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test the safety and efficacy of this new formulation in young children

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Bringing antiretroviral drugs to children

The CHAPAS trials have ensured that many more children with HIV have benefited
from life-saving antiretrovirals.

The challenge

More than 20 million people are living with HIV in sub-Saharan Africa. Thanks to increasing access to antiretroviral therapy, more people living with HIV are surviving to older age, when they are at increased risk of a range of cardiometabolic diseases, including high blood pressure, cardiovascular disease and chronic kidney disease. In addition, long-term use of antiretroviral drugs may also increase the risk of these conditions.

Non-communicable diseases are already more common in people with HIV than in the general population, and modelling studies suggest that, by 2030, 84% of people with HIV will have at least one non-communicable disease and about one-third will have three or more.

Currently, care of people living with HIV is provided in parallel with other healthcare provision, and focuses primarily on the infectious diseases they are at risk of acquiring. This limits opportunities to address non-communicable disease risk factors in this group. In addition, there is a limited understanding of the nature and extent of non-communicable disease risk factors in people living with HIV.

In his EDCTP Senior Fellowship, Professor Andre Kengne is building on existing links to establish a network to generate additional evidence on non-communicable disease risk factors. The network brings together the South African Medical Research Council, the Nigerian Institute of Medical Research, and the Clinical Research, Education and Consultancy Network in Cameroon.

Professor Kengne’s research will draw on the resources of three existing large-scale projects. In Nigeria, data on risk factors for chronic kidney disease will be collected from a cohort of nearly 24,000 people living with HIV who are receiving antiretroviral therapy and have been followed for nearly 15 years. In Cameroon, information on cardi-metabolic risk factors will be obtained from a cohort of nearly 20,000 people living with HIV. And in South Africa, Professor Kengne is evaluating a text messaging intervention designed to improve adherence to anti-hypertensive medicines in people with HIV and high blood pressure.

The project

The later CHAPAS-3 trial compared the efficacy and safety of three fixed-dose combinations including two without stavudine (found to have some long-term side effects in adults, leading to a recommendation that its use be discontinued in children). The trial the first of its kind in Africa studied nearly 500 children at four sites in two African countries.

Professor Kengne’s Senior Fellowship project will gather additional information on the risk factors for non-communicable disease in sub-Saharan African populations. A clearer understanding of the most important risk factors could underpin the design of integrated services for people living with HIV that address both infectious and non-communicable co-morbidities.

ratios forfixed-dose combinations and on appropriatedosage according to weight. 

The CHAPAS-3 trial confirmed the effectiveness of fixed-dose combinations, providing further impetus to the rollout of antiretrovirals to children. Its evidence on abacavir informed the WHO recommendation of abacavir-containing combinations for first-line therapy in children. Trial data have also been used to support applications for regulatory approval for new scored efavirenz tablets.

Impact