Long-term response to highly active antiretroviral therapy with lopinavir/ritonavir in pre-treated vertically HIV-infected children

• Published in: Journal of antimicrobial chemotherapy 2008-01, Vol.61 (1), p.183-190
• Main Authors: Larrú, Beatriz, Resino, Salvador, Bellón, Jose M., de José, M. Isabel, Fortuny, Claudia, Navarro, M. Luisa, Gurbindo, M. Dolores, Ramos, José Tomás, Soler Palacín, Pere, Léon, Juan Antonio, Asensi, Manuel, Mellado, M. José, Muñoz-Fernández, M. Ángeles
• Format: Article
• Language: English
• Subjects: Antibiotics. Antiinfectious agents. Antiparasitic agents; Antiretroviral drugs; Antiretroviral Therapy, Highly Active; Biological and medical sciences; CD4 Lymphocyte Count; Child; Female; HIV; HIV Infections - drug therapy; HIV Infections - transmission; HIV Infections - virology; HIV Protease Inhibitors - administration & dosage; HIV Protease Inhibitors - adverse effects; HIV Protease Inhibitors - therapeutic use; HIV-1 - drug effects; HIV-1 - genetics; HIV-1 - isolation & purification; Human immunodeficiency virus; Human viral diseases; Humans; immune reconstitution; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunology; Immunopathology; Infectious Disease Transmission, Vertical; Infectious diseases; Lopinavir; Male; Medical sciences; Microbiology; Pediatrics; Pharmacology. Drug treatments; Protease inhibitors; Pyrimidinones - administration & dosage; Pyrimidinones - adverse effects; Pyrimidinones - therapeutic use; Retrospective Studies; Ritonavir - administration & dosage; Ritonavir - adverse effects; Ritonavir - therapeutic use; Time Factors; Treatment Outcome; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; viral suppression
• ISSN: 0305-7453; 1460-2091
• DOI: 10.1093/jac/dkm436

Background Immune recovery after prolonged highly active antiretroviral therapy (HAART) with lopinavir/ritonavir has been reported in adults but not in children. Our study aimed at evaluating the long-term use of lopinavir/ritonavir among children in a clinical setting. Methods We carried out a retrospective study on 69 protease inhibitor (PI)-experienced vertically HIV-infected children on HAART containing lopinavir/ritonavir. We analysed the changes in percentage CD4+ cell count (%CD4+) and viral load (VL) and identified prognostic factors to achieve CD4+ >25% and undetectable VL (uVL) (≤400 copies/mL) by logistic regression. Results During the first 2 years, we found an increase in the %CD4+ in children with baseline CD4+ between 0% and 15% and those with baseline VL < 30 000 copies/mL. We found a decrease in VL in all groups of children. From second to fourth year, we found an increase in %CD4+ in all the children who had CD4+ 100 000 copies/mL. We found that %CD4+ at baseline had a strong positive association with achieving CD4+ >25% at 6, 12, 18, 24, 36 and 48 months of follow-up. We also found that length of PI use had a negative association with reaching CD4+ >25% at 24 and 48 months and achieving uVL at 12 and 24 months. VL at baseline had a negative association with achieving uVL at 18 and 24 months. Conclusions Our study demonstrates ongoing immune recovery among children on HAART with lopinavir/ritonavir after 4 years of follow-up. Lopinavir/ritonavir, when given as part of a salvage regimen, is safe and well tolerated in HIV-infected children.