Comparison of virological responses of children commenced on an abacavir versus stavudine based antiretroviral regimen at King Edward VIII Hospital : Durban.

Abstract

Background: UNAIDS estimated that in 2014 just over 160 000 children in South Africa were receiving HAART, accounting for 20% of the global HAART cohort. Finding the appropriate HAART regimen that is safe, well tolerated and efficacious is of extreme importance in ensuring continued and ongoing success of the Paediatric HAART program. In 2010 the World Health Organisation, due to concerns of short and long term stavudine toxicity changed the recommendation regarding first-line HAART regimen from a stavudine based regimen. In South Africa, an abacavir based regimen was chosen as the preferred background regimen. However questions have been raised as to whether this change has replaced the safety concerns associated with stavudine with a less efficacious regimen. Method: A Retrospective chart review was conducted to evaluate the virological responses at 6 and 12 months in a cohort of children initiated on an abacavir based regimen at King Edward VIII hospital between January 2012 – December 2012. Data of 94 children under the age of 12 years who were initiated on abacavir and lamivudine with either lopinavir/ritonavir or efavirenz regimen (abacavir cohort) were analysed using Fisher’s exact test and logistical regression to evaluate virological suppression at 12 months. The data was compared to a prior retrospective chart review conducted between 2004 – 2010 at King Edward VIII Hospital during which a stavudine and lamivudine with either Lopinavir/ritonavir or efavirenz (stavudine cohort) was the standard of care. Results: In both the abacavir cohort and stavudine cohort there was no difference in gender distribution and the mean age of initiation was 6years. In the abacavir cohort, 62,8% were initiated on ABC/3TC/EFV and 37,2% on ABC/3TC/KAL. 88,4% were initiated on D4T/3TC/EFV and 11,6% were initiated on D4T/3TC/KAL in the stavudine cohort. The virological suppression rate in the abacavir cohort was 80.7% compared to 85.2% in the stavudine cohort, which was not a significant difference (p= 0,38:). In the abacavir cohort there was no statistical significant difference in virological suppression between patients on efavirenz versus lopinavir/ritonavir (p= 0.427:). Conclusion: This study demonstrates that children treated with an abacavir based regimen have a good probability of virological suppression, and there was no statistical difference between patients initiating an abacavir-based regimen versus a stavudine based regimen. These findings are in keeping with data from several clinical trials and support the WHO recommendation of an abacavir-based regimen for infants and children initiating antiretroviral treatment.