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Boehringer Ingelheim GmbH’s HIV drug Viramune helped infected infants more than Abbott Laboratories’ more expensive pill Kaletra in a study, suggesting that the cheaper pill should be used in poorer countries to cut costs.

The World Health Organization recommends mothers use Viramune to prevent passing the AIDS-causing virus to their children in the womb, and give infected infants a cocktail containing Kaletra after birth. Of 195 HIV-infected children under 2 years given that initial treatment, switching back to Viramune kept the virus under control in 56 percent of them, compared with 42 percent who stayed on Kaletra, the study showed.

About 1,000 children are infected with HIV every day, according to the Geneva-based WHO. More children in Africa are likely to start receiving anti-AIDS drugs after a previous study showed they do better when treatment begins earlier, researchers led by Louise Kuhn at Columbia University wrote in the Journal of the American Medical Association. That makes it important to ensure the drugs used are affordable and effective, they said.

The result shows children “could benefit from the switch strategy, which would allow reductions in costs of pediatric treatment programs,” Kuhn and colleagues said yesterday.

UNITAID and the William J. Clinton Foundation negotiated a price of $53 a year for pediatric Viramune in developing nations in 2010, compared with $220 annually for Kaletra, according to the Clinton foundation’s website.

Kaletra has an unpleasant taste, must be refrigerated, limits options for second-line treatment and causes side effects including raised levels of fats in the blood, the researchers said.


Confounding the findings, Viramune failed to control the virus in about 20 percent of the children, compared with 2 percent whose disease didn’t react to Kaletra. Most of those who failed to respond to Viramune had pre-existing resistance to the Boehringer drug after being exposed to it in the womb, the researchers said.

Previous studies have shown resistance to Viramune develops in about half of children exposed to it in the womb when women take it on its own. When they combine it with other drugs, Viramune resistance drops to about 17 percent. The switch strategy should only be used where children can be tested for resistance, the researchers said. The cost of that testing could be offset by the lower cost of Viramune, they said.

The children’s guardians agreed to their participation in the trial, which was funded by the U.S. National Institute of Child Health and Human Development and Bristol-Myers Squibb Co.’s Secure the Future foundation.

Boehringer, based in Ingelheim, Germany, is the world’s biggest family-owned drugmaker. Kaletra earned Abbott Park, Illinois-based Abbott $1.37 billion last year, making it the company’s second-best seller after the arthritis drug Humira.

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