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Lopinavir/Ritonavir
Is an Effective Option for Salvage Therapy in PI-experienced Children
Lopinavir/ritonavir
(Kaletra) has demonstrated antiviral activity
in the HIV-infected patient. The aim of the current study was to
analyze virological
response to lopinavir/ritonavir therapy in previously
protease inhibitor (PI)-experienced HIV-1-infected children.
Sixty-seven
HIV-1-children on lopinavir/ritonavir were studied in a multicentre,
prospective cohort observational study. The outcome variables were
undetectable viral load (uVL; VL </=400 copies/mL) and virological failure
after uVL with a rebound of VL >400 copies/mL.
VL
and genotype of HIV-1-isolates were measured using standard assays.
Results
83.5%
of children had a 1 log10 VL decrease including 65.6% who reached
uVL.
Children
with >2 changes of antiretroviral therapy (ART) or >5 drugs
needed a median time of 3-4 months higher than children with </=2
changes of ART or </=5 drugs previous to lopinavir/ritonavir,
to reach those values, and the relative proportions (RP) were 2.2
(P =0.038) and 1.9 (P=0.050), respectively.
Children
with CD4+ >15% (P=0.122), VL </=30 000 (P < 0.001) copies/mL,
and age >12 years (P=0.096) achieved an earlier control of VL
during the follow-up.
The
children with virological failure or rebound of VL had higher baseline
VL and lower CD4+ T-lymphocytes/mm(3) and had taken a greater number
of drugs previous to lopinavir/ritonavir.
HIV-children
with a new nucleoside
reverse transcriptase inhibitor (NRTI), or protease
inhibitor (PI) or PI plus non-nucleoside
reverse transcriptase inhibitors (NNRTI) in the current
regimen had a better virological response than children without
these new drugs.
Also,
children with <6 protease mutations had an RP of 2.31 of achieving
uVL.
Conclusions
In
conclusion, the authors write, “HAART including lopinavir/ritonavir
induces beneficial effects in terms of virological outcome responses,
and it is an effective option for salvage therapy in PI-experienced
HIV-1-infected children.”
Laboratory
of Immuno-Molecular Biology, Hospital Gregorio Maranon, Madrid,
Spain.
10/13/04
Reference
S Resino and others. Positive virological outcome after
lopinavir/ritonavir salvage therapy in protease inhibitor-experienced
HIV-1-infected children: a prospective cohort study. Journal
of Antimicrobial Chemotherapy. October 7, 2004 [Epub ahead of
print].
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