title: Monoboosted lopinavir/ritonavir as simplified second-line maintenance therapy in virologically suppressed children.
abstract: BACKGROUND
  Monoboosted protease inhibitor is being evaluated as a strategy to simplify therapy in virologically suppressed patients who are on complex regimens.
  
  
  METHODS
  Children with two consecutive HIV-RNA below 50 copies/ml at least 3 months apart while on double boosted protease inhibitor (dPI) were switched to monoboosted lopinavir/r (mLPV/r). The previous dPI regimen was resumed within 4 weeks in children who experienced virological failure defined as two HIV-RNA at least 500 or three HIV-RNA at least 50 copies/ml. Primary endpoint was the proportion of children still on mLPV/r and having HIV-RNA less than 50 copies/ml at week 48.
  
  
  RESULTS
  Forty children on LPV/r + saquinavir (90%) or LPV/r + indinavir (10%) were enrolled, 50% were female, median [interquartile range (IQR)] age was 11.7 (10.2-13.5) years, and body weight was 29.4 (24.1-40.2 kg). The median (IQR) CD4% was 27 (23.5-29.5%). At 48 weeks, none had died or had HIV disease progression. Thirty-one children were on mLPV/r and 29 (72.5%) had HIV-RNA less than 50 copies/ml. Nine resumed dPI due to mLPV/r failure with four achieving undetectable HIV-RNA. Overall, 31 children (82.5%) had HIV-RNA suppression. Predicting factor for failing mLPV/r was baseline HIV-RNA at least 50 copies/ml. No major protease mutations were found.
  
  
  CONCLUSIONS
  By simplifying second-line treatment from dPI to mLPV/r, the majority of children had sustained viral suppression at 48 weeks. Randomized study of simplified mono protease inhibitor therapy in children is warranted.
authors.affiliation: The HIV Netherlands Australia Thailand Research Collaboration, Bangkok, Thailand. torsak.b@hivnat.org
authors.forename: Torsak
authors.initials: T
authors.lastname: Bunupuradah
authors.forename: Pope
authors.initials: P
authors.lastname: Kosalaraksa
authors.forename: Thanyawee
authors.initials: T
authors.lastname: Puthanakit
authors.forename: Tawan
authors.initials: T
authors.lastname: Mengthaisong
authors.forename: Jiratchaya
authors.initials: J
authors.lastname: Wongsabut
authors.forename: Pagakrong
authors.initials: P
authors.lastname: Lumbiganon
authors.forename: Praphan
authors.initials: P
authors.lastname: Phanuphak
authors.forename: David
authors.initials: D
authors.lastname: Burger
authors.forename: Chitsanu
authors.initials: C
authors.lastname: Pancharoen
authors.forename: Jintanat
authors.initials: J
authors.lastname: Ananworanich
mesh_terms: D000293:Adolescent; D023241:Antiretroviral Therapy, Highly Active; D002648:Child; D004334:Drug Administration Schedule; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology; D017320:HIV Protease Inhibitors / Q000008:administration & dosage* / Q000494:pharmacology; D015497:HIV-1 / Q000187:drug effects*; D006801:Humans; D061466:Lopinavir; D008297:Male; D011744:Pyrimidinones / Q000008:administration & dosage* / Q000494:pharmacology; D012367:RNA, Viral / Q000187:drug effects* / Q000276:immunology; D019438:Ritonavir / Q000008:administration & dosage* / Q000494:pharmacology; D013785:Thailand
chemical_list: D017320:HIV Protease Inhibitors; D011744:Pyrimidinones; D012367:RNA, Viral; D061466:Lopinavir; D019438:Ritonavir