title: Factors associated with clinical, immunological and virological responses in protease-inhibitor-experienced Brazilian children receiving highly active antiretroviral therapy containing lopinavir-ritonavir.
abstract: This study evaluates clinical, virological and immunological responses to antiretroviral (ARV) therapy based on Lopinavir/ritonovir (LPV/r) in previously protease -inhibitor-experienced children. The study included 29 Brazilian children (median age = 5.91 years) who had failed previous ARV therapy and had begun a regimen based on LPV/r. At 12 months follow-up, a good virological response to LPV/r therapy was defined as achieving an undetectable viral load or as a decrease in plasma HIV RNA levels to > 1 log. A good immunological response was defined as an increase in CD4+ cell count from baseline sufficient to attain a better CDC immune stage classification. The number of infectious episodes 12 months before and 12 months after beginning LPV/r was assessed. Sixteen (55.2%) and 19 (65.5%) of 29 patients exhibited good virological and immunological responses, respectively. Baseline CD4+ values (>500) predicted both virological and immunological responses (p<0.05). Older children were less likely to develop an immunological response (p<0.001) than younger children. Nine children receiving 3 ARV drugs plus LPV/r showed an immunological response (100%) compared to 10/20 (50%) children receiving 2 drugs plus LPV/r (p=0.01). A lower number (n<5) of infectious episodes was noted after 12 months follow-up in children using the LPV/r regimen (p=0.006). There was a positive correlation between children whose baseline CD4+ values were greater than 500 cells/mm(3) and virological responses. Although virological responses to therapy were seen in about half the children (55.2%), the use of HAART containing LPV/r provided clinical and immmunological benefits.
authors.affiliation: Federal University of São Paulo, São Paulo, SP, Brazil. dm.machado@uol.com.br
authors.forename: Daisy Maria
authors.initials: DM
authors.lastname: Machado
authors.forename: Aída de Fátima Barbosa
authors.initials: Ade F
authors.lastname: Gouvêa
authors.forename: Maria Regina
authors.initials: MR
authors.lastname: Cardoso
authors.forename: Suênia Vasconcelos
authors.initials: SV
authors.lastname: Beltrão
authors.forename: Kelly Simone
authors.initials: KS
authors.lastname: Cunegundes
authors.forename: Fabiana
authors.initials: F
authors.lastname: Bononi
authors.forename: Fernanda
authors.initials: F
authors.lastname: Almeida
authors.forename: Kaline
authors.initials: K
authors.lastname: Cavalheiro
authors.forename: Daniela Souza Araújo de
authors.initials: DS
authors.lastname: Angelis
authors.forename: Regina Célia de Menezes
authors.initials: RC
authors.lastname: Succi
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D017320:HIV Protease Inhibitors / Q000627:therapeutic use*; D006801:Humans; D008137:Longitudinal Studies; D061466:Lopinavir; D011744:Pyrimidinones / Q000627:therapeutic use*; D012367:RNA, Viral; D019438:Ritonavir / Q000627:therapeutic use*; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D017320:HIV Protease Inhibitors; D011744:Pyrimidinones; D012367:RNA, Viral; D061466:Lopinavir; D019438:Ritonavir