JAC Advance Access published online on September 29, 2005
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dki356
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1 Laboratory of Immunobiología-Molecular, Hospital General Universitario ‘Gregorio Marañón’, Madrid, Spain
* To whom correspondence should be addressed. Background: Lopinavir/ritonavir is a protease inhibitor (PI) that has shown great effectiveness as salvage therapy in PI-experienced HIV-infected children. Objectives: To study whether mutations in the HIV-1 protease gene can reliably predict virological responses to salvage therapy with lopinavir/ritonavir in HIV-infected children. Patients and methods: We carried out a prospective study in 56 HIV-infected children. PI-associated resistance mutations were determined by genotypic testing and were scored according to the IAS-USA guidelines 2005. Results: Children with a ‘lopinavir mutation score’ (LMS) Conclusions: LMS and PRAMs in HIV-infected children were associated with virological failure in pre-treated HIV-infected children on salvage therapy with lopinavir/ritonavir. Moreover, I54V and V82A/F led to the poorest virological response.
Received July 5, 2005
Revised September 8, 2005
Accepted September 9, 2005
Original article
Mutations at codons 54 and 82 of HIV protease predict virological response of HIV-infected children on salvage lopinavir/ritonavir therapy
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Ma Ángeles Muñoz-Fernández, E-mail: mmunoz.hgugm{at}salud.madrid.org
Abstract 
6 had a negative association for achieving viral load (VL) control [undetectable viral load (uVL) 
400 copies/mL] and maintaining uVL for at least 6 months. Moreover, children with protease-associated mutations (PRAMs) 2 had a negative association for achieving VL control but not for maintaining uVL for at least 6 months. The relative proportion (RP) to uVL was 0.32 (CI95%: 0.16; 0.33; P = 0.002) in children with I54V (46% of total) and 0.48 (CI95%: 0.24; 0.97; P = 0.041) in children with V82A/F (52% of total). Children with I54V and V82A/F had higher prevalence of lopinavir-associated resistance mutations and showed RP of 0.36 (CI95%: 0.17; 0.76; P = 0.007) for achieving uVL.Both authors contributed equally to this work.Participants are listed in the Acknowledgements section.
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