title: Comparison of levels of antiretroviral drugs with efficacy in children with HIV infection.
abstract: OBJECTIVE
  To determine the prevalence of low and high antiretroviral (ARV) plasma levels and to analyze correlation between ARV concentrations and the appearance of therapeutic failure and toxicity.
  
  
  METHODS
  The authors present here a study evaluating antiretroviral plasma concentrations in HIV infected children on nonnucleoside reverse transcriptase inhibitors and protease inhibitors based therapy. The authors carried out a multicentre, cross-sectional study, including HIV-infected children from five large Hospitals in Madrid, Spain. Clinical, haematological, biochemical and immuno-virological parameters were assessed. Antiretroviral plasma trough levels were performed using a validated high performance liquid chromatography method.
  
  
  RESULTS
  Between April 2006 and April 2008, 129 children were enrolled in the present study, with median treatment duration of 39.2 months. 25.5% of the non-nucleoside reverse transcriptase inhibitors levels were low and 17.6%, high. 27.9% percent of the protease inhibitors levels were low and 12.5%, high. A correlation was found among adequate or high levels of antiretrovirals and normal CD4 percentage and low viral load. Lopinavir/ritonavir plasma levels were correlated with an increase in lipodystrophy. Patients with Tanner stage 1 presented the lowest ARV plasma levels. Full adherence was reported for all the participants by a questionnaire.
  
  
  CONCLUSIONS
  Many HIV-infected children show ARV plasma levels out of the therapeutic range which demands a child-adjusted approach. However, larger studies are urgently needed in pediatric populations to define optimal reference values.
authors.affiliation: Servicio de Pediatría-Infecciosas, Hospital Universitario La Paz, Paseo de la Castellana 261, Madrid, Spain. ananso@yahoo.es
authors.forename: Ana Pilar
authors.initials: AP
authors.lastname: Nso
authors.forename: Beatriz
authors.initials: B
authors.lastname: Larru
authors.forename: Jose Ma
authors.initials: JM
authors.lastname: Bellón
authors.forename: Ma José
authors.initials: MJ
authors.lastname: Mellado
authors.forename: Jose Tomás
authors.initials: JT
authors.lastname: Ramos
authors.forename: Ma Isabel
authors.initials: MI
authors.lastname: González
authors.forename: María Luisa
authors.initials: ML
authors.lastname: Navarro
authors.forename: María Angeles
authors.initials: MA
authors.lastname: Muñoz-Fernández
authors.forename: María Isabel
authors.initials: MI
authors.lastname: de José
mesh_terms: D000293:Adolescent; D044966:Anti-Retroviral Agents / Q000493:pharmacokinetics* / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000635:transmission; D017320:HIV Protease Inhibitors / Q000493:pharmacokinetics / Q000627:therapeutic use; D015497:HIV-1; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D008297:Male; D018894:Reverse Transcriptase Inhibitors / Q000493:pharmacokinetics / Q000627:therapeutic use; D019562:Viral Load
chemical_list: D044966:Anti-Retroviral Agents; D017320:HIV Protease Inhibitors; D018894:Reverse Transcriptase Inhibitors