Browsing by Author "MWANGWA, Florence"

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    Virologic and Immunologic Outcomes of HIV-Infected Ugandan Children Randomized to Lopinavir-ritonavir or Nonnucleoside-reverse-transcriptase-inhibitor therapy
    (Journal of acquired immune deficiency syndromes, 2014) RUEL, Theodore; KAKURU, Abel; IKILEZI, Gloria; MWANGWA, Florence; CHARLEBOIS, Edwin; KAMYA, Moses; ACHAN, Jane
    In the PROMOTE-pediatrics trial, HIV-infected Ugandan children randomized to receive lopinavir-ritonavir (LPV/r)-based antiretroviral therapy (ART) experienced a lower incidence of malaria compared to children receiving non-nucleoside-reverse-transcriptase-inhibitor (NNRTI)-based-ART. Here we present the results of the non-inferiority (NI) analysis of virologic efficacy and comparison of immunologic outcomes. The proportion of children with virologic suppression (HIV RNA <400copies/ml) at 48 weeks was compared using a pre-specified NI margin of −11% in per-protocol analysis. Time to virologic failure by 96 weeks, change in CD4 counts and percentages, and incidence of adverse event rates were also compared. Of 185 children enrolled, 91 initiated LPV/r and 92 initiated NNRTI-based ART. At baseline, the median age was 3.1 years (range: 0.4 to 5.9) and 131 (71%) were ART-naïve. The proportion of children with virologic suppression at 48 weeks was 80% (67/84) in the LPV/r-arm vs. 76% (59/78) in the NNRTI-arm, a difference of 4% (95%CI: −9% to +17%). Time to virologic failure, CD4 changes, and the incidence of DAIDS grade III/IV adverse events were similar between arms. LPV/r-based ART was not associated with worse virologic efficacy, immunologic efficacy, or adverse event rates compared to NNRTI-based ART. Considering these results and the reduction in malaria incidence associated with LPV/r previously reported for this trial, wider use of LPV/r to treat HIV-infected African children in similar malaria endemic settings could be considered.