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Lopinavir-Ritonavir Impairs Adrenal Function in Infants
Dulanjalee Kariyawasam1,2,3, Marianne Peries4, Frantz Foissac5,6
1Pediatric Endocrinology, Gynecology, and Diabetology Unit, Hopital Universitaire Necker-Enfants Malades, Assistance Publique-Hopitaux de Paris (AP-HP), Paris, France.
Perinatal lopinavir/ritonavir (LPV/r) prophylaxis in HIV-exposed infants is linked to adrenal dysfunction, evidenced by elevated dehydroepiandrosterone (DHEA) levels. Long-term infant health impacts require further investigation.
Area of Science:
- Pediatric Endocrinology
- Pharmacology
- Infectious Diseases
Background:
- Perinatal lopinavir/ritonavir (LPV/r) prophylaxis is used to prevent mother-to-child HIV transmission.
- LPV/r has been associated with steroidogenic abnormalities, but long-term infant effects are unknown.
Purpose of the Study:
- To compare adrenal-hormone profiles in HIV-exposed, uninfected infants receiving LPV/r or lamivudine (3TC) prophylaxis.
- To assess the in vitro effect of LPV/r on steroidogenesis.
Main Methods:
- Infants were randomized to LPV/r or 3TC prophylaxis at 7 days of life.
- Plasma samples were analyzed for adrenal hormones at 6 and 26 weeks.
- In vitro steroidogenesis was studied using H295R cells.
Main Results:
- LPV/r-exposed infants had significantly higher dehydroepiandrosterone (DHEA) levels at 6 and 26 weeks compared to 3TC-exposed infants.
- Elevated DHEA at 6 weeks correlated with altered 17-OH-pregnenolone and testosterone levels.
- Lopinavir, not ritonavir, inhibited CYP17A1 and CYP21A2 activity in vitro.
Conclusions:
- Infant exposure to lopinavir is associated with dose-dependent adrenal dysfunction.
- Further evaluation is needed to understand the long-term clinical consequences of this exposure.
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