title: Early outcomes of darunavir- and/or raltegravir-based antiretroviral therapy in children with multidrug-resistant HIV at a pediatric center in Botswana.
abstract: BACKGROUND
  Data on the use of ritonavir-boosted darunavir (DRV/r) and/or raltegravir (RAL) in resource-limited settings are rare and there is currently no published data regarding their use among African children. Botswana has recently made DRV/r and RAL available for patients failing second-line antiretroviral therapy (ART).
  
  
  METHODS
  Retrospective chart review of 4 multidrug-resistant pediatric patients on DRV/r- and/or RAL-based regimens. Viral load, CD4 count, adherence by pill count, and World Health Organization (WHO) clinical stage prior to and after switch to DRV/r- and/or RAL-based regimen were assessed. Antiretroviral therapy history, duration of virologic failure, and time to viral suppression were also noted. Genotypic resistance assays reviewed for mutations present prior to switch.
  
  
  RESULTS
  All patients achieved viral suppression, showed improved/stable CD4 counts, and obtained or maintained WHO clinical treatment stage I, even after long-standing virologic/immunologic failure.
  
  
  CONCLUSIONS
  Well tolerated by and effective in our patients, DRV/r and RAL provide potentially lifesaving ART options for children and adolescents in resource-limited settings failing ART due to ritonavir-boosted lopinavir (LPV/r) resistance.
authors: Botswana-Baylor Children's Clinical Centre of Excellence, Gaborone, Botswana. briannakirk@me.com
authors: Brianna L
authors: BL
authors: Kirk
authors: Andres
authors: A
authors: Gomila
authors: Mogomotsi
authors: M
authors: Matshaba
authors: Marape
authors: M
authors: Marape
authors: Dipesalema R
authors: DR
authors: Joel
authors: Gabriel
authors: G
authors: Anabwani
authors: Michael A
authors: MA
authors: Tolle
mesh_terms: D000293:Adolescent; D023241:Antiretroviral Therapy, Highly Active; D001902:Botswana; D002648:Child; D000069454:Darunavir; D024921:Drug Resistance, Multiple, Viral; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D017320:HIV Protease Inhibitors / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D011760:Pyrrolidinones / Q000627:therapeutic use*; D000068898:Raltegravir Potassium; D012189:Retrospective Studies; D019438:Ritonavir / Q000627:therapeutic use*; D013449:Sulfonamides / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D017320:HIV Protease Inhibitors; D011760:Pyrrolidinones; D013449:Sulfonamides; D000068898:Raltegravir Potassium; D019438:Ritonavir; D000069454:Darunavir