New antiretroviral combinations show promise for children living with HIV
The CHAPAS-4 trial has presented important advancements in second-line antiretroviral therapy for children living with HIV. Published in the New England Journal of Medicine, the trial results show that new antiretroviral combinations, specifically tenofovir alafenamide (TAF) and dolutegravir (DTG), are superior to older second-line options such as abacavir (ABC) or zidovudine (ZDV) plus lamivudine (3TC).
Conducted across Uganda, Zambia, and Zimbabwe, the trial involved 919 children aged 3 to 15 years, all of whom required second-line treatment after their initial regimens failed. Notably, the TAF plus FTC combination successfully suppressed HIV in 6% more children compared to the traditional standard of care, with equivalent side-effect profiles. Furthermore, the economic analysis indicates that TAF plus FTC is likely to be cost-saving, reducing treatment costs by $37.68.
The study also evaluated various anchor drugs, revealing that DTG-based regimens outperformed both LPV/r and ATV/r, achieving full viral suppression in 10% more children. Additionally, children receiving DRV/r exhibited better overall growth, bone health, and cholesterol levels compared to those on LPV/r.
These findings reinforce the World Health Organization’s recommendation for DTG-based regimens as the preferred second-line treatment for children. The CHAPAS-4 trial presents a critical step forward in enhancing treatment options and outcomes for young individuals living with HIV.
“We congratulate the CHAPAS Consortium on the CHAPAS-4 results, which provide real world evidence on the best treatment options for children living with HIV. EDCTP is proud to have supported the CHAPAS consortium.”
Mr Abdoulie Barry, EDCTP Executive Director
Musiime V, Bwakura-Dangarembizi M, Szubert A.J., et al. Second-Line Antiretroviral Therapy for Children Living with HIV in Africa. N Engl J Med. 2025;392:1917-1932. DOI: 10.1056/NEJMoa2404597