHODS The PHPT-5 study in Thailand assessed the efficacy of "Perinatal Antiretroviral Intensification" to prevent mother-to-child transmission of HIV in women with <8 weeks of antiretroviral treatment before delivery (NCT01511237). Infants received a 2-week course of zidovudine/lamivudine/NVP (NVP syrup/once daily: 2 mg/kg for 7 days; then 4 mg/kg for 7 days). Infant samples were assessed during the first 2 weeks of life. NVP population pharmacokinetics (PK) parameters were estimated using nonlinear mixed-effects models. Simulations were performed to estimate the probability of achieving target NVP trough concentrations for prophylaxis (>0.10 mg/L) and for therapeutic efficacy (>3.0 mg/L) using different infant dosing strategies. RESULTS Sixty infants (55% male) were included. At birth, median (range) weight was 2.9 (2.3-3.6) kg. NVP concentrations were best described by a 1-compartment PK model. Infant weight and postnatal age influenced NVP PK parameters. Based on simulations for a 3-kg infant, ≥92% would have an NVP trough >0.1 mg/L after 48 hours through 2 weeks using the PHPT-5 and WHO-dosing regimens. For NVP-based therapy, a 6-mg/kg twice daily dose produced a trough >3.0 mg/L in 87% of infants at 48 hours and 80% at 2 weeks. CONCLUSION WHO weight-band prophylactic guidelines achieved target concentrations. Starting NVP 6 mg/kg twice daily from birth is expected to achieve therapeutic concentrations during the first 2 weeks of life.
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Affiliation(s)
- Tim R. Cressey
- PHPT/IRD 174, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
- Department of Immunology & Infectious Diseases, Boston, Harvard T.H Chan School of Public Health, MA, USA
- Department of Molecular & Clinical Pharmacology, University of Liverpool, UK
| | - Baralee Punyawudho
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Sophie Le Coeur
- PHPT/IRD 174, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
- Department of Immunology & Infectious Diseases, Boston, Harvard T.H Chan School of Public Health, MA, USA
- Institut d’Etudes Démographiques, Paris, France
| | - Gonzague Jourdain
- PHPT/IRD 174, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
- Department of Immunology & Infectious Diseases, Boston, Harvard T.H Chan School of Public Health, MA, USA
- Institut de Recherche pour le Développement (IRD) UMI 174-PHPT, Marseille, France
| | - Chalermpong Saenjum
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Chiang Mai University, Thailand
| | | | - Kanokwan Jittayanun
- Pediatric Department, Health Promotion Center Region 10, Chiang Mai, Thailand
| | | | - Anita Luvira
- Pediatric Department, Nopparat Rajathanee Hospital
| | | | | | - Leon Aarons
- Manchester Pharmacy School, The University of Manchester, Manchester, UK
| | | | - Saik Urien
- EAU7323 Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Marc Lallemant
- PHPT/IRD 174, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
- Department of Immunology & Infectious Diseases, Boston, Harvard T.H Chan School of Public Health, MA, USA
- Institut de Recherche pour le Développement (IRD) UMI 174-PHPT, Marseille, France
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Lallemant M, Baeza C, Monnin C, Malincenco M, Gay C. [Self-evaluation of conization indications since the introduction of the French colposcopy and cervico-vaginal pathology quality charter in 2 colposcopy centers]. ACTA ACUST UNITED AC 2017; 45:421-428. [PMID: 28716490 DOI: 10.1016/j.gofs.2017.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 06/06/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Analyze the efficiency of the implementation of the colposcopy and cervico-vaginal pathology quality charter. The question was to determine whether the criteria of more than 70% of excisional conizations containing CIN2+ lesions (cervical intraepithelial neoplasia 2 or 3 or carcinoma in situ) had been reached and demonstrate a reduction of the conization rate is possible. METHODS An epidemiological descriptive, retrospective and multicenter study was performed in "Nord Franche-Comté Hospitals" (Belfort and Montbéliard, France) during the period from November 2013 to January 2015. Inclusion criteria were patients over 25 years undergoing cervical excisions for diagnostic and/or therapeutic purposes after Pap smear screening followed by colposcopically directed biopsies. The files were selected from a data collection and studied using the computerized patient record. RESULTS In total, 116 conizations were performed: 103 by four French Society of Colposcopy and Cervico-Vaginal Pathology (SFCPCV) members and 13 by four SFCPCV non-members. The overall result of the primary outcome showed 53% of CIN2+ lesions found in cervical conization specimens, which can be broken down to 55% for the group of SFCPCV members and to 38% for the group of SFCPCV non-members. The statistical analysis indicates a significant difference (P=0.02) in the percentage of CIN2+ lesions discovered on the surgical specimen for the group of SFCPCV members. CONCLUSIONS This self-evaluation shows that it is essential to be a SFCPCV member and to adhere to the charter. By complying with the charter and associating the new National Cancer Institute recommendations (December 2016), it is possible to reduce the conization rate and even to surpass the target of more than 70% of excisional conizations containing CIN2+ lesions.
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Affiliation(s)
- M Lallemant
- Service de gynécologie, Hôpital Nord Franche-Comté, 100, route de Moval, 90400 Trevenans, France.
| | - C Baeza
- Service de gynécologie, Hôpital Nord Franche-Comté, 100, route de Moval, 90400 Trevenans, France
| | - C Monnin
- Service d'anatomopathologie, Hôpital Nord Franche-Comté, 100, route de Moval, 90400 Trevenans, France
| | - M Malincenco
- Service de gynécologie, Hôpital Nord Franche-Comté, 100, route de Moval, 90400 Trevenans, France
| | - C Gay
- Service de gynécologie, Hôpital Nord Franche-Comté, 100, route de Moval, 90400 Trevenans, France
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Salvadori N, Ngo-Giang-Huong N, Duclercq C, Kanjanavanit S, Ngampiyaskul C, Techakunakorn P, Puangsombat A, Figoni J, Mary JY, Collins IJ, Cressey TR, Le Cœur S, Sirirungsi W, Lallemant M, McIntosh K, Jourdain G. Incidence of Tuberculosis and Associated Mortality in a Cohort of Human Immunodeficiency Virus-Infected Children Initiating Antiretroviral Therapy. J Pediatric Infect Dis Soc 2017; 6:161-167. [PMID: 28204517 PMCID: PMC5907848 DOI: 10.1093/jpids/piw090] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 01/26/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND. We assessed the incidence of tuberculosis, risk factors for tuberculosis, and the contribution of tuberculosis on mortality in a large cohort of human immunodeficiency virus (HIV)-infected children <15 years of age initiating first-line antiretroviral therapy (ART) between 1999 and 2012 in Thailand, one of the 22 high tuberculosis burden countries. METHODS. A physician reviewed and classified tuberculosis cases. Incidence was the number of children with incident tuberculosis, defined as a first or recurrent tuberculosis diagnosis >30 days after ART initiation, divided by the total person-years of follow-up (PYFU). Risk factors for incident tuberculosis were identified using Fine and Gray's competing risks models, with death from other causes treated as a competing event, and risk factors for death were identified using Cox models. RESULTS. At ART initiation, 670 children (55% female) had a median age of 6.4 years (interquartile range, 2.0-9.6), body mass index-for-age z-score -0.8 (-1.9 to 0.0), HIV ribonucleic acid viral load 5.1 log10 copies/mL (4.6-5.6), and CD4 9% (3-17). Median duration of follow-up was 7.7 years. Tuberculosis incidence was 7 per 1000 PYFU (95% confidence interval [CI], 5-11) and decreased with ART duration. Lower age-adjusted hemoglobin, hematocrit, and CD4 at ART initiation were associated with a higher risk of incident tuberculosis. Of the 30 incident tuberculosis cases, 9 died. Diagnosis of incident tuberculosis was associated with mortality (unadjusted hazard ratio = 10.2, 95% CI = 4.8-21.5, P < .001 and adjusted hazard ratio = 5.4, 95% CI = 2.5-11.7, P < .001). CONCLUSIONS. Incident tuberculosis was strongly associated with mortality. CD4 counts or hemoglobin or hematocrit levels may prompt clinicians to consider a possible tuberculosis infection.
