10 April 2017 Volume :5 Issue :16

Children Treated with Abacavir-Based Regimen Have Good Probability of Virological Suppression

Children Treated with Abacavir-Based Regimen Have Good Probability of Virological Suppression
Dr Stephane Montgomery celebrates with her husband, graduating with a Masters of Medicine in Paediatrics.

A study which demonstrated that HIV positive children treated with an abacavir- based regimen have a good probability of virological suppression, earned Dr Stephane Montgomery a Master of Medicine degree in Paediatrics.

‘The primary objectives of my thesis, based on HIV therapy; were to describe the demographic characteristics, baseline characteristics and the virological responses in children at six months and 12 months in the abacavir cohort and to compare these to children in the stavudine cohort,’ said Montgomery.

She found no statistical difference between patients initiating an abacavir-based regimen versus a stavudine based regimen, saying her findings were in line with data from several clinical trials and supported the World Health Organization (WHO) recommendation of an abacavir-based regimen for infants and children initiating antiretroviral treatment.

UNAIDS has 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 programme,’ said Montgomery. ‘In 2010 the WHO, 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,’ she said.

Montgomery conducted a retrospective chart review to evaluate the virological responses at 6 and 12 months in a cohort of children initiated on an abacavir-based regimen at Durban’s King Edward VIII Hospital between January and December 2012.

Data on 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 and 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.

In both the abacavir cohort and stavudine cohort there was no difference in gender distribution and the mean age of initiation was six years old.

The study demonstrated that children treated with an abacavir-based regimen have a good probability of virological suppression.

Montgomery is currently working as a Paediatrician at Netcare Umhlanga hospital.

She is a long distance runner and finished the Comrades Marathon in 2015 and 2016. This year she completed the Dusi Canoe Marathon. ‘Sport is my passion and it helps with relieving the stress of my job. It especially helped with reducing stress levels during my Registrar training.’

Nombuso Dlamini

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