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Rojas Sánchez P, Prieto L, Jiménez De Ory S, Fernández Cooke E, Navarro ML, Ramos JT, Holguín Á. Impact of lopinavir-ritonavir exposure in HIV-1 infected children and adolescents in Madrid, Spain during 2000-2014. PLoS One 2017; 12:e0173168. [PMID: 28350802 PMCID: PMC5369685 DOI: 10.1371/journal.pone.0173168] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 02/16/2017] [Indexed: 01/18/2023] Open
Abstract
Background The most-used protease-inhibitor in children is Lopinavir-ritonavir (LPV/r), which provides durable suppression of viral load and increases CD4+T-counts. This study describes the virological outcome of the HIV-1-infected paediatric population exposed to LPV/r during 15 years in Spain. Methodology Patients from the Madrid Cohort of HIV-1-infected-children and adolescents exposed to LPV/r as different line therapy during 2000–2014 were selected. The baseline epidemiological-clinical features, viral suppression, changes in CD4+T-CD8+T cell counts and drug susceptibility were recorded before and during LPV/r exposure. Drug resistance mutations (DRM) were identified in viruses from samples collected until 2011. We predicted drug susceptibility to 19 antiretrovirals among those carrying DRM using the Stanford′s HIVdb Algorithm. Results A total of 199 (37.3%) of the 534 patients from the cohort were exposed to LPV/r during 2000–2014 in first (group 1), second (group 2) or more line-therapies (group 3). Patients were mainly Spaniards (81.9%), perinatally infected (96.5%) with subtype-B (65.3%) and HIV-diagnosed before year 2000 (67.8%). The mean age at first LPV/r exposure was 9.7 years. After protease-inhibitor exposure, viral suppression was higher in groups 1 and 2 than in group 3. Viral suppression occurred in 87.5%, 68.6% and 64.8% patients from groups 1, 2 and 3, respectively. Among the 64 patients with available resistance data during LPV/r treatment, 27(42.3%) carried DRM to protease-inhibitor, 28 (58.3%) to reverse-transcriptase-inhibitors and 21 (43.7%) to non-reverse-transcriptase-inhibitors. Darunavir/ritonavir, atazanavir-ritonavir and tipranavir/ritonavir presented the highest susceptibility and nelfinavir the lowest. Conclusions A better lymphocyte recovering occurred when protease-inhibitor was taken as part of a first-line regimen and a higher number of patients reached viral suppression. The least compromised antiretrovirals for rescue antiretroviral regimens, according to DRM in the LPV/r-exposed-paediatric cohort, were mainly the new protease inhibitors.
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Affiliation(s)
- Patricia Rojas Sánchez
- HIV-1 Molecular Epidemiology Laboratory, Microbiology and Parasitology Department, Hospital RamÓn y Cajal-IRYCIS and CIBER-ESP, Madrid, Spain
| | - Luis Prieto
- Infectious Diseases Department, Hospital Universitario de Getafe, Madrid, Spain
| | - Santiago Jiménez De Ory
- Molecular Inmuno-Biology Laboratory, Hospital Universitario Gregorio Marañón-IISGM and CIBER-BBN, Madrid, Spain
| | - Elisa Fernández Cooke
- Infectious Diseases Department, Hospital Universitario Doce de Octubre, Madrid, Spain
| | - Maria Luisa Navarro
- Infectious Diseases Unit, Paediatric Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - José Tomas Ramos
- Infectious Diseases Department, Hospital Clínico Universitario and Universidad Complutense, Madrid, Spain
| | - África Holguín
- HIV-1 Molecular Epidemiology Laboratory, Microbiology and Parasitology Department, Hospital RamÓn y Cajal-IRYCIS and CIBER-ESP, Madrid, Spain
- * E-mail:
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Tran TA, Ghosn J, Avettand-Fenoël V, Hendel-Chavez H, de Goër de Herve MG, Cohen-Codar I, Rouzioux C, Delfraissy JF, Taoufik Y. Residual HIV-1 replication may impact immune recovery in patients on first-line lopinavir/ritonavir monotherapy. J Antimicrob Chemother 2015; 70:2627-31. [PMID: 26023212 DOI: 10.1093/jac/dkv138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 04/24/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Antiretroviral combination therapy raises issues of long-term adherence and toxicity. Initial treatment simplification based on single-drug therapy was investigated in the MONARK trial, which compared first-line lopinavir/ritonavir monotherapy (arm A) with first-line lopinavir/ritonavir + zidovudine/lamivudine tritherapy (arm B). The MONARK trial is registered as a randomized trial at clinical trials.gov under identifier NCT 00234923. PATIENTS AND METHODS Immune recovery was compared in patients with undetectable plasma virus (<50 copies/mL) after 60 weeks of treatment (arm A, n = 21; arm B, n = 13). RESULTS The week 60 CD4 T cell count and CD4 T cell subset distribution did not differ significantly between the treatment arms. Memory CD4 T cell responses to HIV and recall antigens were better with triple therapy than with monotherapy. The frequencies of activated CD8 T cells and anti-HIV CD8 T cell effector responses were similar in the two arms. However, the repertoire of CD8 T cell effector responses was broader and persistent residual viraemia more frequent (by ultrasensitive PCR) in the monotherapy arm. CONCLUSIONS While viral control can be achieved with first-line lopinavir/ritonavir monotherapy, the quality of immune recovery is inferior to that obtained with triple therapy, possibly owing to a higher level of residual viral replication. Thus, the benefits of first-line lopinavir/ritonavir monotherapy in terms of toxicity and adherence might be offset by an increased risk of residual viral replication, which may also fuel latent viral reservoirs.
