Title : Antiretroviral therapy – Switch of therapy
 
Clinical Problem : A 6 years old HIV infected boy was referred for further management. He was on antituberculous therapy {ATT} for past 2 months in view of pulmonary TB and father having died of TB 8 months ago. His CD4 count was 630, cumm {12 percent}. In view of good CD4 count, ART was not started. At 7 years of age, his X-Ray Chest had remained the same {bilateral perihilar haziness} and CD4 count was 447 {18.6 percent} with weight of 20 kg. He was thus started on antiretroviral therapy consisting of Zidovudine {AZT}, Lamivudine {3TC} and Efavirenz {EFV} following which his Chest X-Ray improved and ATT could be stopped. He was then continued on ART. At 9 years, his weight had increased to 40 kg and CD4 count was 1535 {49.2 percent} with CD4:CD8 of 1.14. He was then referred to an ART center for free ART and he was shifted to AZT plus 3TC and Nevirapine {NVP} instead of EFV.
 
Question : Is it agreeable to shift a patient doing well on Efavirenz based regime to Nevirapine based regime_?
 
Expert Opinion : Switching of efavirenz to nevirapine can be done in patients who have a suppressed HIV virus. Since both belong to the NNRTI group, both have same action. Switch in this case can ease the number of pill as AZT, 3TC and NVP are available as fixed drug combinations and also the cost of therapy. Efavirenz is used for the antiretroviral treatment of HIV, tuberculosis-coinfected patients in developing countries. A switch to nevirapine is regularly carried out because of the cost and side effects of efavirenz. Pharmacokinetic studies suggested that nevirapine should be initiated at full dose when used as a substitute for efavirenz. However before switching one should always make sure that the virus is suppressed by doing the HIV viral load.
 
Funding : None
 
Conflict of Interest : None
 
DOI No. : 10.7199/ped.oncall.2014.36
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