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Mortality and long-term virologic outcomes in children and infants treated with lopinavir/ritonavir

Dora Estripeaut1, Jon Mosser, Meg Doherty

  • 1From the *Department of Pediatrics, Hospital del Niño, Panama; †Johns Hopkins University School of Medicine; ‡Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; and §Instituto Conmemorativo Gorgas de Estudios de Salud, Panama.

The Pediatric Infectious Disease Journal
|June 27, 2013
PubMed

Insights

Lopinavir/ritonavir (LPV/r)-based therapy significantly improved survival in HIV-infected children, including those over one year old, in a resource-limited setting. Virologic outcomes were not affected by prior antiretroviral exposure or treatment initiation age.

Area of Science:

  • Pediatric Infectious Diseases
  • HIV/AIDS Treatment
  • Public Health in Resource-Limited Settings

Background:

  • Limited data exists on protease inhibitor-based therapy for young children in resource-limited environments.
  • Optimal timing for initiating antiretroviral therapy (ART) in children surviving infancy requires further investigation.
  • The Hospital del Niño in Panama has routinely used lopinavir/ritonavir (LPV/r)-based therapy for children since 2002.

Purpose of the Study:

  • To evaluate the outcomes of HIV-infected children treated with lopinavir/ritonavir (LPV/r)-based therapy.
  • To assess the impact of LPV/r therapy on survival and virologic suppression in a real-world, resource-limited setting.
  • To determine the optimal timing for initiating LPV/r-based therapy in children.

Main Methods:

  • Retrospective cohort analysis of HIV-infected children from January 1, 1991, to June 1, 2011.
  • Kaplan-Meier method and Cox proportional hazards regression were employed.
  • Evaluation of death, virologic suppression, and virologic rebound as primary outcomes.

Main Results:

  • LPV/r-based therapy improved survival in infants and children over one year old.
  • Virologic suppression rates were 42.1% at 12 months, 70.5% at 24 months, and 85.1% at 60 months.
  • Factors associated with poorer survival included residence outside Panama City; high baseline viral load (>100,000 copies/mL) was linked to lower suppression rates.

Conclusions:

  • LPV/r-based therapy is effective in improving survival for HIV-infected children, regardless of age at initiation or prior antiretroviral exposure.
  • Achieving virologic suppression with LPV/r therapy was associated with improved survival outcomes.
  • Further research is needed to optimize treatment strategies in resource-limited settings.
Abstract

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