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Affiliation(s)
- Nicolas Salvadori
- Institut de Recherche Pour le Développement, Unité Mixte Internationale 174-Program for HIV Prevention and Treatment, Marseille, France;,Faculty of Associated Medical Sciences, Chiang Mai University, Thailand
| | - Nicole Ngo-Giang-Huong
- Institut de Recherche Pour le Développement, Unité Mixte Internationale 174-Program for HIV Prevention and Treatment, Marseille, France;,Faculty of Associated Medical Sciences, Chiang Mai University, Thailand;,Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Chloé Duclercq
- Institut de Recherche Pour le Développement, Unité Mixte Internationale 174-Program for HIV Prevention and Treatment, Marseille, France;,Faculty of Associated Medical Sciences, Chiang Mai University, Thailand
| | | | | | | | | | - Julie Figoni
- Institut de Recherche Pour le Développement, Unité Mixte Internationale 174-Program for HIV Prevention and Treatment, Marseille, France;,Faculty of Associated Medical Sciences, Chiang Mai University, Thailand
| | - Jean-Yves Mary
- Institut National de la Santé et de la Recherche Médicale Unité 1153, Equipe Epidémiologie Clinique, Statistique pour la Recherche en Santé, Université Paris Diderot - Paris 7, Hôpital Saint-Louis, France
| | - Intira J. Collins
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, United Kingdom
| | - Tim R. Cressey
- Institut de Recherche Pour le Développement, Unité Mixte Internationale 174-Program for HIV Prevention and Treatment, Marseille, France;,Faculty of Associated Medical Sciences, Chiang Mai University, Thailand;,Harvard T.H. Chan School of Public Health, Boston, Massachusetts;,Department of Molecular and Clinical Pharmacology, University of Liverpool, United Kingdom
| | - Sophie Le Cœur
- Institut de Recherche Pour le Développement, Unité Mixte Internationale 174-Program for HIV Prevention and Treatment, Marseille, France;,Faculty of Associated Medical Sciences, Chiang Mai University, Thailand;,Institut National d’Etudes Démographiques, Mortality, Health and Epidemiology Unit, Paris, France
| | - Wasna Sirirungsi
- Faculty of Associated Medical Sciences, Chiang Mai University, Thailand
| | - Marc Lallemant
- Institut de Recherche Pour le Développement, Unité Mixte Internationale 174-Program for HIV Prevention and Treatment, Marseille, France;,Faculty of Associated Medical Sciences, Chiang Mai University, Thailand;,Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Kenneth McIntosh
- Boston Children’s Hospital and Harvard Medical School, Massachusetts
| | - Gonzague Jourdain
- Institut de Recherche Pour le Développement, Unité Mixte Internationale 174-Program for HIV Prevention and Treatment, Marseille, France;,Faculty of Associated Medical Sciences, Chiang Mai University, Thailand;,Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Penazzato M, Gnanashanmugam D, Rojo P, Lallemant M, Lewis LL, Rocchi F, Saint Raymond A, Ford N, Hazra R, Giaquinto C, Belew Y, Gibb DM, Abrams EJ. Optimizing Research to Speed Up Availability of Pediatric Antiretroviral Drugs and Formulations. Clin Infect Dis 2017; 64:1597-1603. [PMID: 29190337 PMCID: PMC5927327 DOI: 10.1093/cid/cix194] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 03/02/2017] [Indexed: 01/07/2023] Open
Abstract
Globally 1.8 million children are living with human immunodeficiency virus (HIV), yet only 51% of those eligible actually start treatment. Research and development (R&D) for pediatric antiretrovirals (ARVs) is a lengthy process and lags considerably behind drug development in adults. Providing safe, effective, and well-tolerated drugs for children remains critical to ensuring scale-up globally. We review current approaches to R&D for pediatric ARVs and suggest innovations to enable simplified, faster, and more comprehensive strategies to develop optimal formulations. Several approaches could be adopted, including focusing on a limited number of prioritized formulations and strengthening existing partnerships to ensure that pediatric investigation plans are developed early in the drug development process. Simplified and more efficient mechanisms to undertake R&D need to be put in place, and financing mechanisms must be made more sustainable. Lessons learned from HIV should be shared to support progress in developing pediatric formulations for other diseases, including tuberculosis and viral hepatitis.
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Affiliation(s)
| | - Devasena Gnanashanmugam
- Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Pablo Rojo
- Hospital 12 de Octubre, Facultad de Medicina, Universidad Complutense, Madrid, Spain
- Paediatric European Network for Treatment of AIDS, Padua, Italy
| | - Marc Lallemant
- Drugs for Neglected Diseases Initiative, Geneva, Switzerland
| | - Linda L Lewis
- Clinton Health Access Initiative, Bethesda, Maryland
| | | | | | - Nathan Ford
- HIV Department, World Health Organization, Geneva, Switzerland
| | - Rohan Hazra
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Carlo Giaquinto
- Department of Women and Child Health, University of Padua, Italy
| | - Yodit Belew
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Diana M Gibb
- Medical Research Council Clinical Trials Unit, University College London, United Kingdom
| | - Elaine J Abrams
- ICAP, Mailman School of Public Health and
- College of Physicians and Surgeons, Columbia University, New York
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Nebot Giralt A, Nöstlinger C, Lee J, Salami O, Lallemant M, Ouma O, Nyamongo I, Marchal B. Understanding the acceptability and adherence to paediatric antiretroviral treatment in the new formulation of pellets (LPV/r): the protocol of a realist evaluation. BMJ Open 2017; 7:e014528. [PMID: 28360249 PMCID: PMC5372016 DOI: 10.1136/bmjopen-2016-014528] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Improving access to paediatric HIV treatment requires both large-scale treatment programmes and medication that is adapted to infants and children's needs. The WHO recommends lopinavir/ritonavir as first-line antiretroviral therapy for all HIV-infected children younger than 3 years. There is currently little evidence on the acceptability of, and adherence to, a formulation of this combination treatment if given in the form of pellets. This protocol presents how we will carry a realist evaluation to assess the factors that contribute to the acceptability and adherence to the new pellets formulation in 3 hospitals in Kenya. METHODS We structured the protocol along the realist evaluation cycle following 4 steps: (1) the initial programme theory, (2) the study design, (3) the data collection methods and (4) the data analysis plan. Theories of behavioural sciences were reviewed for frames that could provide insights into how using such new formulations may contribute to better acceptability and adherence. ETHICS AND DISSEMINATION This study was approved by the Institutional Review Board of the Institute of Tropical Medicine, the Ethical Committee of the University Hospital Antwerp and the Kenyatta National Hospital/University of Nairobi Ethics and Research Committee. We aim to disseminate the findings through international conferences and peer-reviewed journals and to share them with Drugs for Neglected Diseases initiative's (DNDi) programme managers and with the Kenyan healthcare providers. DISCUSSION In developing this study, we encountered some challenges. First, methods to measure the acceptability of any formulation and adherence to it are not standardised. The second challenge is common in realist evaluation and relates to how to choose from different potentially interesting theoretical frameworks. We identified relevant and empirically tested theories from behavioural science that may be helpful in our study. We will test them in 3 settings by exploring the multilevel factors that influence acceptability and adherence of this new paediatric Antiretroviral (ARV) formulation.
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Affiliation(s)
| | | | - Janice Lee
- Drugs for Neglected Diseases Initiative, Geneva, Switzerland
| | | | - Marc Lallemant
- Drugs for Neglected Diseases Initiative, Geneva, Switzerland
| | - Onyango Ouma
- Institute of Anthropology, Gender and African Studies, University of Nairobi, Nairobi, Kenya
| | - Isaac Nyamongo
- Institute of Anthropology, Gender and African Studies, University of Nairobi, Nairobi, Kenya
| | - Bruno Marchal
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Rabie H, Decloedt EH, Garcia-Prats AJ, Cotton MF, Frigati L, Lallemant M, Hesseling A, Schaaf HS. Antiretroviral treatment in HIV-infected children who require a rifamycin-containing regimen for tuberculosis. Expert Opin Pharmacother 2017; 18:589-598. [PMID: 28346018 DOI: 10.1080/14656566.2017.1309023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION In high prevalence settings, tuberculosis and HIV dual infection and co-treatment is frequent. Rifamycins, especially rifampicin, in combination with isoniazid, ethambutol and pyrazinamide are key components of short-course antituberculosis therapy. Areas covered: We reviewed available data, for which articles were identified by a Pubmed search, on rifamycin-antiretroviral interactions in HIV-infected children. Rifamycins have potent inducing effects on phase I and II drug metabolising enzymes and transporters. Antiretroviral medications are often metabolised by the enzymes induced by rifamycins or may suppress specific enzyme activity leading to drug-drug interactions with rifamycins. These may cause significant alterations in their phamacokinetic and pharmacodynamic properties, and sometimes that of the rifamycin. Recommended strategies to adapt to these interactions include avoidance and dose adjustment. Expert opinion: Despite the importance and frequency of tuberculosis as an opportunistic disease in HIV-infected children, current data on the management of co-treated children is based on few studies. We need new strategies to rapidly assess the use of rifamycins, new anti-tuberculosis drugs and antiretroviral drugs together as information on safety and dosing of individual drugs becomes available.
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Affiliation(s)
- Helena Rabie
- a Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences , Stellenbosch University and Tygerberg Hospital , Cape Town , South Africa.,b Children's Infectious Diseases Clinical Research Unit , Stellenbosch University , Cape Town , South Africa
| | - Eric H Decloedt
- c Division of Clinical Pharmacology, Faculty of Medicine and Health Sciences , Stellenbosch University and Tygerberg Hospital , Cape Town , South Africa
| | - Anthony J Garcia-Prats
- d Desmond Tutu TB Centre, Faculty of Medicine and Health Sciences , Stellenbosch University , Cape Town , South Africa
| | - Mark F Cotton
- a Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences , Stellenbosch University and Tygerberg Hospital , Cape Town , South Africa.,b Children's Infectious Diseases Clinical Research Unit , Stellenbosch University , Cape Town , South Africa
| | - Lisa Frigati
- a Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences , Stellenbosch University and Tygerberg Hospital , Cape Town , South Africa.,b Children's Infectious Diseases Clinical Research Unit , Stellenbosch University , Cape Town , South Africa
| | - Marc Lallemant
- e Pediatric HIV Program , Drugs for Neglected Diseases Initiative , Geneva , Switzerland
| | - Anneke Hesseling
- d Desmond Tutu TB Centre, Faculty of Medicine and Health Sciences , Stellenbosch University , Cape Town , South Africa
| | - H Simon Schaaf
- a Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences , Stellenbosch University and Tygerberg Hospital , Cape Town , South Africa.,d Desmond Tutu TB Centre, Faculty of Medicine and Health Sciences , Stellenbosch University , Cape Town , South Africa
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Delory T, Ngo-Giang-Huong N, Rangdaeng S, Chotivanich N, Limtrakul A, Putiyanun C, Suriyachai P, Matanasarawut W, Jarupanich T, Liampongsabuddhi P, Heard I, Jourdain G, Lallemant M, Le Coeur S. Human Papillomavirus infection and cervical lesions in HIV infected women on antiretroviral treatment in Thailand. J Infect 2017; 74:501-511. [PMID: 28254419 DOI: 10.1016/j.jinf.2017.02.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 02/19/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To estimate the prevalence and factors associated with Human Papillomavirus (HPV) infection, HPV genotypes and cytological/histological high-grade (HSIL+/CIN2+) lesions. METHODS We conducted a cross-sectional study within a prospective cohort of HIV-infected women on combination antiretroviral therapy (cART). Cervical specimens were collected for cytology and HPV genotyping (Papillocheck®). Any women with High-Risk-HPV (HR-HPV), and/or potentially HR-HPV (pHR-HPV) and/or ASC-US or higher (ASC-US+) lesions were referred for colposcopy. Factors associated with HR-HPV infection and with HSIL+/CIN2+ lesions were investigated using mixed-effects logistic regression models. RESULTS 829 women were enrolled: median age 40.4 years, on cART for a median of 6.9 years, median CD4 cell-count 536 cells/mm3, and 788 (96%) with HIV-viral load<50copies/mL. Of 214 (26%) infected with HPV: 159 (19%) had ≥1 HR-HPV, of whom 38 (5%) HPV52, 22 (3%) HPV16, 9 (1%) HPV18; 21 (3%) had pHR-HPV, 34 (4%) low risk-HPV infection, and 56 (26%) had multiple genotypes. Younger age, low CD4 cell-counts and low education were independently associated with HR-HPV infection. 72 women (9%) had ASC-US+ and 28 (3%) HSIL+/CIN2+ lesions. HR-HPV infection was independently associated with HSIL+/CIN2+ lesions. CONCLUSION The prevalence of HPV infection and of cervical lesions was low. The HPV genotype distribution supports the use of 9-valent vaccine in Thailand.
