Salvage lopinavir-ritonavir therapy in human immunodeficiency virus-infected children.
OBJECTIVE
To study the control of viral replication in human immunodeficiency virus (HIV)-infected children on different salvage therapies.


METHODS
A retrospective observational study in 120 HIV-infected children was conducted. The children were divided into 3 groups according to their salvage therapies: (1) children receiving first line highly active antiretroviral therapy (HAART); (2) protease inhibitor-experienced children receiving second line HAART; (3) protease inhibitor-experienced children receiving HAART including lopinavir-ritonavir (LPV/r). The outcome variables examined were time to achieve viral load (VL) < or =400 copies/mL, success in achieving VL < or =400 copies/mL and time to virologic failure (VL >400 copies/mL).


METHODS
VL (HIV-RNA copies/mL) was quantified with reverse transcription-polymerase chain reaction molecular assay. For each protocol, survival analyses were conducted to determine the probability of achieving VL < or =400 copies/mL and rebound of VL.


RESULTS
VL < or =400 copies/mL was achieved by 52.4% of children receiving first line HAART, 48.3% receiving second line HAART and 71.5% receiving HAART including LPV/r. Children receiving HAART including LPV/r reached VL < or =400 copies/mL in a shorter time than children receiving second line HAART (P = 0.017), but quite similar to children receiving first line HAART. In terms of adjusted relative risk, children receiving HAART including LPV/r were 3.36 [95% confidence interval (95% CI), 1.59, 7.07] more likely to achieve VL < or =400 copies/mL than children receiving a different second line HAART. VL rebound occurred in 68.2% children receiving first line HAART, 73.4% receiving second line HAART and 32.4% receiving HAART including LPV/r. Children receiving HAART that includes LPV/r has less incidence of VL rebound (P=0.013) and 3.29 (95% CI 1.04, 10.3) times less risk to achieve a VL rebound than children receiving a different second line HAART.


CONCLUSIONS
HAART that includes LPV/r is able to control HIV replication more efficiently than other classic salvage antiretroviral therapies.
Resino
Salvador
S
Laboratory of Immuno-Molecular Biology, Department of Pediatrics, Hospital Carlos III, and Abbott Laboratories, Madrid, Spain.
Bellón
José Maria
JM
Ramos
José Tomás
JT
Navarro
Maria Luisa
ML
Martín-Fontelos
Pablo
P
Cabrero
Esther
E
Muñoz-Fernández
Maria Angeles
MA
D000595:Amino Acid Sequence; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D002648:Child; D024882:Drug Resistance, Viral; D004359:Drug Therapy, Combination; D005814:Genes, Viral; D005838:Genotype; D015658:HIV Infections / Q000188:drug therapy*; D015497:HIV-1 / Q000187:drug effects / Q000235:genetics; D006801:Humans; D061466:Lopinavir; D009154:Mutation / Q000187:drug effects; D011744:Pyrimidinones / Q000008:administration & dosage / Q000627:therapeutic use*; D019438:Ritonavir / Q000008:administration & dosage / Q000627:therapeutic use*; D016879:Salvage Therapy; D019562:Viral Load
D019380:Anti-HIV Agents; D011744:Pyrimidinones; D061466:Lopinavir; D019438:Ritonavir