Immunologic and Virologic Responses to Nevirapine Based Antiretroviral Therapy (ART) Among HIV-Tuberculosis Co-Infected Ugandan Children on Rifampicin Based Anti-Tubercular Treatment

Moreen Kamateeka*, L. Barlow-Mosha, M. Mubiru, M. Lutajumwa, P. Mudiope and P. M. Musoke

Immunologic and Virologic Responses to Nevirapine Based Antiretroviral Therapy (ART) Among HIV-Tuberculosis Co-Infected Ugandan Children on Rifampicin Based Anti-Tubercular Treatment

The global estimate of HIV infected children at the end of 2013 stood at 3.2 million
with 91% in sub-Saharan Africa. TB is among the most common opportunistic infections affecting
HIV infected children.

In 2013, the World Health OrganizationĀ estimated that there were 550,000 TB cases and 80,000
TB deaths among children. WHO recommends initiating ART as soon as possible for any HIV infected child diagnosed with TB disease.

In areas of high HIV/TB incidence such as sub-Saharan Africa, co-administration of ART and anti-TB treatment
is very common. Despite the general trend of increasing availability of ART in Sub-Saharan Africa over the past decade, paediatric ART in resource-limited settings still faces multiple challenges,
particularly the availability of appropriate, affordable and simplified pediatric ARV formulations.

Nevirapine is widely used in sub-Saharan Africa because of its availability in fixed
dose formulations which provides easy drug administration, reduced pill burden,
convenient storage and low cost. In resource limited settings, NVP is the most widely used Non-nucleoside
reverse transcriptase inhibitor in first line ART regimens for children unless contraindicated.

WHO currently recommends a Lopinavir/ritonavir based regimen for first
line ART among all children under 3 years of age, however NVP is still
recommended for this age group if a LPV/r regimen is not feasible.

HIV/TB co-infected children under 3 years of age cannot use an Efavirenz containing
ART regimen, therefore NVP and LPV/r are commonly used with rifampicinĀ resulting in
drug-drug interactions.

HIV/AIDS Res Treat Open J. 2015; 2(1): 27-36. doi: 10.17140/HARTOJ-2-104