Children treated for HIV with a drug called Nevirapine have delayed brain function compared to those who received other drugs, a new assessment shows.
Kenya discontinued Nevirapine in children in 2019 and put them on a new drug therapy.
The drug is still available in antiretroviral therapy clinics but is prescribed in extremely rare cases sanctioned at the highest levels of the National Aids And STIs Control Programme.
However, a study released last week shows the drug’s negative effects linger in children who took it before the age of three.
Findings reported in the journal 'Frontiers in Paediatrics' showed those children score poorly on some neuropsychological tests to measure how well a brain is working.
“Children randomised to the Nevirapine arm in early childhood, and then maintained on that arm until study entry at school age, do most poorly across all the global performance-based neuropsychology measures,” the authors said.
Nevirapine was a preferred first-line antiretroviral treatment in children in many poor countries including Kenya until 2013.
In October 2019, former acting Health director general Wekesa Masasabi said it was still being taken by about 15,000 children aged up to 15 years, but was replaced with a regimen containing Dolutegravir (DTG).
"Kenya will phase out Nevirapine by December 2019. All children and adolescents living with HIV currently on Nevirapine-based first-line should be transitioned to an optimal regimen," Dr Masasabi wrote to county Health CECs in early October 2019.
Even then, it was associated with many side effects including included rash, fatigue, headache, vomiting, diarrhoea, abdominal pain and muscle pain, which would go away after one month.
It was also associated with liver damage in some people and an increasing resistance was registered in many countries.
Last week, the researchers said even if the children were switched to a better drug regimen at school age, the “die was already cast”.
“The brain/behaviour development of the child initially treated on Nevirapine in early childhood, may have been at a neuropsychological disadvantage even if they responded well to their treatment,” they said.
The fundings are from a study conducted between October 2013 and December 2016 in South Africa, Zimbabwe, Malawi and Uganda.
The researchers compared neuropsychological outcomes in HIV-positive children aged five to 11 years and compared them to age-matched HIV-exposed uninfected children and children not exposed to HIV, from similar neighborhoods.
“Children receiving Nevirapine had poorer neuropsychological scores than those on lopinavir/ritonavir,” the authors report in a study titled 'Antiretroviral choice and severe disease predict poorer neuropsychological outcomes in HIV+ children from Africa',
“Antiretroviral choice might adversely impact neuropsychological performance,” they said.
The investigators called for research into potential cognitive rehabilitation training for children treated with the drug.
They also noted the damage from failure to prevent HIV in children or failure to begin treatment early, is incomparably worse than effects of Nevirapine.