Comparison of Viral Load Suppression among HIV-1 Infected Children Aged 5 to 12 Years on Once Daily Versus Twice Daily Abacavir-Containing Regimens at University Teaching Hospitals - Children’s Hospital, Lusaka, Zambia
Keywords:
Abacavir, Viral Suppression, Once-daily dosing, Twice-daily dosing
Abstract
Objectives and Study Design: Abacavir is one of the first-line drugs used to treat HIV infection in paediatric patients in Zambia whose use in children has not been widely published in Zambia. This study sought to compare the virologic response of abacavir given as part of a once-daily regimen with the response when given as part of a twice-daily regimen. A total of eighty-two children aged two to twelve years currently receiving antiretroviral therapy at the Paediatric Centre of Excellence, University Teaching Hospitals, Lusaka, Zambia were observed in the study. This was a prospective cohort study. All the children were initially on twice daily abacavir containing regimen with lamivudine twice daily and efavirenz once daily, with 40 maintained on this regimen by the attending clinician and 42 switched to once daily abacavir, lamivudine and efavirenz by the attending clinician. Profiles were obtained for each child to compare viral load at baseline and at week 24. Data was analysed using Stata Version 16. Results: The proportion of children with undetectable viral load in the once daily group at 24 weeks was 64.3% compared to 72.5% in the twice daily group. Twice-daily dosing reduced the odds of achieving undetectable viral load by about 59%, while being male reduced the odds of achieving undetectable HIV viral load by 19.6%. Baseline haemoglobin, creatinine or alanine transferase levels were not predictors of viral load suppression. Conclusion: The study suggests that once daily dosing of an abacavir containing regimen achieved lower viral suppression rate when compared to twice daily dosing. It is recommended that once daily dosing of abacavir containing regimen should be considered as a dosing option for Zambian children living with HIV. Key Words: Abacavir, Viral Suppression, Once-daily dosing, Twice-daily dosingReferences
1. Joint United Nations Programme on HIV/AIDS (UNAIDS), Global Report (2018)
2. Ministry of Health, Zambia. Zambia Population-based HIV Impact Assesment (ZAMPHIA) 2016:
3. Gross, R., Yip, B., Lo Re, V., Wood, E., Alexander, C. S., Harrigan, P. R., Bangsberg, D. R., Montaner, J. S. G., & Hogg, R. S. (2006). A simple, dynamic measure of antiretroviral therapy adherence predicts failure to maintain HIV-1 suppression. Journal of Infectious Diseases, 194(8), 1108–1114.
4. Stone, V. E., Jordan, J., Tolson, J., Miller, R., & Pilon, T. (2004). Perspectives on Adherence and Simplicity for HIV-Infected Patients on Antiretroviral Therapy. JAIDS Journal of Acquired Immune Deficiency Syndromes, 36(3), 808–816.
5. Munthali, B. T., Hachizovu, S., & Washington, M. (2020). Perspective. 6–9.
6. Maitland, D., Jackson, A., Osorio, J., Mandalia, S., Gazzard, B. G., & Moyle, G. J. (2008). Switching from twice-daily abacavir and lamivudine to the once-daily fixed-dose combination tablet of abacavir and lamivudine improves patient adherence and satisfaction with therapy. HIV Medicine, 9(8), 667–672.
7. Bergshoeff, A., Burger, D., Verweij, C., Farrelly, L., Flynn, J., Le Prevost, M., Walker, S., Novelli, V., Lyall, H., Khoo, S., & Gibb, D. (1359). Plasma pharmacokinetics of once-versus twice-daily lamivudine and abacavir: simplification of combina-tion treatment in HIV-1-infected children (PENTA-13).
8. Jacqz-Aigrain et al., (2010). Pharmacokinetic study of once-daily versus twice-daily abacavir and lamivudine in HIV type-1-infected children aged 3-<36 months. Antiviral therapy, 15(3), 297–305. doi.org/10.3851/IMP1532
9. Joint United Nations Programme on HIV/AIDS (UNAIDS), Global Report (2019)
10. Buchanan, A. L., Montepiedra, G., Sirois, P. A., Kammerer, B., Garvie, P. A., Storm, D. S., & Nichols, S. L. (2012). Barriers to medication adherence in HIV-infected children and youth based on self- and caregiver report. Pediatrics, 129(5).
