amfAR, The Foundation for AIDS Research

Investigator Video: Improving Pediatric HIV Treatment in Asia

Thailand’s Dr. Wanatpreeya Phongsamart discusses her study on the efficacy of switching children and adolescents living with HIV from the antiretroviral medicine efavirenz to rilpivirine, which causes fewer side effects.

The HIV medicine efavirenz remains the standard first-line therapy for young people living with HIV in the Asia-Pacific region. But while the treatment is highly effective in suppressing HIV, it can occasionally result in serious side effects, including toxicities that increase the risk of headaches, nightmares, depression, and elevations of cholesterol and triglyceride levels. This can also result in poor adherence to the drug, risking treatment failure and drug resistance. This has led some clinicians and researchers to look for alternative medicines to use when these side effects occur.

One of these alternatives is the antiretroviral medicine rilpivirine, which was first approved for use in adults in 2011. It causes fewer side effects than efavirenz, but there is limited experience with using it in children and adolescents. TREAT Asia Network investigator Dr. Wanatpreeya Phongsamart is leading a study to test rilpivirine’s effectiveness in Asian adolescents in the hope that it can be an option for young people who have difficulties with other HIV medicines.

“We hope that switching to rilpivirine will improve the quality of life of adolescents, so that their adherence will be better and they won’t develop resistance,” says Dr. Phongsamart, a pediatric physician and researcher at Siriraj Hospital in Bangkok.

Resistance to antiretroviral therapy poses health challenges for anyone with HIV, but is especially challenging for young people facing a lifetime of HIV treatment. In addition, the second- and third-line medicines needed when people develop treatment failure and drug resistance are more expensive, making it harder to ensure access to effective therapy in low- and middle-income countries.

Dr. Phongsamart’s two-year rilpivirine study, which began in July 2015 and is supported by the Thai government, Siriraj Hospital, and amfAR, aims to enroll 100 HIV-positive adolescents ages 12–18  currently taking efavirenz at four sites in Thailand—Siriraj Hospital, the Thai Red Cross AIDS Research Center, Chulalongkorn University, and Khon Kaen University. Her team will evaluate the impact of switching the patients from efavirenz to rilpivirine, including their levels of viral suppression, neurological outcomes, and adherence and resistance rates.

Click on the above video to hear Dr. Phongsamart discuss her work.