JAC Advance Access first published online on November 19, 2007
This version published online on December 4, 2007
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkm436
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Long-term response to highly active antiretroviral therapy with lopinavir/ritonavir in pre-treated vertically HIV-infected children
1 Laboratorio de Inmuno-Biología Molecular, Hospital General Universitario ‘Gregorio Marañón’, Madrid, Spain 2 Centro Nacional de Microbiología, Instituto de Salud ‘Carlos III’, Majadahonda, Madrid, Spain 3 Inmuno-Pediatría, Hospital Universitario ‘La Paz’, Madrid, Spain 4 Inmuno-Pediatría, Hospital ‘San Joan de Déu’, Barcelona, Spain 5 Inmuno-Pediatría, Hospital General Universitario ‘Gregorio Marañón’, Madrid, Spain 6 Inmuno-Pediatría, Hospital Universitario ‘12 de Octubre’, Madrid, Spain 7 Inmuno-Pediatría, Hospital ‘Val d'Hebron’, Barcelona, Spain 8 Pediatría-Infecciosas, Hospital Universitario ‘Virgen de Rocío’, Sevilla, Spain 9 Pediatría-Infecciosas, Hospital ‘La Fe’, Valencia, Spain 10 Pediatría-Infecciosas, Hospital Universitario ‘Carlos III’, Madrid, Spain
Received 13 July 2007; returned 8 September 2007; revised 9 October 2007; accepted 11 October 2007
* Corresponding author. Tel: +34-91-586-8565; Fax: +34-91-586-8018; E-mail: bealarru{at}yahoo.es
Background: Immune recovery after prolonged highly active antiretroviral therapy (HAART) with lopinavir/ritonavir has been reported in adults but not in children. Our study aimed at evaluating the long-term use of lopinavir/ritonavir among children in a clinical setting.
Methods: We carried out a retrospective study on 69 protease inhibitor (PI)-experienced vertically HIV-infected children on HAART containing lopinavir/ritonavir. We analysed the changes in percentage CD4+ cell count (%CD4+) and viral load (VL) and identified prognostic factors to achieve CD4+ >25% and undetectable VL (uVL) (
400 copies/mL) by logistic regression.
Results: During the first 2 years, we found an increase in the %CD4+ in children with baseline CD4+ between 0% and 15% and those with baseline VL < 30 000 copies/mL. We found a decrease in VL in all groups of children. From second to fourth year, we found an increase in %CD4+ in all the children who had CD4+ <25% and in those with baseline VL > 100 000 copies/mL. We found that %CD4+ at baseline had a strong positive association with achieving CD4+ >25% at 6, 12, 18, 24, 36 and 48 months of follow-up. We also found that length of PI use had a negative association with reaching CD4+ >25% at 24 and 48 months and achieving uVL at 12 and 24 months. VL at baseline had a negative association with achieving uVL at 18 and 24 months.
Conclusions: Our study demonstrates ongoing immune recovery among children on HAART with lopinavir/ritonavir after 4 years of follow-up. Lopinavir/ritonavir, when given as part of a salvage regimen, is safe and well tolerated in HIV-infected children.
Key Words: protease inhibitors , immune reconstitution , viral suppression
The originally published version of this paper was incorrect. There was an error in an author's name: ‘Pere Soler’ should have read ‘Pere Soler Palacín’.
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