title: Second-line protease inhibitor-based HAART after failing non-nucleoside reverse transcriptase inhibitor-based regimens in Asian HIV-infected children.
abstract: BACKGROUND
  The World Health Organization (WHO) recommends boosted protease inhibitor (bPI)-based HAART after failing non-nucleoside reverse transcriptase inhibitor (NNRTI) treatment. We examined outcomes of this regimen in Asian HIV-infected children.
  
  
  METHODS
  Children from five Asian countries in the TREAT Asia Pediatric HIV Observational Database (TApHOD) with ≥ 24 weeks of NNRTI-based HAART followed by ≥ 24 weeks of bPI-based HAART were eligible. Primary outcomes were the proportions with virological suppression (HIV RNA < 400 copies/ml) and immune recovery (CD4+ T-cell percentage [CD4%]≥ 25% if age < 5 years and CD4+ T-cell count ≥ 500 cells/mm3 if age ≥ 5 years) at 48 and 96 weeks.
  
  
  RESULTS
  Of 3,422 children, 153 were eligible; 52% were female. At switch, median age was 10 years, 26% were in WHO stage 4. Median weight-for-age z-score (WAZ) was -1.9 (n = 121), CD4% was 12.5% (n = 106), CD4+ T-cell count was 237 cells/mm3 (n = 112), and HIV RNA was 4.6 log10 copies/ml (n = 61). The most common bPI was lopinavir/ritonavir (83%). At 48 weeks, 61% (79/129) had immune recovery, 60% (26/43) had undetectable HIV RNA and 73% (58/79) had fasting triglycerides ≥ 130 mg/dl. By 96 weeks, 70% (57/82) achieved immune recovery, 65% (17/26) had virological suppression, and hypertriglyceridaemia occurred in 66% (33/50). Predictors for virological suppression at week 48 were longer duration of NNRTI-based HAART (P = 0.006), younger age (P = 0.007), higher WAZ (P = 0.020) and HIV RNA at switch < 10,000 copies/ml (P = 0.049).
  
  
  CONCLUSIONS
  In this regional cohort of Asian children on bPI-based second-line HAART, 60% of children tested had immune recovery by 1 year, and two-thirds had hyperlipidaemia, highlighting difficulties in optimizing second-line HAART with limited drug options.
authors.affiliation: HIV-NAT, the Thai Red Cross AIDS Research Centre, Bangkok, Thailand. torsak.b@hivnat.org.
authors.forename: Torsak
authors.initials: T
authors.lastname: Bunupuradah
authors.forename: Thanyawee
authors.initials: T
authors.lastname: Puthanakit
authors.forename: Paul
authors.initials: P
authors.lastname: Fahey
authors.forename: Azar
authors.initials: A
authors.lastname: Kariminia
authors.forename: Nik K N
authors.initials: NK
authors.lastname: Yusoff
authors.forename: Truong H
authors.initials: TH
authors.lastname: Khanh
authors.forename: Annette H
authors.initials: AH
authors.lastname: Sohn
authors.forename: Kulkanya
authors.initials: K
authors.lastname: Chokephaibulkit
authors.forename: Pagakrong
authors.initials: P
authors.lastname: Lumbiganon
authors.forename: Rawiwan
authors.initials: R
authors.lastname: Hansudewechakul
authors.forename: Kamarul
authors.initials: K
authors.lastname: Razali
authors.forename: Nia
authors.initials: N
authors.lastname: Kurniati
authors.forename: Bui V
authors.initials: BV
authors.lastname: Huy
authors.forename: Tavitiya
authors.initials: T
authors.lastname: Sudjaritruk
authors.forename: Nagalingeswaran
authors.initials: N
authors.lastname: Kumarasamy
authors.forename: Siew M
authors.initials: SM
authors.lastname: Fong
authors.forename: Vonthanak
authors.initials: V
authors.lastname: Saphonn
authors.forename: Jintanat
authors.initials: J
authors.lastname: Ananworanich
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D001210:Asia, Southeastern; D001786:Blood Glucose / Q000378:metabolism; D015496:CD4-Positive T-Lymphocytes / Q000187:drug effects* / Q000276:immunology / Q000821:virology; D002648:Child; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D015497:HIV-1 / Q000187:drug effects; D006801:Humans; D008074:Lipoproteins / Q000097:blood; D061466:Lopinavir / Q000627:therapeutic use; D008297:Male; D011480:Protease Inhibitors / Q000627:therapeutic use*; D012367:RNA, Viral / Q000037:antagonists & inhibitors*; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D019438:Ritonavir / Q000627:therapeutic use; D019562:Viral Load / Q000187:drug effects
chemical_list: D019380:Anti-HIV Agents; D001786:Blood Glucose; D008074:Lipoproteins; D011480:Protease Inhibitors; D012367:RNA, Viral; D018894:Reverse Transcriptase Inhibitors; D061466:Lopinavir; D019438:Ritonavir