11. Fetzer, B. C., Mupenda, B., Lusiama, J., Kitetele, F., Golin, C., & Behets, F. (2011). Barriers to and facilitators of adherence to pediatric antiretroviral therapy in a sub-Saharan setting: Insights from a qualitative study. AIDS Patient Care and STDs, 25(10), 611–621.
12. Ministry of Health. (2020). Zambia Guidelines for Treatment and Prevention of HIV Infection. February, 138.
13. Mulenga, V., Musiime, V., Kekitiinwa, A., Cook, A. D., Abongomera, G., Kenny, J., Chabala, C., Mirembe, G., Asiimwe, A., Owen-Powell, E., Burger, D., McIlleron, H., Klein, N., Chintu, C., Thomason, M. J., Kityo, C., Walker, A. S., Gibb, D. M., Kabamba, D., … Lyall, H. (2016). Abacavir, zidovudine, or stavudine as paediatric tablets for African HIV-infected children (CHAPAS-3): An open-label, parallel-group, randomised controlled trial. In The Lancet Infectious Diseases (Vol. 16, Issue 2, pp. 169–179).
14. Musiime V, Kendall L. Bakeera-Kitaka S, Snowden WB, Odongo F, Thomason M, Musoke P, Adkison K, Burger D, Mugyeni P, Kekitiinwa A, Gibb D, Walker AS 2010. Pharmacokinetics and acceptability of once-versus twice-daily lamivudine and abacavir in HIV type-1-infected Ugandan children in the ARROW Trial. Antivir Ther.2010;15(8):1115-24. doi: 10.3851/IMP1695. PMID: 2114991
15. Musiime V, Kasirye P, Naidoo-James B, Nahirya-Ntege P, Mhute T, Cook A, Mugurura L, Munjoma M, Thoofer NK, Ndashimye E, Nankya I, Spyer MJ, Thomason MJ, Snowden W, Gibb DM, Walker AS, (2016). Once versus twice-daily abacavir and lamivudine in African children. AIDS, 30(11), 1761-1770. doi 10.97/QAD.0000000000001116
16. Bunupuradah T, Punyahotra P, Cressey TR, Srimuan A, Thammajaruk N, Sophonphan J, Sriheara C, Burger DM, Puthanakit T, Ananworanich J (2015). Plasma pharmacokinetics od once-daily abacavir-and-lamivudine-containing regimens and week 96 efficacy in HIV-infected Thai children. J Virus Erad. Jul 1;1(3):185-91. PMID: 27482411; PMCID: PMC4946738
17. Parienti JJ, Bangsberg DR, Verdon R, Gardner EM (2009). Better adherence with once-daily antiretroviral regimens: a meta-analysis. Clin Infect Dis. Doi:10.1086/596482. PMID: 19140758; PMCID: PMC2708315
2. Ministry of Health, Zambia. Zambia Population-based HIV Impact Assesment (ZAMPHIA) 2016:
3. Gross, R., Yip, B., Lo Re, V., Wood, E., Alexander, C. S., Harrigan, P. R., Bangsberg, D. R., Montaner, J. S. G., & Hogg, R. S. (2006). A simple, dynamic measure of antiretroviral therapy adherence predicts failure to maintain HIV-1 suppression. Journal of Infectious Diseases, 194(8), 1108–1114.
4. Stone, V. E., Jordan, J., Tolson, J., Miller, R., & Pilon, T. (2004). Perspectives on Adherence and Simplicity for HIV-Infected Patients on Antiretroviral Therapy. JAIDS Journal of Acquired Immune Deficiency Syndromes, 36(3), 808–816.
5. Munthali, B. T., Hachizovu, S., & Washington, M. (2020). Perspective. 6–9.
6. Maitland, D., Jackson, A., Osorio, J., Mandalia, S., Gazzard, B. G., & Moyle, G. J. (2008). Switching from twice-daily abacavir and lamivudine to the once-daily fixed-dose combination tablet of abacavir and lamivudine improves patient adherence and satisfaction with therapy. HIV Medicine, 9(8), 667–672.
7. Bergshoeff, A., Burger, D., Verweij, C., Farrelly, L., Flynn, J., Le Prevost, M., Walker, S., Novelli, V., Lyall, H., Khoo, S., & Gibb, D. (1359). Plasma pharmacokinetics of once-versus twice-daily lamivudine and abacavir: simplification of combina-tion treatment in HIV-1-infected children (PENTA-13).