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Affiliation(s)
- Tristan Delory
- Institut de recherche pour le développement (IRD) UMI 174-PHPT, Marseille, France; Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand; APHP, Service de maladies infectieuses et tropicales, hôpital Saint Louis, F-75010, Paris, France; Institut National d'Etudes Démographiques (Ined), UR-5, Paris, France.
| | - Nicole Ngo-Giang-Huong
- Institut de recherche pour le développement (IRD) UMI 174-PHPT, Marseille, France; Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand; Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Samreung Rangdaeng
- Faculty of Medicine, Department of Pathology, Chiang Mai University, Chiang Mai, Thailand
| | | | - Aram Limtrakul
- Ministry of Public Health, Nakornping Hospital, Chiang Mai, Thailand
| | - Chaiwat Putiyanun
- Ministry of Public Health, Chiang Kham Hospital, Chiang Kham, Thailand
| | | | | | | | | | - Isabelle Heard
- HPV National Reference Center, Pasteur Institute, Paris, France; APHP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Gonzague Jourdain
- Institut de recherche pour le développement (IRD) UMI 174-PHPT, Marseille, France; Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand; Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Marc Lallemant
- Institut de recherche pour le développement (IRD) UMI 174-PHPT, Marseille, France; Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand; Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Sophie Le Coeur
- Institut de recherche pour le développement (IRD) UMI 174-PHPT, Marseille, France; Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand; Institut National d'Etudes Démographiques (Ined), UR-5, Paris, France; Harvard T.H. Chan School of Public Health, Boston, MA, United States
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Ngo-Giang-Huong N, Wittkop L, Judd A, Reiss P, Goetghebuer T, Duiculescu D, Noguera-Julian A, Marczynska M, Giacquinto C, Ene L, Ramos JT, Cellerai C, Klimkait T, Brichard B, Valerius N, Sabin C, Teira R, Obel N, Stephan C, de Wit S, Thorne C, Gibb D, Schwimmer C, Campbell MA, Pillay D, Lallemant M. Prevalence and effect of pre-treatment drug resistance on the virological response to antiretroviral treatment initiated in HIV-infected children - a EuroCoord-CHAIN-EPPICC joint project. BMC Infect Dis 2016; 16:654. [PMID: 27825316 PMCID: PMC5101717 DOI: 10.1186/s12879-016-1968-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 10/25/2016] [Indexed: 12/14/2022] Open
Abstract
Background Few studies have evaluated the impact of pre-treatment drug resistance (PDR) on response to combination antiretroviral treatment (cART) in children. The objective of this joint EuroCoord-CHAIN-EPPICC/PENTA project was to assess the prevalence of PDR mutations and their association with virological outcome in the first year of cART in children. Methods HIV-infected children <18 years initiating cART between 1998 and 2008 were included if having at least one genotypic resistance test prior to cART initiation. We used the World Health Organization 2009 resistance mutation list and Stanford algorithm to infer resistance to prescribed drugs. Time to virological failure (VF) was defined as the first of two consecutive HIV-RNA > 500 copies/mL after 6 months cART and was assessed by Cox proportional hazards models. All models were adjusted for baseline demographic, clinical, immunology and virology characteristics and calendar period of cART start and initial cART regimen. Results Of 476 children, 88 % were vertically infected. At cART initiation, median (interquartile range) age was 6.6 years (2.1–10.1), CD4 cell count 297 cells/mm3 (98–639), and HIV-RNA 5.2 log10copies/mL (4.7–5.7). Of 37 children (7.8 %, 95 % confidence interval (CI), 5.5–10.6) harboring a virus with ≥1 PDR mutations, 30 children had a virus resistant to ≥1 of the prescribed drugs. Overall, the cumulative Kaplan-Meier estimate for virological failure was 19.8 % (95 %CI, 16.4–23.9). Cumulative risk for VF tended to be higher among children harboring a virus with PDR and resistant to ≥1 drug prescribed than among those receiving fully active cART: 32.1 % (17.2–54.8) versus 19.4 % (15.9–23.6) (P = 0.095). In multivariable analysis, age was associated with a higher risk of VF with a 12 % reduced risk per additional year (HR 0.88; 95 %CI, 0.82–0.95; P < 0.001). Conclusions PDR was not significantly associated with a higher risk of VF in children in the first year of cART. The risk of VF decreased by 12 % per additional year at treatment initiation which may be due to fading of PDR mutations over time. Lack of appropriate formulations, in particular for the younger age group, may be an important determinant of virological failure. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1968-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nicole Ngo-Giang-Huong
- IRD UMI 174 - PHPT-Faculty of Associated Medical Sciences, Chiang Mai University, 110, Intrawarorot Road, Sripoom, Muang, Chiang Mai, 50200, Thailand. .,Harvard T.H. Chan School of Public Health, Boston, USA.
| | - Linda Wittkop
- Univ. Bordeaux, ISPED; INSERM, Centre INSERM U1219; CHU de Bordeaux, Pole de Sante Publique, F-33000, Bordeaux, France
| | - Ali Judd
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Peter Reiss
- Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | | | - Dan Duiculescu
- "Dr. Victor Babes" Hospital for Infectious and Tropical Diseases, Bucharest, Romania
| | | | | | | | - Luminita Ene
- "Dr. Victor Babes" Hospital for Infectious and Tropical Diseases, Bucharest, Romania
| | | | | | | | | | - Niels Valerius
- Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Niels Obel
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - Claire Thorne
- University College London, Institute of Child Health, London, UK
| | - Diana Gibb
- Medical Research Council Clinical Trials Unit, London, UK
| | | | | | | | - Marc Lallemant
- IRD UMI 174 - PHPT-Faculty of Associated Medical Sciences, Chiang Mai University, 110, Intrawarorot Road, Sripoom, Muang, Chiang Mai, 50200, Thailand
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Bouazza N, Cressey TR, Foissac F, Bienczak A, Denti P, McIlleron H, Burger D, Penazzato M, Lallemant M, Capparelli EV, Treluyer JM, Urien S. Optimization of the strength of the efavirenz/lamivudine/abacavir fixed-dose combination for paediatric patients. J Antimicrob Chemother 2016; 72:490-495. [PMID: 27798221 DOI: 10.1093/jac/dkw444] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 09/14/2016] [Accepted: 09/20/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Child-friendly, low-cost, solid, oral fixed-dose combinations (FDCs) of efavirenz with lamivudine and abacavir are urgently needed to improve clinical management and drug adherence for children. METHODS Data were pooled from several clinical trials and therapeutic drug monitoring datasets from different countries. The number of children/observations was 505/3667 for efavirenz. Population pharmacokinetic analyses were performed using a non-linear mixed-effects approach. For abacavir and lamivudine, data from 187 and 920 subjects were available (population pharmacokinetic models previously published). Efavirenz/lamivudine/abacavir FDC strength options assessed were (I) 150/75/150, (II) 120/60/120 and (III) 200/100/200 mg. Monte Carlo simulations of the different FDC strengths were performed to determine the optimal dose within each of the WHO weight bands based on drug efficacy/safety targets. RESULTS The probability of being within the target efavirenz concentration range 12 h post-dose (1-4 mg/L) varied between 56% and 60%, regardless of FDC option. Option I provided a best possible balance between efavirenz treatment failure and toxicity risks. For abacavir and lamivudine, simulations showed that for option I >75% of subjects were above the efficacy target. CONCLUSIONS According to simulations, a paediatric efavirenz/lamivudine/abacavir fixed-dose formulation of 150 mg efavirenz, 75 mg lamivudine and 150 mg abacavir provided the most effective and safe concentrations across WHO weight bands, with the flexibility of dosage required across the paediatric population.
