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Integrase strand transfer inhibitors use in children with perinatal HIV-1 infection: a narrative review.

INTRODUCTION
Integrase strand transfer inhibitors (INSTIs), including raltegravir (RAL), dolutegravir (DTG), elvitegravir (EVG), bictegravir (BIC), and cabotegravir (CAB), are increasingly used given excellent data on their efficacy, effectiveness, and tolerability profile in adults, while data in children are accumulating.


OBJECTIVE AND METHODS
To review the most recent evidence on the efficacy, effectiveness, safety, and resistance of INSTIs in children, a quick narrative review of the available literature data was performed using,the MEDLINE/PubMed and Scopus databases, including only English-language studies, published between 2009-2022. All articles were included.


RESULTS
Six studies (259 children) on RAL use, 17 studies (3448 children) on DTG,2 studies (73 children) on EVG and 1 study (102 children) on BIC were retrievied. Results on efficacy and effectiveness are close to those reported in adult studies, suggesting similar in children as well as in adult population. Resistance was detected in four studies on RAL, the range of resistance development ranged from 5% to 35.3% of participants. In the four studies on DTG resistant mutations occurred in 12.4% to 22% of children. Adverse events to RAL have been reported in rare cases. In studies on EVG ranged from 8% to 74% developed uveitis, nausea or abdominal pain. In DTG studies the proportion of weight gain ranged from 10% to 87%, and neuropsychiatric effects ranged from 1% to 16%. BIC study reported adverse events >10% of participants.


CONCLUSION
The evidence supports high efficacy and low toxicity of INSTIs in pediatric and adolescent populations and their role as preferred ART regimens as recommended by the WHO and US guidelines recommendations.