Weight Monitoring Key to Pediatric ART Dosing in Resource-Limited Countries

Study findings in a short communication published in HIV Medicine revealed that a large percentage of children living with HIV were prescribed inappropriate doses of antiretroviral therapy (ART) at a pediatric outpatient clinic at Harare Central Hospital in Zimbabwe.

According to Zimbabwe national guidelines, all children aged 0 to 10 years and 11 to 17 years who weigh <35 kg should receive weight-based dosing for ART. In this cross-sectional study, 309 children were recruited (<age 10 years or <35 kg). Median age was 7 years (interquartile [IQR] range 5-10 years) and 55% were boys. The median CD4 cell count was 899 cells/µL (IQR 519-1287 cells/µL), and the median time on the current ART regimen was 11.2 months (IQR 4.9-17.1 months).

Of the 110 children who were prescribed inappropriate doses of at least 1 drug in their ART regimen, 49 received higher doses and 64 were underdosed.

Children receiving a higher than recommended dose of at least 1 drug were younger compared with correctly dosed children (median age 6 vs 7 years, respectively; P =.001), had been on their current ART regimen for a shorter time (median 7.2 vs 13 months, respectively; P =.003) and were less likely to be treated with a 3-drug fixed-dose combination (42.9% vs 63.3%, respectively; P =.009).

Children who were underdosed were also less likely to be on a 3-drug fixed-dose combination compared with children receiving accurate-for-weight ART dosages (25% vs 63.3%, respectively; P <.001).

In addition, children on a triple-drug fixed-dose combination ART were more likely to have all 3 drugs correctly dosed compared with children on a dual-drug fixed-dose combination (plus a third agent; 77.3% vs 51.1%, respectively; P <.001).

Results showed that more than a third of children were inappropriately dosed on at least one of their ART drugs. To ensure that children are prescribed correct ART doses, consistent availability of drugs, more user-friendly ART guidelines, and adequate training and treatment monitoring facilities are essential.

“Further work is needed in reviewing antiretroviral prescribing practice against national recommendations and determining the impact this has on antiretroviral dosing and overall clinical outcome,” noted the study authors. Moreover, “a broader range of pediatric fixed-dose combination formulations with a wider range of weight-band dosing is needed, which may alleviate suboptimal antiretroviral dosing,” they concluded.

Reference

Dakshina S, Olaru ID, Khan P, et al. Evaluation of weight-based prescription of antiretroviral therapy in children [published online January 11, 2019]. HIV Med. doi: 10.1111/hiv.12702