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Affiliation(s)
- Naïm Bouazza
- EA7323, Université Paris Descartes, Sorbonne Paris Cité, Paris, France .,Unité de Recherche Clinique Necker Cochin, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France.,CIC-1419 Inserm, Paris, France
| | - Tim R Cressey
- Program for HIV Prevention and Treatment (PHPT/IRD UMI 174), Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand.,Department of Immunology & Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Molecular & Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Frantz Foissac
- EA7323, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Unité de Recherche Clinique Necker Cochin, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France.,CIC-1419 Inserm, Paris, France
| | - Andrzej Bienczak
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Paolo Denti
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Helen McIlleron
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - David Burger
- Department of Pharmacy, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Marc Lallemant
- Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland
| | | | - Jean-Marc Treluyer
- EA7323, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Unité de Recherche Clinique Necker Cochin, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France.,CIC-1419 Inserm, Paris, France
| | - Saïk Urien
- EA7323, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Unité de Recherche Clinique Necker Cochin, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France.,CIC-1419 Inserm, Paris, France
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Kekitiinwa A, Musiime V, Thomason MJ, Mirembe G, Lallemant M, Nakalanzi S, Baptiste D, Walker AS, Gibb DM, Judd A. Acceptability of lopinavir/r pellets (minitabs), tablets and syrups in HIV-infected children. Antivir Ther 2016; 21:579-585. [PMID: 27128199 DOI: 10.3851/imp3054] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Lopinavir/ritonavir 'pellets' were recently tentatively approved for licensing. We describe their acceptability for infants and children up to 48 weeks. METHODS CHAPAS-2 was a randomized, two-period crossover trial comparing syrup and pellets in HIV-infected infants (n=19, group A, aged 3-<12 months) and children (n=26, group B, 1-<4 years) and tablets and pellets in older children (n=32, group C, 4-<13 years) from two clinics ('JCRC', 'PIDC') in Uganda. At week 8, all groups chose which formulation to continue. Acceptability data were collected at weeks 0, 4, 8, 12 and 48. RESULTS For groups A and B overall, the proportion preferring pellets increased between week 0 and week 12 and decreased at week 48 (group A 37%, 72%, 44%; group B 12%, 64% and 36%, respectively), although there were marked differences between clinics. For group C, pellets were progressively less preferred to tablets over time: 41%, 19% and 13% at weeks 0, 12 and 48, respectively. During follow-up unpleasant taste was similarly reported among young children taking pellets and syrups (37%/43% group A; 29%/26% group B), whereas among older children, pellets tasted worse than tablets (40%/2%). No participants reported problems with storage/transportation for pellets (0%/0%) unlike syrups (23%/13%). CONCLUSIONS For children <4 years, pellets were more acceptable at week 12 but not week 48. Clinic differences could reflect bias among health-care workers for different formulations. Pellets taste similar to syrup, are easier to store and transport than syrup and represent an alternative formulation for young children unable to swallow tablets; improvements in taste and support for health-care workers may help sustain acceptability.
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Affiliation(s)
- Adeodata Kekitiinwa
- Department of Pediatrics and Adolescent Health, Baylor College of Medicine Children's Foundation Uganda, Paediatric Infectious Diseases Clinic, Mulago Hospital Kampala, Kampala, Uganda
| | - Victor Musiime
- Department of Paediatrics, Joint Clinical Research Centre, Kampala, Uganda.,Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Margaret J Thomason
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Grace Mirembe
- Department of Paediatrics, Joint Clinical Research Centre, Kampala, Uganda
| | - Marc Lallemant
- HCV and Paediatric HIV Program, Drugs for Neglected Diseases initiative, Geneva, Switzerland
| | - Sarah Nakalanzi
- Department of Pediatrics and Adolescent Health, Baylor College of Medicine Children's Foundation Uganda, Paediatric Infectious Diseases Clinic, Mulago Hospital Kampala, Kampala, Uganda
| | - David Baptiste
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - A Sarah Walker
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Diana M Gibb
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Ali Judd
- Medical Research Council Clinical Trials Unit, University College London, London, UK
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Lee JSF, Sagaon Teyssier L, Dongmo Nguimfack B, Collins IJ, Lallemant M, Perriens J, Moatti JP. An analysis of volumes, prices and pricing trends of the pediatric antiretroviral market in developing countries from 2004 to 2012. BMC Pediatr 2016; 16:41. [PMID: 26979974 PMCID: PMC4793558 DOI: 10.1186/s12887-016-0578-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 03/09/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The pediatric antiretroviral (ARV) market is poorly described in the literature, resulting in gaps in understanding treatment access. We analyzed the pediatric ARV market from 2004 to 2012 and assessed pricing trends and associated factors. METHODS Data on donor funded procurements of pediatric ARV formulations reported to the Global Price Reporting Mechanism database from 2004 to 2012 were analyzed. Outcomes of interest were the volume and mean price per patient-year ARV formulation based on WHO ARV dosing recommendations for a 10 kg child. Factors associated with the price of formulations were assessed using linear regression; potential predictors included: country income classification, geographical region, market segment (originator versus generic ARVs), and number of manufacturers per formulation. All analyses were adjusted for type of formulations (single, dual or triple fixed-dose combinations (FDCs)) RESULTS Data from 111 countries from 2004 to 2012 were included, with procurement of 33 formulations at a total value of USD 204 million. Use of dual and triple FDC formulations increased substantially over time, but with limited changes in price. Upon multivariate analysis, prices of originator formulations were found to be on average 72 % higher than generics (p < 0.001). A 10 % increase in procurement volume was associated with a 1 % decrease (p < 0.001) in both originator and generic prices. The entry of one additional manufacturer producing a formulation was associated with a decrease in prices of 2 % (p < 0.001) and 8 % (p < 0.001) for originator and generic formulations, respectively. The mean generic ARV price did not differ by country income level. Prices of originator ARVs were 48 % (p < 0.001) and 14 % (p < 0.001) higher in upper-middle income and lower-middle income countries compared to low income countries respectively, with the exception of South Africa, which had lower prices despite being an upper-middle income country. CONCLUSIONS The donor funded pediatric ARV market as represented by the GPRM database is small, and lacks price competition. It is dominated by generic drugs due to the lower prices offered and the practicality of FDC formulations. This market requires continued donor support and the current initiatives to protect it are important to ensure market viability, especially if new formulations are to be introduced in the future.
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Affiliation(s)
- Janice Soo Fern Lee
- Drugs for Neglected Diseases initiative (DNDi), 15 Chemin Louis Dunant, 1202, Geneva, Switzerland.
| | - Luis Sagaon Teyssier
- INSERM, UMR912 "Economics and Social Sciences Applied to Health & Analysis of Medical Information" (SESSTIM), 13006, Marseille, France.,Aix Marseille University, UMR_S912, IRD, 13006, Marseille, France.,ORS PACA, Southeastern Health Regional Observatory, 13006, Marseille, France
| | | | - Intira Jeannie Collins
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Marc Lallemant
- Drugs for Neglected Diseases initiative (DNDi), 15 Chemin Louis Dunant, 1202, Geneva, Switzerland
| | - Joseph Perriens
- HIV Department, World Health Organization, Geneva, Switzerland
| | - Jean-Paul Moatti
- INSERM, UMR912 "Economics and Social Sciences Applied to Health & Analysis of Medical Information" (SESSTIM), 13006, Marseille, France.,Aix Marseille University, UMR_S912, IRD, 13006, Marseille, France.,ORS PACA, Southeastern Health Regional Observatory, 13006, Marseille, France
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Lallemant M, Le Coeur S, Sirirungsi W, Cressey TR, Ngo-Giang-Huong N, Traisathit P, Klinbuayaem V, Sabsanong P, Kanjanavikai P, Jourdain G, Mcintosh K, Koetsawang S. Randomized noninferiority trial of two maternal single-dose nevirapine-sparing regimens to prevent perinatal HIV in Thailand. AIDS 2015; 29:2497-507. [PMID: 26372485 PMCID: PMC4871947 DOI: 10.1097/qad.0000000000000865] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Perinatal single-dose nevirapine (sdNVP) selects for resistance mutations. The objective of this trial was to compare two maternal sdNVP-sparing regimens with standard zidovudine (ZDV)/sdNVP prophylaxis. DESIGN PHPT-5 was a randomized, partially double-blind placebo-controlled, noninferiority trial in Thailand (NCT00409591). Study participants were women with CD4 of at least 250 cells/μl and their infants. METHODS All women received ZDV from 28 weeks' gestation and their newborn infants for one week. Women were also randomized to receive NVP-NVP (reference): maternal intrapartum sdNVP with a 7-day 'tail' of ZDV along with lamivudine, and infant NVP (one dose immediately, another 48 h later); infant-only NVP: maternal placebos for sdNVP and the 'tail', with infant NVP; LPV/r: maternal LPV/r starting at 28 weeks. Infants were formula-fed. HIV-diagnosis was determined by DNA-PCR. RESULTS Four-hundred and thirty-five women were randomized between January 2009 and September 2010. Accrual was terminated prematurely following a change in Thai guidelines recommending antiretroviral combination therapy for all pregnant women. Data on 405 mothers and 407 live-born children were analyzed. Baseline characteristics were similar between arms. Intent-to-treat transmission rates were 3.8% (95% confidence interval: 1.2-8.6) in NVP-NVP, 1.6% (0.2-5.6) in infant-only NVP, and 1.4% (0.4-5.1) in LPV/r arms. As-treated rates were 2.2% (0.5-6.4), 3.2% (0.9-7.9), and 1.5% (0.2-5.2), respectively. Factors independently associated with transmission were prophylaxis duration less than 8 weeks (adjusted odds ratio 15.5; 3.6-66.1) and viral load at baseline at least 4 log10copies/ml (adjusted odds ratio 10.9; 1.3-91.5). Regimens appeared well tolerated. CONCLUSION Transmission rates in all arms were low but noninferiority was not proven. Antiretroviral prophylaxis for at least 8 weeks before delivery is necessary to minimize transmission risk.