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Affiliation(s)
- Tu-Anh Tran
- INSERM U-1184, Université Paris-Sud, Le Kremlin-Bicêtre, France Department of Pediatrics, Nimes University Hospital, Nimes, France
| | - Jade Ghosn
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, EA 7327 Paris, France APHP, UF de Thérapeutique en Immuno-Infectiologie, CHU Hotel Dieu, Paris, France
| | - Véronique Avettand-Fenoël
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, EA 7327 Paris, France APHP, Laboratoire de Virologie, Hôpital Necker-Enfants Malades, Paris, France
| | - Houria Hendel-Chavez
- INSERM U-1184, Université Paris-Sud, Le Kremlin-Bicêtre, France Laboratoire d'Immunologie, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Marie-Ghislaine de Goër de Herve
- INSERM U-1184, Université Paris-Sud, Le Kremlin-Bicêtre, France Laboratoire d'Immunologie, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | | | - Christine Rouzioux
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, EA 7327 Paris, France APHP, Laboratoire de Virologie, Hôpital Necker-Enfants Malades, Paris, France
| | - Jean-François Delfraissy
- INSERM U-1184, Université Paris-Sud, Le Kremlin-Bicêtre, France AP-HP, Department of Internal Medicine, Bicetre University Hospital, Le Kremlin-Bicetre, France
| | - Yassine Taoufik
- INSERM U-1184, Université Paris-Sud, Le Kremlin-Bicêtre, France Laboratoire d'Immunologie, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
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Verweel G, Burger DM, Sheehan NL, Bergshoeff AS, Warris A, Van Der Knaap LC, Driessen G, de Groot R, Hartwig NG. Plasma Concentrations of the HIV-Protease Inhibitor Lopinavir are Suboptimal in Children Aged 2 Years and Below. Antivir Ther 2007. [DOI: 10.1177/135965350701200405] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Lopinavir/ritonavir (LPV/r) has been licensed for the treatment of HIV-infected children >6 months in the US and >2 years in the EU. Limited LPV paediatric pharmacokinetic data are available. We studied LPV pharmacokinetics to determine whether the recommended dose (230/57.5 mg/m2 twice daily) results in optimal LPV exposure in all age groups. Virological efficacy was a secondary objective. Methods HIV-1-infected children who started treatment with LPV/r and two nucleoside reverse transcriptase inhibitors underwent a 12-h pharmacokinetic curve. LPV plasma concentrations were determined with a validated HPLC method with UV detection. If Cmin was <1.0 mg/l LPV/r dose was increased by 33%. Plasma trough levels were drawn subsequently. HIV-1 RNA was followed-up until week 48. Results A total of 23 children were included (seven girls; 16 boys), with a median (range) age of 5.6 (0.4–13.2) years. Mean (±SD) AUC0–12h, Cmax and Cmin of LPV were 75.3 (±33.7) mg/l.h, 9.33 (±3.27) mg/l and 3.68 (±2.48) mg/l, respectively, which is similar to previously published data. Interindividual variability was large. Cmin was inadequate in 7/23 children. Significantly more children <2 years had inadequate Cmin compared with children >2 years. Dose increase to ±300/75 mg/m2 LPV/r led to Cmin >1.0 mg/l. The studied regimen provided excellent viral suppression for naive and pretreated patients. Conclusions Mean LPV pharmacokinetic parameters in these HIV-infected children are similar to published data, but exposure is significantly reduced in children <2 years. Prospective pharmacokinetic studies using 300/75 mg/m2 LPV/r in this age population are urgently warranted.
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Affiliation(s)
- Gwenda Verweel
- Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - David M Burger
- Radboud University Medical Centre Nijmegen, the Netherlands
- Nijmegen University Centre for Infectious Diseases (NUCI), the Netherlands
| | - Nancy L Sheehan
- McGill University Health Centre & University of Montréal, Canada
| | - Alina S Bergshoeff
- Radboud University Medical Centre Nijmegen, the Netherlands
- Nijmegen University Centre for Infectious Diseases (NUCI), the Netherlands
| | - Adilia Warris
- Radboud University Medical Centre Nijmegen, the Netherlands
- Nijmegen University Centre for Infectious Diseases (NUCI), the Netherlands
| | | | - Gertjan Driessen
- Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Ronald de Groot
- Radboud University Medical Centre Nijmegen, the Netherlands
- Nijmegen University Centre for Infectious Diseases (NUCI), the Netherlands
| | - Nico G Hartwig
- Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
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