Neuropsychiatric Side Effects of Efavirenz in Children Living With HIV

NCT ID: NCT03227653

Last Updated: 2018-07-10

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

144 participants

Study Classification

OBSERVATIONAL

Study Start Date

2017-06-19

Study Completion Date

2017-12-31

Brief Summary

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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.

Detailed Description

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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. .

Conditions

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Efavirenz Child Behavior Cognitive Symptom Medication Adherence Drug-Related Side Effects and Adverse Reactions

Study Design

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Observational Model Type

COHORT

Study Time Perspective

CROSS_SECTIONAL

Study Groups

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Efavirenz

Children using efavirenz-based cART for at least 6 months

Efavirenz

Intervention Type DRUG

Weight-based dosing according to the National Guidelines for the Management of HIV and AIDS

Non-efavirenz

Children using non-efavirenz-based cART (nevirapine or Lopinavir-Ritonavir Drug Combination) for at least 6 months.

Nevirapine

Intervention Type DRUG

Weight-based dosing according to the National Guidelines for the Management of HIV and AIDS

Lopinavir-Ritonavir Drug Combination

Intervention Type DRUG

Weight-based dosing according to the National Guidelines for the Management of HIV and AIDS

Interventions

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Efavirenz

Weight-based dosing according to the National Guidelines for the Management of HIV and AIDS

Intervention Type DRUG

Nevirapine

Weight-based dosing according to the National Guidelines for the Management of HIV and AIDS

Intervention Type DRUG

Lopinavir-Ritonavir Drug Combination

Weight-based dosing according to the National Guidelines for the Management of HIV and AIDS

Intervention Type DRUG

Other Intervention Names

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Efavirenz-group Non-efavirenz group Non-efavirenz group

Eligibility Criteria

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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
Minimum Eligible Age

6 Years

Maximum Eligible Age

12 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Kilimanjaro Christian Medical Centre, Tanzania

OTHER

Sponsor Role collaborator

Kilimanjaro Clinical Research Institute

OTHER

Sponsor Role collaborator

Radboud University Medical Center

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Grace Kinabo, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Kilimanjaro Christian Medical Centre

André van der Ven, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Radboud University Medical Center

Locations

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Kilimanjaro Christian Medical Centre

Moshi, Kilimanjaro, Tanzania

Site Status

Mawenzi Regional Hospital

Moshi, Kilimanjaro, Tanzania

Site Status

Kibosho Hospital

Kibosho, , Tanzania

Site Status

Kiboroloni Dispensary

Moshi, , Tanzania

Site Status

Majengo Health Centre

Moshi, , Tanzania

Site Status

Pasua Health Centre

Moshi, , Tanzania

Site Status

Countries

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Tanzania

References

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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.

Reference Type BACKGROUND
PMID: 27599655 (View on PubMed)

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.

Reference Type BACKGROUND
PMID: 25808896 (View on PubMed)

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.

Reference Type BACKGROUND
PMID: 29088326 (View on PubMed)

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.

Reference Type DERIVED
PMID: 30770324 (View on PubMed)

Other Identifiers

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EFV Kids

Identifier Type: -

Identifier Source: org_study_id

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