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Affiliation(s)
- Marc Lallemant
- aUnité Mixte Internationale 174, Institut de Recherche pour le Développement (IRD)-PHPT, Chiang Mai, Thailand bDepartment of Immunology and Infectious, Diseases, Harvard School of Public Health, Boston, Massachusetts, USA cDepartment of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand dUnité Mixte de Recherche 196, Centre Français de la Population et du Développement, (INED-IRD-Paris V University), Paris, France eDepartment of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai fSanpatong Hospital, Ministry of Public Health, Sanpatong gSamutprakarn Hospital, Ministry of Public Health, Samutprakarn hBanglamung Hospital, Ministry of Public Health, Chonburi, Thailand iChildren's Hospital, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA jFamily Health Research Center, Mahidol University, Bangkok, Thailand
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Sripan P, Le Coeur S, Ingsrisawang L, Cressey TR, Bouazza N, Foissac F, Ngo-Giang-Huong N, Traisathit P, Srirompotong U, Ayudhaya OPN, Puangsombat A, Jungpipun J, Jittayanun K, Tréluyer JM, Jourdain G, Lallemant M, Urien S. Contribution of different antiretroviral regimens containing zidovudine, lamivudine and ritonavir-boosted lopinavir on HIV viral load reduction during pregnancy. Antivir Ther 2015; 21:435-40. [PMID: 26492107 DOI: 10.3851/imp3001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Antiretroviral (ARV) regimens used for the prevention of mother-to-child transmission of HIV have evolved over time. We evaluated the contribution of different ARV regimens on the reduction of the plasma HIV RNA viral load (VL) during pregnancy. METHODS A total of 1,833 VL measurements from ARV-naive pregnant women participating in perinatal prevention trials in Thailand were included. Women received either zidovudine (ZDV) monotherapy, ZDV plus lopinavir/ritonavir (LPV/r), or ZDV plus lamivudine (3TC) plus LPV/r. VL time-course during pregnancy was described as a function of pretreatment VL and treatment duration using an Emax non-linear mixed-effect model. VL reduction and median time to achieve a VL<50 copies/ml were estimated for each regimen. RESULTS Among 745 women, 279 (37%), 145 (20%) and 321 (43%) received ZDV monotherapy, ZDV+LPV/r and ZDV+3TC+LPV/r, respectively. The predicted VL reduction from baseline to delivery after a median of 10 weeks of treatment were 0.5, 2.7 and 2.9 log10 copies/ml with ZDV monotherapy, ZDV+LPV/r and ZDV+3TC+LPV/r, respectively. At delivery, 1%, 57% and 63% of women receiving ZDV monotherapy, ZDV+LPV/r or ZDV+3TC+LPV/r had a VL<50 copies/ml. The addition of 3TC to ZDV+LPV/r reduced the time to achieve a VL<50 copies/ml and the higher the pretreatment VL, the larger the effect 3TC had on reducing the time to VL<50 copies/ml. CONCLUSIONS The addition of 3TC to ZDV+LPV/r was associated with a slight further VL reduction but the time to reach a VL<50 copies/ml was shorter. This beneficial effect of 3TC is crucial for prevention of mother-to-child transmission in women who receive ARVs late and with high pretreatment VL.
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Affiliation(s)
- Patumrat Sripan
- Department of Statistics, Faculty of Science, Kasetsart University, Bangkok, Thailand
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Sripan P, Le Coeur S, Amzal B, Ingsrisawang L, Traisathit P, Ngo-Giang-Huong N, McIntosh K, Cressey TR, Sangsawang S, Rawangban B, Kanjanavikai P, Tréluyer JM, Jourdain G, Lallemant M, Urien S. Correction: Modeling of In-Utero and Intra-Partum Transmissions to Evaluate the Efficacy of Interventions for the Prevention of Perinatal HIV. PLoS One 2015; 10:e0130917. [PMID: 26114293 PMCID: PMC4482690 DOI: 10.1371/journal.pone.0130917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Sripan P, Le Coeur S, Amzal B, Ingsrisawang L, Traisathit P, Ngo-Giang-Huong N, McIntosh K, Cressey TR, Sangsawang S, Rawangban B, Kanjanavikai P, Tréluyer JM, Jourdain G, Lallemant M, Urien S. Modeling of In-Utero and Intra-Partum Transmissions to Evaluate the Efficacy of Interventions for the Prevention of Perinatal HIV. PLoS One 2015; 10:e0126647. [PMID: 25992639 PMCID: PMC4438074 DOI: 10.1371/journal.pone.0126647] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 04/03/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Antiretroviral treatments decrease HIV mother-to-child transmission through pre/post exposure prophylaxis and reduction of maternal viral load. We modeled in-utero and intra-partum HIV transmissions to investigate the preventive role of various antiretroviral treatments interventions. METHODS We analysed data from 3,759 women-infant pairs enrolled in 3 randomized clinical trials evaluating (1) zidovudine monotherapy, (2) zidovudine plus perinatal single-dose nevirapine or (3) zidovudine plus lopinavir/ritonavir for the prevention of mother-to-child transmission of HIV in Thailand. All infants were formula-fed. Non-linear mixed effect modeling was used to express the viral load evolution under antiretroviral treatments and the probability of transmission. RESULTS Median viral load was 4 log10 copies/mL (Interquartile range: 3.36-4.56) before antiretroviral treatments initiation. An Emax model described the viral load time-course during pregnancy. Half of the maximum effect of zidovudine (28% decrease) and lopinavir/ritonavir (72% decrease) were achieved after 98 and 12 days, respectively. Adjusted on viral load at baseline (Odds ratio = 1.50 [95% confidence interval: 1.34, 1.68] per log10 copies/mL increment), antiretroviral treatments duration (OR = 0.80 [0.75, 0.84] per week increment) but not the nature of antiretroviral treatments were associated with in-utero transmission. Adjusted on gestational age at delivery (<37 weeks, OR = 2.37 [1.37, 4.10]), baseline CD4 (Odds ratio = 0.79 [0.72, 0.88] per 100 cells/mm3 increment) and predicted viral load at delivery (OR = 1.47 [1.25, 1.64] per log10 copies/mL increment), single-dose nevirapine considerably reduced intra-partum transmission (OR = 0.32 [0.2, 0.51]). CONCLUSION These models determined the respective contributions of various antiretroviral strategies on prevention of mother-to-child transmission. This can help predict the efficacy of new antiretroviral treatments and/or prevention of mother-to-child transmission strategies particularly for women with no or late antenatal care who are at high risk of transmitting HIV to their offspring. TRIAL REGISTRATION This analysis is based on secondary data obtained from three clinical trials. ClinicalTrials.gov. NCT00386230, NCT00398684, NCT00409591.
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Affiliation(s)
- Patumrat Sripan
- Department of Statistics, Kasetsart University, Bangkok, Thailand
- Institut de recherche pour le développement (IRD) UMI 174-PHPT, Marseille, France
- Ecole Doctorale de Santé Publique, Université Paris-Sud, Paris, France
- * E-mail:
| | - Sophie Le Coeur
- Institut de recherche pour le développement (IRD) UMI 174-PHPT, Marseille, France
- Department of Medical Technology, Chiang Mai University, Chiang Mai, Thailand
- Institut d'Etudes Démographiques, Paris, France
| | - Billy Amzal
- Institut de recherche pour le développement (IRD) UMI 174-PHPT, Marseille, France
- LASER Analytica, London, United Kingdom
| | | | | | - Nicole Ngo-Giang-Huong
- Institut de recherche pour le développement (IRD) UMI 174-PHPT, Marseille, France
- Department of Medical Technology, Chiang Mai University, Chiang Mai, Thailand
- Harvard School of Public Health, Boston, MA, United States of America
| | - Kenneth McIntosh
- Boston Children's Hospital, Boston, MA, United States of America
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States of America
| | - Tim R. Cressey
- Institut de recherche pour le développement (IRD) UMI 174-PHPT, Marseille, France
- Department of Medical Technology, Chiang Mai University, Chiang Mai, Thailand
- Harvard School of Public Health, Boston, MA, United States of America
| | | | | | | | - Jean-Marc Tréluyer
- EAU08 Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Unité de Recherche Clinique, AP-HP, Hôpital Tarnier, Paris, France
- CIC1419 INSERM, Cochin-Necker, Paris, France
| | - Gonzague Jourdain
- Institut de recherche pour le développement (IRD) UMI 174-PHPT, Marseille, France
- Department of Medical Technology, Chiang Mai University, Chiang Mai, Thailand
- Harvard School of Public Health, Boston, MA, United States of America
| | - Marc Lallemant
- Institut de recherche pour le développement (IRD) UMI 174-PHPT, Marseille, France
| | - Saïk Urien
- EAU08 Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Unité de Recherche Clinique, AP-HP, Hôpital Tarnier, Paris, France
- CIC1419 INSERM, Cochin-Necker, Paris, France
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Suaysod R, Ngo-Giang-Huong N, Salvadori N, Cressey TR, Kanjanavanit S, Techakunakorn P, Krikajornkitti S, Srirojana S, Laomanit L, Chalermpantmetagul S, Lallemant M, Le Cœur S, McIntosh K, Traisathit P, Jourdain G. Treatment Failure in HIV-Infected Children on Second-line Protease Inhibitor-Based Antiretroviral Therapy. Clin Infect Dis 2015; 61:95-101. [PMID: 25838288 DOI: 10.1093/cid/civ271] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 03/21/2015] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV)-infected children failing second-line antiretroviral therapy (ART) have no access to third-line antiretroviral drugs in many resource-limited settings. It is important to identify risk factors for second-line regimen failure. METHODS HIV-infected children initiating protease inhibitor (PI)-containing second-line ART within the Program for HIV Prevention and Treatment observational cohort study in Thailand between 2002 and 2010 were included. Treatment failure was defined as confirmed HIV type 1 RNA load >400 copies/mL after at least 6 months on second-line regimen or death. Adherence was assessed by drug plasma levels and patient self-report. Cox proportional hazards regression analyses were used to identify risk factors for failure. RESULTS A total of 111 children started a PI-based second-line regimen, including 59 girls (53%). Median first-line ART duration was 1.9 years (interquartile range [IQR], 1.4-3.3 years), and median age at second-line initiation was 10.7 years (IQR, 6.3-13.4 years). Fifty-four children (49%) experienced virologic failure, and 2 (2%) died. The risk of treatment failure 24 months after second-line initiation was 41%. In multivariate analyses, failure was independently associated with exposure to first-line ART for >2 years (adjusted hazard ratio [aHR], 1.8; P = .03), age >13 years (aHR, 2.9; P < .001), body mass index-for-age z score < -2 standard deviations at second-line initiation (aHR, 2.8; P = .03), and undetectable drug levels within 6 months following second-line initiation (aHR, 4.5; P < .001). CONCLUSIONS Children with longer exposure to first-line ART, entry to adolescence, underweight, and/or undetectable drug levels were at higher risk of failing second-line ART and thus should be closely monitored.
