Adherence and Acceptability of Once Daily Lamivudine and Abacavir in Human Immunodeficiency Virus Type-1 Infected Children

Abstract

Adherence to once daily abacavir/lamivudine was good with no evidence of an association between nonadherence and virologic rebound. Acceptability of once daily drugs was best when the whole regimen was dosed once daily.

Paediatric European Network for Treatment of AIDS (PENTA) guidelines for treatment of paediatric HIV‐1 infection 2015: optimizing health in preparation for adult life

“…Starting with ABC and 3TC also has the advantage of preserving (and even increasing) susceptibility to ZDV for future options in cases of virological failure, whereas starting on ZDV may lead to accumulation of thymidine analogue‐associated mutations (TAMs) affecting subsequent susceptibility to ABC 84, 85. Both ABC and 3TC can be given once daily to children over 3 months old, which is supported by PK data in PENTA 13 and PENTA 15, and virological outcomes in ARROW 71, 86, 87, 88. 3TC and ABC both have palatable liquid formulations, and scored breakable tablets have recently become available.…”

Association of Antiretroviral and Clinic Adherence With Orphan Status Among HIV-Infected Children in Western Kenya

“…Such a comparison would not necessarily validate our reports of adherence given that proxy-or self-report methods are not consistently associated with pediatric clinical outcomes in other studies using these methods. 6,45,[53][54][55][56][57][58][59][60] Our study may also underestimate the extent of ART nonadherence because it was based on clinic assessments and thus compounded by clinic nonadherence. Although patients may have some extra medication supplies and should report nonadherence from missed visits during their subsequent visits, the clinic-based ART assessments likely underestimate ART nonadherence.…”

“…Although proxy or self-report is the most widely used method of adherence assessment, these reports tend to overestimate adherence 9 and are not consistently associated with pediatric clinical outcomes. 6,45,[53][54][55][56][57][58][59][60] However, the majority of pediatric HIV centers rely on self-or proxy-reported measures alone, 9 indicating the need to determine the accuracy of these low-cost assessments. Effort should be made to develop and evaluate reliable, valid adherence measurement instruments for these populations.…”

How can we simplify antiretroviral therapy in children?

“…Although failure-free survival was comparable to similar studies in adults (76% after 48 weeks), 39% of the children had to discontinue the study regimen due to failure or nonadherence [24]. A study from the UK examined the adherence to and acceptability of switching to once-daily abacavir and lamivudine as part of a highly active ART regimen [25 ]. Almost all caregivers (21 of 23) reported their preference for the once-daily regimen, with full adherence reported for those children on completely once-daily regimens (i.e., not mixed with other twice-daily drugs) [25 ].…”

“…A study from the UK examined the adherence to and acceptability of switching to once-daily abacavir and lamivudine as part of a highly active ART regimen [25 ]. Almost all caregivers (21 of 23) reported their preference for the once-daily regimen, with full adherence reported for those children on completely once-daily regimens (i.e., not mixed with other twice-daily drugs) [25 ]. Although this study showed noninferior pharmacokinetic results relative to a twice-daily regimen [26], there are other studies looking at once-daily regimens with lopinavir/ritonavir that demonstrate greater variability in drug levels [27,28].…”