8. Jacqz-Aigrain et al., (2010). Pharmacokinetic study of once-daily versus twice-daily abacavir and lamivudine in HIV type-1-infected children aged 3-<36 months. Antiviral therapy, 15(3), 297–305. doi.org/10.3851/IMP1532
9. Joint United Nations Programme on HIV/AIDS (UNAIDS), Global Report (2019)
10. Buchanan, A. L., Montepiedra, G., Sirois, P. A., Kammerer, B., Garvie, P. A., Storm, D. S., & Nichols, S. L. (2012). Barriers to medication adherence in HIV-infected children and youth based on self- and caregiver report. Pediatrics, 129(5).
11. Fetzer, B. C., Mupenda, B., Lusiama, J., Kitetele, F., Golin, C., & Behets, F. (2011). Barriers to and facilitators of adherence to pediatric antiretroviral therapy in a sub-Saharan setting: Insights from a qualitative study. AIDS Patient Care and STDs, 25(10), 611–621.
12. Ministry of Health. (2020). Zambia Guidelines for Treatment and Prevention of HIV Infection. February, 138.
13. Mulenga, V., Musiime, V., Kekitiinwa, A., Cook, A. D., Abongomera, G., Kenny, J., Chabala, C., Mirembe, G., Asiimwe, A., Owen-Powell, E., Burger, D., McIlleron, H., Klein, N., Chintu, C., Thomason, M. J., Kityo, C., Walker, A. S., Gibb, D. M., Kabamba, D., … Lyall, H. (2016). Abacavir, zidovudine, or stavudine as paediatric tablets for African HIV-infected children (CHAPAS-3): An open-label, parallel-group, randomised controlled trial. In The Lancet Infectious Diseases (Vol. 16, Issue 2, pp. 169–179).
14. Musiime V, Kendall L. Bakeera-Kitaka S, Snowden WB, Odongo F, Thomason M, Musoke P, Adkison K, Burger D, Mugyeni P, Kekitiinwa A, Gibb D, Walker AS 2010. Pharmacokinetics and acceptability of once-versus twice-daily lamivudine and abacavir in HIV type-1-infected Ugandan children in the ARROW Trial. Antivir Ther.2010;15(8):1115-24. doi: 10.3851/IMP1695. PMID: 2114991
15. Musiime V, Kasirye P, Naidoo-James B, Nahirya-Ntege P, Mhute T, Cook A, Mugurura L, Munjoma M, Thoofer NK, Ndashimye E, Nankya I, Spyer MJ, Thomason MJ, Snowden W, Gibb DM, Walker AS, (2016). Once versus twice-daily abacavir and lamivudine in African children. AIDS, 30(11), 1761-1770. doi 10.97/QAD.0000000000001116
16. Bunupuradah T, Punyahotra P, Cressey TR, Srimuan A, Thammajaruk N, Sophonphan J, Sriheara C, Burger DM, Puthanakit T, Ananworanich J (2015). Plasma pharmacokinetics od once-daily abacavir-and-lamivudine-containing regimens and week 96 efficacy in HIV-infected Thai children. J Virus Erad. Jul 1;1(3):185-91. PMID: 27482411; PMCID: PMC4946738
17. Parienti JJ, Bangsberg DR, Verdon R, Gardner EM (2009). Better adherence with once-daily antiretroviral regimens: a meta-analysis. Clin Infect Dis. Doi:10.1086/596482. PMID: 19140758; PMCID: PMC2708315
Published
2023-06-01
How to Cite
1.
Mutenda M, Mwamba M, Munkombwe D, Kaonga P. Comparison of Viral Load Suppression among HIV-1 Infected Children Aged 5 to 12 Years on Once Daily Versus Twice Daily Abacavir-Containing Regimens at University Teaching Hospitals - Children’s Hospital, Lusaka, Zambia. Journal of Agricultural and Biomedical Sciences [Internet]. 1Jun.2023 [cited 16Nov.2024];6(3). Available from: https://nscme.unza.zm/index.php/JABS/article/view/1000
Section
General
Copyright: ©️ JABS. Articles in this journal are distributed under the terms of the Creative Commons Attribution License Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.