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Affiliation(s)
- Rapeepan Suaysod
- Institut de Recherche pour le Développement, UMI 174-PHPT Bioinformatics Research Laboratory, Faculty of Science
| | - Nicole Ngo-Giang-Huong
- Institut de Recherche pour le Développement, UMI 174-PHPT Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Thailand Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Nicolas Salvadori
- Institut de Recherche pour le Développement, UMI 174-PHPT Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Thailand
| | - Tim R Cressey
- Institut de Recherche pour le Développement, UMI 174-PHPT Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Thailand Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | | | | | | | - Laddawan Laomanit
- Institut de Recherche pour le Développement, UMI 174-PHPT Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Thailand
| | - Suwalai Chalermpantmetagul
- Institut de Recherche pour le Développement, UMI 174-PHPT Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Thailand
| | - Marc Lallemant
- Institut de Recherche pour le Développement, UMI 174-PHPT Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Thailand Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Sophie Le Cœur
- Institut de Recherche pour le Développement, UMI 174-PHPT Harvard T.H. Chan School of Public Health, Boston, Massachusetts Institut National d'Etudes Démographiques, Paris, France
| | - Kenneth McIntosh
- Boston Children's Hospital and Harvard Medical School, Massachusetts
| | - Patrinee Traisathit
- Institut de Recherche pour le Développement, UMI 174-PHPT Department of Statistics, Faculty of Science Center of Excellence for Innovation in Analytical Science and Technology, Chiang Mai University, Thailand
| | - Gonzague Jourdain
- Institut de Recherche pour le Développement, UMI 174-PHPT Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Thailand Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Bouazza N, Foissac F, Fauchet F, Burger D, Kiechel JR, Treluyer JM, Capparelli EV, Lallemant M, Urien S. Lopinavir/ritonavir plus lamivudine and abacavir or zidovudine dose ratios for paediatric fixed-dose combinations. Antivir Ther 2014; 20:225-33. [PMID: 25279808 DOI: 10.3851/imp2876] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Lopinavir/ritonavir (LPV/r) is available in a liquid formulation that is far from ideal for treatment of children in resource-poor settings. Flexible, low-cost, solid, oral fixed-dose combinations (FDC) of LPV/r with nucleoside reverse transcriptase inhibitors (LPV/r/abacavir [ABC]/lamivudine [3TC] and LPV/r/zidovudine [ZDV]/3TC) are needed to improve both management and adherence of children. This work aimed to develop appropriate drug ratios and dosing for each FDC. METHODS Data from 25 combined datasets included therapeutic drug monitoring and clinical studies from IMPAACT and PENTA. Population pharmacokinetic analyses were performed using Monolix. Monte-Carlo simulations of WHO and FDA dosing recommendations were performed to assess their ability to provide optimal exposure in children weighing 4 to 25 kg based on consensus plasma targets. The LPV/r:3TC:ZDV(ABC) dose ratios were 2.67:1:2(2), respectively. RESULTS Using WHO dosage, LPV efficacy target was reached in all weight bands. Given the recommended drug ratios, the dosage for the 4-5.9 kg weight band (LPV/ZDV: 120/90 mg twice daily [bid]) showed more than 20% of subjects had ZDV levels at high risk of neutropenia. Reducing the LPV/ZDV dose to 80/60 mg bid decreased frequency of high ZDV concentrations but retained the LPV efficacy criteria. CONCLUSIONS This defined a flexible and simple FDC containing 40 mg LPV, 10 mg ritonavir, 15 mg 3TC and 30 mg ABC or ZDV. According to the weight bands defined by WHO, 4-5.9 kg, 6-9.9 kg, 10-13.9 kg, 14-19.9 kg, 20-24.9 kg, therapeutic doses would be 2, 3, 4, 5 or 6 individual units administered by oral route bid.
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Affiliation(s)
- Naïm Bouazza
- EA 7323, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
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Cressey TR, Urien S, Capparelli EV, Best BM, Buranabanjasatean S, Limtrakul A, Rawangban B, Sabsanong P, Treluyer JM, Jourdain G, Stek A, Lallemant M, Mirochnick M. Impact of body weight and missed doses on lopinavir concentrations with standard and increased lopinavir/ritonavir doses during late pregnancy. J Antimicrob Chemother 2014; 70:217-24. [PMID: 25261418 DOI: 10.1093/jac/dku367] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To assess the influence of body weight and missed doses on lopinavir pharmacokinetics with standard and increased doses of lopinavir/ritonavir melt extrusion tablets during late pregnancy. PATIENTS AND METHODS Lopinavir concentration data during the third trimester of pregnancy were pooled from clinical trials in Thailand (NCT00409591) and the USA (NCT00042289). A total of 154 HIV-infected pregnant women receiving either 400/100 mg (standard) or 600/150 mg (increased) twice daily had lopinavir plasma concentration data available. Population parameters were estimated using non-linear mixed-effects regression models. Monte Carlo simulations were performed to estimate the probability of achieving target lopinavir trough concentrations (>1.0 mg/L) with standard and increased doses of lopinavir/ritonavir during pregnancy. RESULTS The median (range) age, weight and gestational age were 28 years (18-43), 62 kg (45-123) and 33 weeks (29-38), respectively. Body weight influenced lopinavir oral clearance (CL/F) and volume of distribution (V/F). Population estimates of lopinavir CL/F and V/F were 6.21 L/h/70 kg and 52.6 L/70 kg, respectively. Based on simulations, the highest risk of subtherapeutic trough concentrations was for women weighing >100 kg using the standard dose (∼ 7%), while the risk was <2% with the 600/150 mg dose for women weighing 40-130 kg. After a missed dose, 61% of women have lopinavir concentrations below target prior to the next dose with the standard dose compared with 42% with the increased dose. CONCLUSIONS Standard dosing provides adequate lopinavir trough concentrations for the majority of pregnant women but increased doses may be preferable for women weighing >100 kg and with a history of lopinavir/ritonavir use and/or adherence issues.
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Affiliation(s)
- Tim R Cressey
- Program for HIV Prevention and Treatment (IRD UMI 174), Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand Harvard School of Public Health, Boston, MA, USA Institut de Recherché pour le Développement (IRD), UMI 174-PHPT, Marseille, France
| | - Saik Urien
- EA-3620 University Paris Descartes and CIC-0901 Inserm, Paris, France Hôpital Cochin, Assistance Publique-Hopitaux de Paris, Paris, France Unité de Recherche clinique, AP-HP, Hôpital Tarnier, Paris, France
| | | | | | | | | | | | | | - Jean-Marc Treluyer
- EA-3620 University Paris Descartes and CIC-0901 Inserm, Paris, France Hôpital Cochin, Assistance Publique-Hopitaux de Paris, Paris, France Unité de Recherche clinique, AP-HP, Hôpital Tarnier, Paris, France
| | - Gonzague Jourdain
- Program for HIV Prevention and Treatment (IRD UMI 174), Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand Harvard School of Public Health, Boston, MA, USA Institut de Recherché pour le Développement (IRD), UMI 174-PHPT, Marseille, France
| | - Alice Stek
- University of Southern California, Los Angeles, CA, USA
| | - Marc Lallemant
- Program for HIV Prevention and Treatment (IRD UMI 174), Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand Harvard School of Public Health, Boston, MA, USA Institut de Recherché pour le Développement (IRD), UMI 174-PHPT, Marseille, France
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Chaillon A, Samleerat T, Zoveda F, Ballesteros S, Moreau A, Ngo-Giang-Huong N, Jourdain G, Gianella S, Lallemant M, Depaulis F, Barin F. Estimating the timing of mother-to-child transmission of the human immunodeficiency virus type 1 using a viral molecular evolution model. PLoS One 2014; 9:e90421. [PMID: 24717647 PMCID: PMC3981669 DOI: 10.1371/journal.pone.0090421] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 01/30/2014] [Indexed: 11/19/2022] Open
Abstract
Background Mother-to-child transmission (MTCT) is responsible for most pediatric HIV-1 infections worldwide. It can occur during pregnancy, labor, or breastfeeding. Numerous studies have used coalescent and molecular clock methods to understand the epidemic history of HIV-1, but the timing of vertical transmission has not been studied using these methods. Taking advantage of the constant accumulation of HIV genetic variation over time and using longitudinally sampled viral sequences, we used a coalescent approach to investigate the timing of MTCT. Materials and Methods Six-hundred and twenty-two clonal env sequences from the RNA and DNA viral population were longitudinally sampled from nine HIV-1 infected mother-and-child pairs [range: 277–1034 days]. For each transmission pair, timing of MTCT was determined using a coalescent-based model within a Bayesian statistical framework. Results were compared with available estimates of MTCT timing obtained with the classic biomedical approach based on serial HIV DNA detection by PCR assays. Results Four children were infected during pregnancy, whereas the remaining five children were infected at time of delivery. For eight out of nine pairs, results were consistent with the transmission periods assessed by standard PCR-based assay. The discordance in the remaining case was likely confused by co-infection, with simultaneous introduction of multiple maternal viral variants at the time of delivery. Conclusions The study provided the opportunity to validate the Bayesian coalescent approach that determines the timing of MTCT of HIV-1. It illustrates the power of population genetics approaches to reliably estimate the timing of transmission events and deepens our knowledge about the dynamics of viral evolution in HIV-infected children, accounting for the complexity of multiple transmission events.
