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Neuropsychiatric Side Effects of Efavirenz in Children Living With HIV

NCT03227653 — Completed, 144 participants, Radboud University Medical Center

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Neuropsychiatric Adverse Effects of Efavirenz in Children Living With HIV in Kilimanjaro, Tanzania

RegistryNCT03227653
StatusCompleted
Study typeObservational
Enrollment144 (Actual)
SponsorRadboud University Medical Center (Other); collaborators: Kilimanjaro Christian Medical Centre, Tanzania, Kilimanjaro Clinical Research Institute
ConditionsEfavirenz, Child Behavior, Cognitive Symptom, Medication Adherence, Drug-Related Side Effects and Adverse Reactions
InterventionsEfavirenz, Nevirapine, Lopinavir-Ritonavir Drug Combination (Drug)
Datesstart 2017-06-19, primary completion 2017-12-31, completion 2017-12-31, first posted 2017-07-24, last updated 2018-07-10
Locations6 sites in Tanzania

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-Summary

Efavirenz is among the preferred antiretroviral drugs for HIV-infected children. Increasing evidence shows that central nervous system side-effects in adults are more common than previously thought. Still, reliable data in children are lacking. As HIV-infected children nowadays have a prospect of reaching adulthood, there is an urgent need to identify potential long-term central nervous system side-effects, interfering with neurodevelopment and psychosocial maturation. Using validated tools, we assessed (1) competence (social/activities/school) and psychopathology (internalizing/externalizing problems), (2) cognitive performance (intelligence and working memory), and (3) adherence in Tanzanian children on an efavirenz or non-efavirenz based regimen

In this cross-sectional observational study the investigators will examine neuropsychiatric and neurocognitive functioning in 126 children (aged 6-11 years) on long-term combination antiretroviral therapy (cART) with or without efavirenz.

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+Detailed description

In this cross-sectional observational study, we include HIV-infected children (6-12 years) on cART for ≥ 6 months, with viral loads ≤ 1000 copies/ml in Kilimanjaro Region, Tanzania. Psychopathology and competence will be assessed using the Child Behaviour Checklist. Cognitive performance will be assessed using the Raven's Coloured Progressive Matrices and the digit span test. Non-adherence is defined as any reported missed doses over the previous 3 days or <100% adherence since the last clinical visit. Analysis of covariance and logistic regression models will be used to assess differences between groups. .

+Arms and interventions

ArmTypeInterventionsDescription
EfavirenzDrug: EfavirenzChildren using efavirenz-based cART for at least 6 months
Non-efavirenzDrug: Nevirapine; Drug: Lopinavir-Ritonavir Drug CombinationChildren using non-efavirenz-based cART (nevirapine or Lopinavir-Ritonavir Drug Combination) for at least 6 months.
  • Efavirenz (Drug), also known as Efavirenz-group: Weight-based dosing according to the National Guidelines for the Management of HIV and AIDS
  • Nevirapine (Drug), also known as Non-efavirenz group: Weight-based dosing according to the National Guidelines for the Management of HIV and AIDS
  • Lopinavir-Ritonavir Drug Combination (Drug), also known as Non-efavirenz group: Weight-based dosing according to the National Guidelines for the Management of HIV and AIDS

+Outcome measures

Primary outcomes

  • Neuropsychological symptoms: competence and psychopathology (internalizing/externalizing symptoms) [At day of inclusion]: Neuropsychological symptoms will be assessed using the Swahili version of the Child Behavior Checklist for 6-18 years (CBCL6-18)

Secondary outcomes

  • Cognitive functioning - non-verbal cognitive ability (general intelligence) [At day of inclusion]: Non-verbal cognitive ability will be assessed using the Raven's Progressive Matrices
  • Cognitive functioning - working memory [At day of inclusion]: Working memory will be assessed using the Wechsler Intelligence Scale for Children (WISC-III) Digit Span Test
  • Treatment adherence [At day of inclusion]: Treatment adherence will be measured using an adherence questionnaire, adapted from the PENTA 16 trial (permission obtained from the author prof. Giaquinto)

Other outcomes

  • Central nervous system symptoms [At day of inclusion]: The presence of central nervous system symptoms (yes/no) in the week prior to study visit will be assessed using a checklist composed of symptoms that have been linked to efavirenz in literature.

+Eligibility

Sex: All, ages: 6 Years to 12 Years

Inclusion Criteria:

* Aged 6 until 12 years
* HIV seropositive
* Using cART, with or without efavirenz, for at least 6 months
* Registered patient at one of the participating centres
* In the presence of at least one parent or caregiver who is part if the child's life/upbringing

Exclusion Criteria:

* Switch of cART regimen in the last 6 months
* History of brain injury, mental health and cognitive impairment before starting cART
* HIV RNA >1000 copies/mL within the past year
* Any AIDS-defining illness or acute illness (e.g. fever, lowered consciousness, dehydration) at time of inclusion
* Children with parent(s) or caregiver(s) not wanting or not able to give informed consent

+Locations (6)

FacilityCityCountryStatus
Kilimanjaro Christian Medical CentreMoshi, KilimanjaroTanzania
Mawenzi Regional HospitalMoshi, KilimanjaroTanzania
Kibosho HospitalKiboshoTanzania
Kiboroloni DispensaryMoshiTanzania
Majengo Health CentreMoshiTanzania
Pasua Health CentreMoshiTanzania

+Publications

  • Van de Wijer L, Schellekens AFA, Burger DM, Homberg JR, de Mast Q, van der Ven AJAM. Rethinking the risk-benefit ratio of efavirenz in HIV-infected children. Lancet Infect Dis. 2016 May;16(5):e76-e81. doi: 10.1016/S1473-3099(16)00117-1. Epub 2016 Apr 18. PMID 27599655
  • Mothapo KM, Schellekens A, van Crevel R, Keuter M, Grintjes-Huisman K, Koopmans P, van der Ven A. Improvement of Depression and Anxiety After Discontinuation of Long- Term Efavirenz Treatment. CNS Neurol Disord Drug Targets. 2015;14(6):811-8. doi: 10.2174/1871527314666150325235847. PMID 25808896
  • Van de Wijer L, Kinabo GD, Mchaile DN, de Mast Q, Schellekens AFA, van der Ven AJAM. Safety Evaluation of Efavirenz in Children: Don't Forget the Central Nervous System. Clin Infect Dis. 2018 Mar 19;66(7):1150. doi: 10.1093/cid/cix926. No abstract available. PMID 29088326
  • Results publication: Van de Wijer L, Mchaile DN, de Mast Q, Mmbaga BT, Rommelse NNJ, Duinmaijer A, van der Ven AJAM, Schellekens AFA, Kinabo GD. Neuropsychiatric symptoms in Tanzanian HIV-infected children receiving long-term efavirenz treatment: a multicentre, cross-sectional, observational study. Lancet HIV. 2019 Apr;6(4):e250-e258. doi: 10.1016/S2352-3018(18)30329-1. Epub 2019 Feb 12. PMID 30770324

+Investigators

  • Grace Kinabo, MD, PhD, Principal investigator, Kilimanjaro Christian Medical Centre
  • André van der Ven, MD, PhD, Principal investigator, Radboud University Medical Center

My Notes