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Published on: April 9, 2014
Salvage lopinavir-ritonavir therapy in human immunodeficiency virus-infected children
Salvador Resino1, José Maria Bellón, José Tomás Ramos
1Laboratory of Immuno-Molecular Biology, Department of Pediatrics, Hospital Carlos III, and Abbott Laboratories, Madrid, Spain.
Insights
Lopinavir-ritonavir (LPV/r) based highly active antiretroviral therapy (HAART) is more effective in controlling viral replication in HIV-infected children compared to other salvage regimens. This combination therapy leads to faster viral load suppression and reduced risk of viral rebound.
Area of Science:
- Pediatric Infectious Diseases
- Virology
- Immunology
Background:
- Human immunodeficiency virus (HIV) infection in children requires effective salvage therapies.
- Controlling viral replication is crucial for managing pediatric HIV.
- Evaluating different highly active antiretroviral therapy (HAART) regimens is essential for optimizing treatment outcomes.
Purpose of the Study:
- To assess the efficacy of different salvage therapies in controlling viral replication in HIV-infected children.
- To compare the effectiveness of HAART regimens including lopinavir-ritonavir (LPV/r) against other second-line treatments.
- To determine the impact of salvage therapies on viral load suppression and rebound.
Main Methods:
- A retrospective observational study involving 120 HIV-infected children.
- Children were categorized into three groups based on salvage HAART: first-line HAART, second-line HAART (protease inhibitor-experienced), and second-line HAART with LPV/r.
- Viral load (VL) was quantified using reverse transcription-polymerase chain reaction, with survival analyses for VL < or =400 copies/mL and rebound.
Main Results:
- HAART including LPV/r achieved VL < or =400 copies/mL in 71.5% of children, surpassing first-line (52.4%) and second-line (48.3%) HAART.
- Children on LPV/r-containing HAART reached VL < or =400 copies/mL significantly faster than those on other second-line regimens (P=0.017).
- LPV/r-based HAART demonstrated a significantly lower incidence of viral rebound (32.4%) compared to other salvage therapies, with a 3.29 times lower risk.
Conclusions:
- Highly active antiretroviral therapy (HAART) incorporating lopinavir-ritonavir (LPV/r) offers superior control of HIV replication in children compared to other classic salvage antiretroviral therapies.
- LPV/r-based salvage regimens are associated with improved viral load suppression and reduced risk of virologic failure in pediatric HIV management.
- These findings support the use of LPV/r-containing HAART as an effective salvage strategy for HIV-infected children.
Objective:
To study the control of viral replication in human immunodeficiency virus (HIV)-infected children on different salvage therapies.
Design And Setting:
A retrospective observational study in 120 HIV-infected children was conducted. The children were divided into 3 groups according to their salvage therapies: (1) children receiving first line highly active antiretroviral therapy (HAART); (2) protease inhibitor-experienced children receiving second line HAART; (3) protease inhibitor-experienced children receiving HAART including lopinavir-ritonavir (LPV/r). The outcome variables examined were time to achieve viral load (VL) < or =400 copies/mL, success in achieving VL < or =400 copies/mL and time to virologic failure (VL >400 copies/mL).
Methods:
VL (HIV-RNA copies/mL) was quantified with reverse transcription-polymerase chain reaction molecular assay. For each protocol, survival analyses were conducted to determine the probability of achieving VL < or =400 copies/mL and rebound of VL.
Results:
VL < or =400 copies/mL was achieved by 52.4% of children receiving first line HAART, 48.3% receiving second line HAART and 71.5% receiving HAART including LPV/r. Children receiving HAART including LPV/r reached VL < or =400 copies/mL in a shorter time than children receiving second line HAART (P = 0.017), but quite similar to children receiving first line HAART. In terms of adjusted relative risk, children receiving HAART including LPV/r were 3.36 [95% confidence interval (95% CI), 1.59, 7.07] more likely to achieve VL < or =400 copies/mL than children receiving a different second line HAART. VL rebound occurred in 68.2% children receiving first line HAART, 73.4% receiving second line HAART and 32.4% receiving HAART including LPV/r. Children receiving HAART that includes LPV/r has less incidence of VL rebound (P=0.013) and 3.29 (95% CI 1.04, 10.3) times less risk to achieve a VL rebound than children receiving a different second line HAART.
Conclusions:
HAART that includes LPV/r is able to control HIV replication more efficiently than other classic salvage antiretroviral therapies.
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