Newly published study on atazanavir/r use in African children with HIV

Researchers from the Pharmacometrics team in UCT's Division of Clinical Pharmacology have published a new study in Antimicrobial Agents and Chemotherapy (doi:10.1128/aac.00592-26), addressing a growing challenge in paediatric HIV care: as more children survive into adolescence and gain access to initial-line therapy, increasing numbers are developing resistance and needing subsequent-line treatment. 

Ritonavir-boosted atazanavir (atazanavir/r) is a once-daily boosted protease inhibitor and an important subsequent-line option for children with HIV.

The population pharmacokinetic analysis, led by Jennie van Dyk, Paolo Denti, and Roeland Wasmann, characterised atazanavir/r pharmacokinetics in African children using data from the CHAPAS-4 trial and the VirTUAL study. Because most children with HIV live in high-TB-burden settings, the team also simulated dosing strategies for children co-treated with rifampicin, drawing on adult drug-interaction data from the DERIVE study.

The findings suggest that, assuming similar interaction in children as adults, twice-daily dosing could overcome the interaction with rifampicin. This strategy requires validation in children and provides a framework for prospective paediatric clinical trials.

Read the full study here.

We would like to thank all participants and their caregivers, the trial sites, co-authors and collaborators who contributed to this work, and the ICTS High-Performance Computing team at the University of Cape Town for providing us with the resources to perform the calculations in this study.