title: Long-term response to highly active antiretroviral therapy with lopinavir/ritonavir in pre-treated vertically HIV-infected children.
abstract: 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) (<or=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+ <25% and in those with baseline VL > 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.
authors.affiliation: Laboratorio de Inmuno-Biología Molecular, Hospital General Universitario Gregorio Marañón, Madrid, Spain. bealarru@yahoo.es
authors.forename: Beatriz
authors.initials: B
authors.lastname: Larrú
authors.forename: Salvador
authors.initials: S
authors.lastname: Resino
authors.forename: Jose M
authors.initials: JM
authors.lastname: Bellón
authors.forename: M Isabel
authors.initials: MI
authors.lastname: de José
authors.forename: Claudia
authors.initials: C
authors.lastname: Fortuny
authors.forename: M Luisa
authors.initials: ML
authors.lastname: Navarro
authors.forename: M Dolores
authors.initials: MD
authors.lastname: Gurbindo
authors.forename: José Tomás
authors.initials: JT
authors.lastname: Ramos
authors.forename: Pere
authors.initials: P
authors.lastname: Soler Palacín
authors.forename: Juan Antonio
authors.initials: JA
authors.lastname: Léon
authors.forename: Manuel
authors.initials: M
authors.lastname: Asensi
authors.forename: M José
authors.initials: MJ
authors.lastname: Mellado
authors.forename: M Angeles
authors.initials: MA
authors.lastname: Muñoz-Fernández
mesh_terms: D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D002648:Child; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000635:transmission / Q000821:virology; D017320:HIV Protease Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D015497:HIV-1 / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D018445:Infectious Disease Transmission, Vertical; D061466:Lopinavir; D008297:Male; D011744:Pyrimidinones / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D012189:Retrospective Studies; D019438:Ritonavir / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D017320:HIV Protease Inhibitors; D011744:Pyrimidinones; D061466:Lopinavir; D019438:Ritonavir