Predictive factors of virologic success in HIV positive children treated with lopinavir/ritonavir

Predictive factors of the virologic success of the use of the protease inhibitor lopinavir/r (Kaletra) in HIV-infected children are unknown, especially in children who have been pretreated with protease inhibitors (PIs).

This longitudinal, single-centre, observational study included 69 children (21 PI-naive and 48 PI-experienced) who had received LPV/r for at least 3 months. The mean (+/-SD) age was 10.3 +/- 4.8 years, and the mean baseline of CD4+ T cell percentage and HIV-1 RNA was 14.9% +/- 9.8% and 4.8 +/- 1.05 log₁₀ copies/mL, respectively.

At 6, 12, and 18 months, 52%, 57%, and 49% of all children, respectively, had a viral load less than 50 copies/mL. The risk of virologic failure, defined as two consecutive viral loads greater than 1000 copies/mL, was significantly higher when the children were previously treated with PIs and when the baseline LPV mutation score exceeded 3 mutations.

In the pretreated children, the ratio of the plasma LPV maximal concentration to the baseline LPV score mutation was also associated with failure, independently of resistance score.

Finally, in children failing an LPV-containing regimen, accumulation of additional PI-associated resistance mutations was evidenced in viral isolates from children with prior PI treatment, even with viral replication levels less than 10,000 copies/mL.

The authors conclude: “In pretreated children, LPV plasma levels should be optimised in an attempt to achieve sufficient drug concentrations to overcome the resistance level.”

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Delaugerre C et al. Predictive factors of virologic success in HIV-1-infected children treated with lopinavir/ritonavir. Journal of Acquired Immune Deficiency Syndromes 37(2): 1269-1275. 1 October 2004.
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