Department of HIV/AIDS, World Health Organization, Geneva, Switzerland.
Division of HIV/AIDS Prevention, US Centers for Disease Control and Prevention, Atlanta, Georgia.
Clin Infect Dis. 2015 Jun 1;60 Suppl 3:S177-81. doi: 10.1093/cid/civ110.
This systematic review aimed to assess the safety and efficacy of antiretroviral options for postexposure prophylaxis (PEP). Recognizing the limited data on the safety and efficacy of antiretroviral drugs for PEP in children, this review was extended to include consideration of data on the use of antiretroviral drugs for treatment of infants and children living with human immunodeficiency virus.
The PEP literature was assessed to identify studies reporting safety and completion rates for children given PEP, and this information was complemented by safety and efficacy data for drugs used in antiretroviral therapy. The proportion of patients experiencing each outcome was calculated and data were pooled using random-effects meta-analysis.
Three prospective cohort studies reported outcomes of children given zidovudine (ZDV) plus lamivudine (3TC) as a 2-drug PEP regimen. The proportion of children completing the full 28-day course of PEP was 64.0% (95% confidence interval [CI], 41.2%-86.8%), whereas the proportion discontinuing due to adverse events was 4.5% (95% CI, .4%-8.6%). One randomized trial compared abacavir (ABC) plus lamivudine (3TC) and ZDV+3TC as part of a dual or triple first-line antiretroviral therapy regimen; this study showed better efficacy in the ABC-containing combinations and no difference in the time to first serious adverse event. Three randomized trials compared lopinavir/ritonavir (LPV/r) to nevirapine (NVP) for antiretroviral therapy and showed a lower risk of treatment discontinuations associated with LPV/r vs NVP (hazard ratio, 0.56 [95% CI, .41-.75]) but no difference in drug-related adverse events. The overall quality of the evidence was rated as very low.
This review supports ZDV+3TC+LPV/r as the preferred 3-drug regimen for PEP in children.
本系统评价旨在评估用于暴露后预防 (PEP) 的抗逆转录病毒方案的安全性和疗效。鉴于儿童 PEP 中抗逆转录病毒药物安全性和疗效的数据有限，本综述扩展到包括对用于治疗感染人类免疫缺陷病毒的婴儿和儿童的抗逆转录病毒药物使用数据的考虑。
评估 PEP 文献，以确定报告接受 PEP 的儿童安全性和完成率的研究，并通过抗逆转录病毒治疗中使用的药物的安全性和疗效数据补充这些信息。计算每种结局的患者比例，并使用随机效应荟萃分析对数据进行汇总。
三项前瞻性队列研究报告了给予齐多夫定 (ZDV) + 拉米夫定 (3TC) 作为 2 药 PEP 方案的儿童结局。完成完整 28 天 PEP 疗程的儿童比例为 64.0%（95%置信区间 [CI]，41.2%-86.8%），而因不良事件停药的比例为 4.5%（95% CI，.4%-8.6%）。一项随机试验比较了阿巴卡韦 (ABC) + 拉米夫定 (3TC) 和 ZDV+3TC 作为双重或三重一线抗逆转录病毒治疗方案的一部分；这项研究表明 ABC 包含的组合具有更好的疗效，且首次严重不良事件的时间无差异。三项随机试验比较了洛匹那韦/利托那韦 (LPV/r) 与奈韦拉平 (NVP) 用于抗逆转录病毒治疗，结果显示 LPV/r 与 NVP 相比，停药风险较低（风险比，0.56 [95% CI，.41-.75]），但药物相关不良事件无差异。证据的总体质量被评为非常低。
本综述支持 ZDV+3TC+LPV/r 作为儿童 PEP 的首选 3 药方案。
