Abacavir is one of the recommended nucleoside reverse
transcriptase inhibitors (NRTIs) for the treatment of HIV infections among
children and adolescents. However, there are concerns that the antiviral
efficacy of abacavir might be low when compared to other NRTIs especially among
children. There are also concerns that abacavir use may lead to serious adverse
events such as hypersensitivity reactions and has potential predisposition to
developing cardiovascular diseases
We searched four electronic databases, four conference
proceedings and two clinical trial registries in August 2014, without language
restrictions. Experimental and observational studies with control groups that
examined the efficacy and safety of abacavir-containing regimens in comparison
with other NRTIs as first-line treatment for HIV-infected children and
adolescents aged between one month and eighteen years were eligible. Two
authors independently screened search results, extracted data and assessed the
risk of bias of included studies using a pre-specified, standardised data
extraction form and validated risk of bias tools. We also assessed the quality
of evidence per outcome with the GRADE tool.
We included two randomised controlled trials (RCTs) and two
analytical cohort studies with a total of 10,595 participants. Among the RCTs
we detected no difference in virologic suppression after a mean duration of
48 weeks between abacavir- and stavudine-containing regimens (2 trials; n = 326:
RR 1.28; 95 % CI 0.67–2.42)
with significant heterogeneity (P = 0.02;
I 2 = 81 %). We also found no significant differences between the
two groups for adverse events and death. After five years of follow-up,
virologic suppression improved with abacavir (1 trial; n = 69:
RR 1.96; 95 % CI 1.11–3.44).
For cohort studies, we detected that the virologic suppression activity of
abacavir was less effective than stavudine in both the lopinavir/ritonavir (1
study, n = 2165: RR 0.79, 95 % CI 0.67–0.92) and efavirenz sub-groups (1
study, n = 3204: RR 0.79, 95 % CI 0.67–0.92) respectively. The quality of
evidence from RCTs was moderate for virologic suppression but low for death and
adverse events, while that of cohort studies was low for all three these
outcomes.
Available evidence showed little or no difference between
abacavir-containing regimen and other NRTIs regarding efficacy and safety when
given to children and adolescents as a first-line antiretroviral therapy.
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at:
1Centre for Evidence-based Health Care,
Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town
7505, South Africa
2Division of Community Health, Faculty of
Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South
Africa
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