Use of Nucleoside Reverse Transcriptase Inhibitor Only Regimens in HIV-infected Children and Adolescents

Antiretroviral treatment regimens that consist of at least three nucleoside reverse transcriptase inhibitors (NRTIs) without any other co-administered class of antiretroviral drug are termed NRTI-only regimens (NOARs). In the late 1990s, NOARs gained favor in antiretroviral-naive HIV-infected adults as well-tolerated alternatives to more complex regimens that included protease inhibitors (PIs) or non-NRTIs (NNRTIs).[1-3] Although several clinical trials demonstrated inferior virologic suppression of NOARs compared to NRTI- or PI-based regimens,[4] NOARs can be effective as maintenance therapy started after a period of complete virologic suppression.[5-7] Nevertheless, NOARs are no longer generally recommended for adult therapy except under specific conditions, such as to avoid drug-drug interactions with rifampin-based therapy for tuberculosis.[8] Published experience with NOARs in children is very limited, but suggests that NOARs have modest immunologic and virologic benefits among ARV-naive children[9,10] or when used in children to maintain virologic suppression achieved with NNRTI- or PI-based regimens.[11] Since existing pediatric data are scant, the objective of this analysis was to use the LEGACY cohort of HIV-infected children and adolescents to describe the use of NOARs and relevant clinical outcomes in this population.