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Affiliation(s)
- Antoine Chaillon
- Université François-Rabelais, Institut National de la Santé et de la Recherche Médicale - Unité 966 et Laboratoire de Virologie, Centre Hopsitalier Universitaire Bretonneau, Tours, France
- University of California San Diego, Department of Pathology, San Diego, California, United States of America
- * E-mail:
| | - Tanawan Samleerat
- Université François-Rabelais, Institut National de la Santé et de la Recherche Médicale - Unité 966 et Laboratoire de Virologie, Centre Hopsitalier Universitaire Bretonneau, Tours, France
- Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Faustine Zoveda
- Laboratoire Ecologie et Evolution, Centre National de la Recherche Scientifique - Unité Mixte de Recherche 7625- Ecole Normale Supérieure, Paris, France
| | - Sébastien Ballesteros
- Laboratoire Ecologie et Evolution, Centre National de la Recherche Scientifique - Unité Mixte de Recherche 7625- Ecole Normale Supérieure, Paris, France
| | - Alain Moreau
- Université François-Rabelais, Institut National de la Santé et de la Recherche Médicale - Unité 966 et Laboratoire de Virologie, Centre Hopsitalier Universitaire Bretonneau, Tours, France
| | - Nicole Ngo-Giang-Huong
- Institut de Recherche pour le Développement, Chiang Mai, Thailand
- Harvard School of Public Health, Department of Immunology and Infectious Diseases, Boston, Massachusetts, United States of America
| | - Gonzague Jourdain
- Institut de Recherche pour le Développement, Chiang Mai, Thailand
- Harvard School of Public Health, Department of Immunology and Infectious Diseases, Boston, Massachusetts, United States of America
| | - Sara Gianella
- University of California San Diego, Department of Pathology, San Diego, California, United States of America
| | - Marc Lallemant
- Institut de Recherche pour le Développement, Chiang Mai, Thailand
- Harvard School of Public Health, Department of Immunology and Infectious Diseases, Boston, Massachusetts, United States of America
| | - Frantz Depaulis
- Laboratoire Ecologie et Evolution, Centre National de la Recherche Scientifique - Unité Mixte de Recherche 7625- Ecole Normale Supérieure, Paris, France
| | - Francis Barin
- Université François-Rabelais, Institut National de la Santé et de la Recherche Médicale - Unité 966 et Laboratoire de Virologie, Centre Hopsitalier Universitaire Bretonneau, Tours, France
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Collins I, Cairns J, Le Coeur S, Pagdi K, Ngampiyaskul C, Layangool P, Borkird T, Na-Rajsima S, Wanchaitanawong V, Jourdain G, Lallemant M. Five-year trends in antiretroviral usage and drug costs in HIV-infected children in Thailand. J Acquir Immune Defic Syndr 2013; 64:95-102. [PMID: 23945253 PMCID: PMC3744770 DOI: 10.1097/qai.0b013e318298a309] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND As antiretroviral treatment (ART) programs mature, data on drug utilization and costs are needed to assess durability of treatments and inform program planning. METHODS Children initiating ART were followed up in an observational cohort in Thailand. Treatment histories from 1999 to 2009 were reviewed. Treatment changes were categorized as: drug substitution (within class), switch across drug class (non nucleoside reverse-transcriptase inhibitors (NNRTI) to/from protease inhibitor (PI)), and to salvage therapy (dual PI or PI and NNRTI). Antiretroviral drug costs were calculated in 6-month cycles (US$ 2009 prices). Predictors of high drug cost including characteristics at start of ART (baseline), initial regimen, treatment change, and duration on ART were assessed using mixed-effects regression models. RESULTS Five hundred seven children initiated ART with a median 54 (interquartile range, 36-72) months of follow-up. Fifty-two percent had a drug substitution, 21% switched across class, and 2% to salvage therapy. When allowing for drug substitution, 78% remained on their initial regimen. Mean drug cost increased from $251 to $428 per child per year in the first and fifth year of therapy, respectively. PI-based and salvage regimens accounted for 16% and 2% of treatments prescribed and 33% and 5% of total costs, respectively. Predictors of high cost include baseline age ≥ 8 years, non nevirapine-based initial regimen, switch across drug class, and to salvage regimen (P < 0.005). CONCLUSIONS At 5 years, 21% of children switched across drug class and 2% received salvage therapy. The mean drug cost increased by 70%. Access to affordable second- and third-line drugs is essential for the sustainability of treatment programs.
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Affiliation(s)
- Intira Collins
- Program for HIV Prevention and Treatment, Institut de Recherche pour le Développement IRD UMI 174-PHPT, France.
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Tang MW, Rhee SY, Bertagnolio S, Ford N, Holmes S, Sigaloff KC, Hamers RL, de Wit TFR, Fleury HJ, Kanki PJ, Ruxrungtham K, Hawkins CA, Wallis CL, Stevens W, van Zyl GU, Manosuthi W, Hosseinipour MC, Ngo-Giang-Huong N, Belec L, Peeters M, Aghokeng A, Bunupuradah T, Burda S, Cane P, Cappelli G, Charpentier C, Dagnra AY, Deshpande AK, El-Katib Z, Eshleman SH, Fokam J, Gody JC, Katzenstein D, Koyalta DD, Kumwenda JJ, Lallemant M, Lynen L, Marconi VC, Margot NA, Moussa S, Ndung'u T, Nyambi PN, Orrell C, Schapiro JM, Schuurman R, Sirivichayakul S, Smith D, Zolfo M, Jordan MR, Shafer RW. Nucleoside reverse transcriptase inhibitor resistance mutations associated with first-line stavudine-containing antiretroviral therapy: programmatic implications for countries phasing out stavudine. J Infect Dis 2013; 207 Suppl 2:S70-7. [PMID: 23687292 DOI: 10.1093/infdis/jit114] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The World Health Organization Antiretroviral Treatment Guidelines recommend phasing-out stavudine because of its risk of long-term toxicity. There are two mutational pathways of stavudine resistance with different implications for zidovudine and tenofovir cross-resistance, the primary candidates for replacing stavudine. However, because resistance testing is rarely available in resource-limited settings, it is critical to identify the cross-resistance patterns associated with first-line stavudine failure. METHODS We analyzed HIV-1 resistance mutations following first-line stavudine failure from 35 publications comprising 1,825 individuals. We also assessed the influence of concomitant nevirapine vs. efavirenz, therapy duration, and HIV-1 subtype on the proportions of mutations associated with zidovudine vs. tenofovir cross-resistance. RESULTS Mutations with preferential zidovudine activity, K65R or K70E, occurred in 5.3% of individuals. Mutations with preferential tenofovir activity, ≥ two thymidine analog mutations (TAMs) or Q151M, occurred in 22% of individuals. Nevirapine increased the risk of TAMs, K65R, and Q151M. Longer therapy increased the risk of TAMs and Q151M but not K65R. Subtype C and CRF01_AE increased the risk of K65R, but only CRF01_AE increased the risk of K65R without Q151M. CONCLUSIONS Regardless of concomitant nevirapine vs. efavirenz, therapy duration, or subtype, tenofovir was more likely than zidovudine to retain antiviral activity following first-line d4T therapy.
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Affiliation(s)
- Michele W Tang
- Division Infectious Diseases, Department of Medicine, Stanford University, California 94305, USA.
