Lopinavir/ritonavir-based antiretroviral therapy in human immunodeficiency virus type 1-infected naive children : rare protease inhibitor resistance mutations but high lamivudine/emtricitabine resistance at the time of virologic failure
BACKGROUND: Lopinavir/ritonavir (LPV/r) is now the protease inhibitor regimen of choice in the first-line antiretroviral therapy for children <6 years of age.
METHODS: We included all the human immunodeficiency virus (HIV) type 1-infected highly active antiretroviral therapy (HAART)-naive children who started an LPV/r-based regimen between 2000 and 2009 at the Necker Hospital (Paris, France). Virologic failure (VF) was defined as an HIV-RNA ≥50 copies/mL. Resistance genotypic test was performed in case of VF.
RESULTS: A total of 43 children were included at a median age of 4.8 years (1.8-8.0). Median level of HIV RNA and percentage of CD4 cell count was 5.5 log₁₀ copies/mL (4.6-6) and 15% (8-27.5), respectively. HAART included LPV/r and 2 nucleoside reverse-transcriptase inhibitors, mainly lamivudine (3TC), zidovudine, and/or abacavir. The median follow-up period was 36 months (18-72). Less than 50 copies/mL of HIV RNA was observed in 46%, 67%, and 70% of the children at months 6, 9, and 12, respectively. In all, 20 children (46.5%) experienced a VF. The risk factors of primary VF were a young age and a low socioeconomic status. The genotypic resistance test, performed for 18 of 20 children with VF, revealed 1 LPV/r-resistant virus and protease inhibitor-related major mutations without LPV/r resistance in 2 other children. Of the 18 children with VF, 15 received a 3TC-based HAART: 12 of 15 (80%) harbored a 3TC-resistant virus. No virus resistant to zidovudine or abacavir was found.
CONCLUSION: In all, 70% of HAART-naive children had virologic success at month 12. The selection of LPV-resistant strains was a rare event. A high rate of selection of 3TC-mutations strengthens the recommendation to prefer a first-line 3TC-sparing regimen, particularly for children with risk factors of poor adherence.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2011 |
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| Erschienen: |
2011 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:30 |
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| Enthalten in: |
The Pediatric infectious disease journal - 30(2011), 8 vom: 20. Aug., Seite 684-8 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Frange, Pierre [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 31.10.2011 Date Revised 19.11.2015 published: Print Citation Status MEDLINE |
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| doi: |
10.1097/INF.0b013e31821752d6 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM206857918 |
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| 100 | 1 | |a Frange, Pierre |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Lopinavir/ritonavir-based antiretroviral therapy in human immunodeficiency virus type 1-infected naive children |b rare protease inhibitor resistance mutations but high lamivudine/emtricitabine resistance at the time of virologic failure |
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| 500 | |a Date Completed 31.10.2011 | ||
| 500 | |a Date Revised 19.11.2015 | ||
| 500 | |a published: Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a BACKGROUND: Lopinavir/ritonavir (LPV/r) is now the protease inhibitor regimen of choice in the first-line antiretroviral therapy for children <6 years of age | ||
| 520 | |a METHODS: We included all the human immunodeficiency virus (HIV) type 1-infected highly active antiretroviral therapy (HAART)-naive children who started an LPV/r-based regimen between 2000 and 2009 at the Necker Hospital (Paris, France). Virologic failure (VF) was defined as an HIV-RNA ≥50 copies/mL. Resistance genotypic test was performed in case of VF | ||
| 520 | |a RESULTS: A total of 43 children were included at a median age of 4.8 years (1.8-8.0). Median level of HIV RNA and percentage of CD4 cell count was 5.5 log₁₀ copies/mL (4.6-6) and 15% (8-27.5), respectively. HAART included LPV/r and 2 nucleoside reverse-transcriptase inhibitors, mainly lamivudine (3TC), zidovudine, and/or abacavir. The median follow-up period was 36 months (18-72). Less than 50 copies/mL of HIV RNA was observed in 46%, 67%, and 70% of the children at months 6, 9, and 12, respectively. In all, 20 children (46.5%) experienced a VF. The risk factors of primary VF were a young age and a low socioeconomic status. The genotypic resistance test, performed for 18 of 20 children with VF, revealed 1 LPV/r-resistant virus and protease inhibitor-related major mutations without LPV/r resistance in 2 other children. Of the 18 children with VF, 15 received a 3TC-based HAART: 12 of 15 (80%) harbored a 3TC-resistant virus. No virus resistant to zidovudine or abacavir was found | ||
| 520 | |a CONCLUSION: In all, 70% of HAART-naive children had virologic success at month 12. The selection of LPV-resistant strains was a rare event. A high rate of selection of 3TC-mutations strengthens the recommendation to prefer a first-line 3TC-sparing regimen, particularly for children with risk factors of poor adherence | ||
| 650 | 4 | |a Journal Article | |
| 650 | 7 | |a Anti-HIV Agents |2 NLM | |
| 650 | 7 | |a Pyrimidinones |2 NLM | |
| 650 | 7 | |a Deoxycytidine |2 NLM | |
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| 700 | 1 | |a Briand, Nelly |e verfasserin |4 aut | |
| 700 | 1 | |a Avettand-fenoel, Véronique |e verfasserin |4 aut | |
| 700 | 1 | |a Veber, Florence |e verfasserin |4 aut | |
| 700 | 1 | |a Moshous, Despina |e verfasserin |4 aut | |
| 700 | 1 | |a Mahlaoui, Nizar |e verfasserin |4 aut | |
| 700 | 1 | |a Rouzioux, Christine |e verfasserin |4 aut | |
| 700 | 1 | |a Blanche, Stéphane |e verfasserin |4 aut | |
| 700 | 1 | |a Chaix, Marie-Laure |e verfasserin |4 aut | |
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