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Jourdain G, Le Cœur S, Ngo-Giang-Huong N, Traisathit P, Cressey TR, Fregonese F, Leurent B, Collins IJ, Techapornroong M, Banchongkit S, Buranabanjasatean S, Halue G, Nilmanat A, Luekamlung N, Klinbuayaem V, Chutanunta A, Kantipong P, Bowonwatanuwong C, Lertkoonalak R, Leenasirimakul P, Tansuphasawasdikul S, Sang-a-gad P, Pathipvanich P, Thongbuaban S, Wittayapraparat P, Eiamsirikit N, Buranawanitchakorn Y, Yutthakasemsunt N, Winiyakul N, Decker L, Barbier S, Koetsawang S, Sirirungsi W, McIntosh K, Thanprasertsuk S, Lallemant M. Switching HIV treatment in adults based on CD4 count versus viral load monitoring: a randomized, non-inferiority trial in Thailand. PLoS Med 2013; 10:e1001494. [PMID: 23940461 PMCID: PMC3735458 DOI: 10.1371/journal.pmed.1001494] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Accepted: 06/27/2013] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Viral load (VL) is recommended for monitoring the response to highly active antiretroviral therapy (HAART) but is not routinely available in most low- and middle-income countries. The purpose of the study was to determine whether a CD4-based monitoring and switching strategy would provide a similar clinical outcome compared to the standard VL-based strategy in Thailand. METHODS AND FINDINGS The Programs for HIV Prevention and Treatment (PHPT-3) non-inferiority randomized clinical trial compared a treatment switching strategy based on CD4-only (CD4) monitoring versus viral-load (VL). Consenting participants were antiretroviral-naïve HIV-infected adults (CD4 count 50-250/mm(3)) initiating non-nucleotide reverse transcriptase inhibitor (NNRTI)-based therapy. Randomization, stratified by site (21 public hospitals), was performed centrally after enrollment. Clinicians were unaware of the VL values of patients randomized to the CD4 arm. Participants switched to second-line combination with confirmed CD4 decline >30% from peak (within 200 cells from baseline) in the CD4 arm, or confirmed VL >400 copies/ml in the VL arm. Primary endpoint was clinical failure at 3 years, defined as death, new AIDS-defining event, or CD4 <50 cells/mm(3). The 3-year Kaplan-Meier cumulative risks of clinical failure were compared for non-inferiority with a margin of 7.4%. In the intent to treat analysis, data were censored at the date of death or at last visit. The secondary endpoints were difference in future-drug-option (FDO) score, a measure of resistance profiles, virologic and immunologic responses, and the safety and tolerance of HAART. 716 participants were randomized, 356 to VL monitoring and 360 to CD4 monitoring. At 3 years, 319 participants (90%) in VL and 326 (91%) in CD4 were alive and on follow-up. The cumulative risk of clinical failure was 8.0% (95% CI 5.6-11.4) in VL versus 7.4% (5.1-10.7) in CD4, and the upper-limit of the one-sided 95% CI of the difference was 3.4%, meeting the pre-determined non-inferiority criterion. Probability of switch for study criteria was 5.2% (3.2-8.4) in VL versus 7.5% (5.0-11.1) in CD4 (p=0.097). Median time from treatment initiation to switch was 11.7 months (7.7-19.4) in VL and 24.7 months (15.9-35.0) in CD4 (p=0.001). The median duration of viremia >400 copies/ml at switch was 7.2 months (5.8-8.0) in VL versus 15.8 months (8.5-20.4) in CD4 (p=0.002). FDO scores were not significantly different at time of switch. No adverse events related to the monitoring strategy were reported. CONCLUSIONS The 3-year rates of clinical failure and loss of treatment options did not differ between strategies although the longer-term consequences of CD4 monitoring would need to be investigated. These results provide reassurance to treatment programs currently based on CD4 monitoring as VL measurement becomes more affordable and feasible in resource-limited settings. TRIAL REGISTRATION ClinicalTrials.govNCT00162682 Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Gonzague Jourdain
- Unité Mixte Internationale 174, Institut de Recherche pour le Développement (IRD)-Programs for HIV Prevention and Treatment (PHPT), Chiang Mai, Thailand
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Sophie Le Cœur
- Unité Mixte Internationale 174, Institut de Recherche pour le Développement (IRD)-Programs for HIV Prevention and Treatment (PHPT), Chiang Mai, Thailand
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts, United States of America
- Unité Mixte de Recherche 196, Centre Français de la Population et du Développement, (INED-IRD-Paris V University), Paris, France
| | - Nicole Ngo-Giang-Huong
- Unité Mixte Internationale 174, Institut de Recherche pour le Développement (IRD)-Programs for HIV Prevention and Treatment (PHPT), Chiang Mai, Thailand
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Patrinee Traisathit
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
| | - Tim R. Cressey
- Unité Mixte Internationale 174, Institut de Recherche pour le Développement (IRD)-Programs for HIV Prevention and Treatment (PHPT), Chiang Mai, Thailand
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Federica Fregonese
- Unité Mixte Internationale 174, Institut de Recherche pour le Développement (IRD)-Programs for HIV Prevention and Treatment (PHPT), Chiang Mai, Thailand
| | - Baptiste Leurent
- Unité Mixte Internationale 174, Institut de Recherche pour le Développement (IRD)-Programs for HIV Prevention and Treatment (PHPT), Chiang Mai, Thailand
| | - Intira J. Collins
- Unité Mixte Internationale 174, Institut de Recherche pour le Développement (IRD)-Programs for HIV Prevention and Treatment (PHPT), Chiang Mai, Thailand
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | | | | | | | - Guttiga Halue
- Phayao Provincial Hospital, Ministry of Public Health, Phayao, Thailand
| | | | | | | | | | - Pacharee Kantipong
- Chiangrai Prachanukroh Hospital, Ministry of Public Health, Chiang Rai, Thailand
| | | | - Rittha Lertkoonalak
- Maharat Nakhon Ratchasima Hospital, Ministry of Public Health, Nakhon Ratchasima, Thailand
| | | | | | | | | | | | | | - Naree Eiamsirikit
- Samutprakarn Hospital, Ministry of Public Health, Samutprakarn, Thailand
| | | | | | - Narong Winiyakul
- Regional Health Promotion Centre 6, Ministry of Public Health, Khon Kaen, Thailand
| | - Luc Decker
- Unité Mixte Internationale 174, Institut de Recherche pour le Développement (IRD)-Programs for HIV Prevention and Treatment (PHPT), Chiang Mai, Thailand
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Sylvaine Barbier
- Unité Mixte Internationale 174, Institut de Recherche pour le Développement (IRD)-Programs for HIV Prevention and Treatment (PHPT), Chiang Mai, Thailand
| | - Suporn Koetsawang
- Family Health Research Center, Mahidol University, Bangkok, Thailand
| | - Wasna Sirirungsi
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Kenneth McIntosh
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts, United States of America
- Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States of America
| | | | - Marc Lallemant
- Unité Mixte Internationale 174, Institut de Recherche pour le Développement (IRD)-Programs for HIV Prevention and Treatment (PHPT), Chiang Mai, Thailand
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts, United States of America
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Khamduang W, Ngo-Giang-Huong N, Gaudy-Graffin C, Jourdain G, Suwankornsakul W, Jarupanich T, Chalermpolprapa V, Nanta S, Puarattana-Aroonkorn N, Tonmat S, Lallemant M, Goudeau A, Sirirungsi W. Prevalence, risk factors, and impact of isolated antibody to hepatitis B core antigen and occult hepatitis B virus infection in HIV-1-infected pregnant women. Clin Infect Dis 2013; 56:1704-12. [PMID: 23487379 DOI: 10.1093/cid/cit166] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Prevalence and risk factors for isolated antibody to hepatitis B core antigen (anti-HBc) and occult hepatitis B virus (HBV) infection are not well known in human immunodeficiency virus type 1 (HIV-1)-infected pregnant women. It is unclear if women with occult infections are at risk of transmitting HBV to their infants. METHODS HIV-1-infected and HBV surface antigen (HBsAg)-negative pregnant women were tested for antibody to HBsAg (anti-HBs) and anti-HBc using enzyme immunoassay. Women with isolated anti-HBc were assessed for occult HBV infection, defined as HBV DNA levels >15 IU/mL, using the Abbott RealTime HBV DNA assay. Infants born to women with isolated anti-HBc and detectable HBV DNA were tested at 4 months of age for HBV DNA. Logistic regression analysis was used to identify factors associated with isolated anti-HBc and occult HBV infection. RESULTS Among 1812 HIV-infected pregnant women, 1682 were HBsAg negative. Fourteen percent (95% confidence interval [CI], 12%-15%) of HBsAg-negative women had an isolated anti-HBc that was independently associated with low CD4 count, age >35 years, birth in northern Thailand, and positive anti-hepatitis C virus serology. Occult HBV infection was identified in 24% (95% CI, 18%-30%) of women with isolated anti-HBc, representing 2.6% (95% CI, 1.9%-3.5%) of HIV-1-infected pregnant women, and was inversely associated with HIV RNA levels. None of the women with isolated anti-HBc and occult HBV infection transmitted HBV to their infants. CONCLUSIONS HIV-1-infected pregnant women with isolated anti-HBc and occult HBV infection have very low HBV DNA levels and are thus at very low risk to transmit HBV to their infants.
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Affiliation(s)
- Woottichai Khamduang
- Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai. Thailand
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Harrison L, Ananworanich J, Hamadache D, Compagnucci A, Penazzato M, Bunupuradah T, Mazza A, Ramos JT, Flynn J, Rampon O, Mellado Pena MJ, Floret D, Marczynska M, Puga A, Forcat S, Riault Y, Lallemant M, Castro H, Gibb DM, Giaquinto C. Adherence to antiretroviral therapy and acceptability of planned treatment interruptions in HIV-infected children. AIDS Behav 2013; 17:193-202. [PMID: 22584916 PMCID: PMC3548111 DOI: 10.1007/s10461-012-0197-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
There have been no paediatric randomised trials describing the effect of planned treatment interruptions (PTIs) of antiretroviral therapy (ART) on adherence, or evaluating acceptability of such a strategy. In PENTA 11, HIV-infected children were randomised to CD4-guided PTIs (n = 53) or continuous therapy (CT, n = 56). Carers, and children if appropriate, completed questionnaires on adherence to ART and acceptability of PTIs. There was no difference in reported adherence on ART between CT and PTI groups; non-adherence (reporting missed doses over the last 3 days or marking <100 % adherence since the last clinical visit on a visual analogue scale) was 18 % (20/111) and 14 % (12/83) on carer questionnaires in the CT and PTI groups respectively (odds ratios, OR (95 % CI) = 1.04 (0.20, 5.41), χ2 (1) = 0.003, p = 0.96). Carers in Europe/USA reported non-adherence more often (31/121, 26 %) than in Thailand (1/73, 1 %; OR (95 % CI) = 54.65 (3.68, 810.55), χ2 (1) = 8.45, p = 0.004). The majority of families indicated they were happy to have further PTIs (carer: 23/36, 64 %; children: 8/13, 62 %), however many reported more clinic visits during PTI were a problem (carer: 15/36, 42 %; children: 6/12, 50 %).
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McIntyre J, Lallemant M. The prevention of mother-to-child transmission of HIV: are we translating scientific success into programmatic failure? Curr Opin HIV AIDS 2012; 3:139-45. [PMID: 19372956 DOI: 10.1097/coh.0b013e3282f5242a] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The prevention of mother-to-child transmission of HIV stands as one of the first and most successful applications of scientific enquiry in the AIDS epidemic. While paediatric HIV has virtually been eliminated in industrialized countries, nearly 500 000 children were infected worldwide in 2007. This review considers the global successes and failures of prevention of mother-to-child transmission in order to shed light on the key question: why have relevant research advances not yet been successfully implemented in low-resource settings? RECENT FINDINGS This review examines the accumulated evidence that has led to the definition of prevention strategies, and corresponding prevention of mother-to-child transmission guidelines. Numerous field implementation reports, in contrast, point to the global lack of success of prevention of mother-to-child transmission programmes and pinpoint key factors which continue to drive their failure, including the low uptake of HIV counselling and testing, continuing postnatal transmission through breastfeeding, and the lack of linkages between prevention of mother-to-child transmission programmes and primary prevention, family planning and, most importantly, the provision of care and treatment. SUMMARY Two country examples, Thailand and South Africa, illustrate that political will is the most important factor for the success of prevention of mother-to-child transmission interventions. Much more needs to be done to translate the remarkable prevention of mother-to-child transmission research progress into programme success.
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Affiliation(s)
- James McIntyre
- aPerinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa bPrograms for HIV Prevention and Treatment (PHPT), Institute of Developmental Research, Chiang Mai, Thailand
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