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A novel pharmacokinetic approach to predict virologic failure in HIV-1-infected paediatric patients

Bouazza, Naïma,b; Tréluyer, Jean-Marca,b,c,d; Msellati, Philippee; Van de Perre, Philippef,g,h; Diagbouga, Sergei; Nacro, Boubacarj; Hien, Hervéi; Zoure, Emmanuellej; Rouet, Françoisi; Ouiminga, Adamai; Blanche, Stephanea,c,k; Hirt, Déboraha,b; Urien, Saika,b,c

doi: 10.1097/QAD.0b013e32835caad1
Clinical Science

Objective: The objective of this study was to develop in children an HIV dynamic model able to predict simultaneously the viral load and CD4+ lymphocyte evolutions, and to take into account, through a composite inhibition score, the relative contribution of each drug of the combination efavirenz–didanosine–lamivudine and use this score as a predictor of treatment failure in a multidrug therapy.

Design: Open phase II trial (BURKINAME – ANRS 12103) registered in the database ( with the no. NCT00122538.

Methods: Forty-nine children aged from 2.5 to 15 years were administered once-daily dose of lamivudine, didanosine and efavirenz. The three drugs effect was then characterized by a composite inhibition score combining the effect of each drug, according to their site and mechanism of action and their relative contribution.

Results: Efavirenz was the most potent antiretroviral and was responsible for 65% of the total effect, and then didanosine for 23% and lamivudine was the less potent with 12% of the total observed effect. An EC90 for efavirenz was determined (3.3 mg/l). AUC90 was estimated for lamivudine and didanosine: 8.4 and 1.5 mg h/l, respectively. The composite inhibition score was the best predictor of virologic failure compared with the concentrations of each drug taken independently [hazard ratio (HR) 0.6 per 10% increase, 95% confidence interval (CI) 0.41–0.88].

Conclusion: The relative contributions of three combined drugs were assessed on plasma viral load and CD4+ lymphocyte count kinetics in HIV-1-infected children. Pharmacokinetics targets have been suggested for lamivudine and didanosine. A composite inhibition score has been determined to be a high predictor of treatment failure in a multidrug therapy.

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aEA 3620, Université Paris Descartes, Sorbonne Paris Cité

bUnité de Recherche clinique, AP-HP, Hôpital Tarnier

cCIC-0901 Inserm, Cochin-Necker

dService de Pharmacologie Clinique, AP-HP, Hôpital Cochin-Saint-Vincent-de-Paul, Université Paris – Descartes, Sorbonne Paris Cité, Paris

eUMI 233, IRD-Université de Montpellier I-Université de Yaoundé 1, Montpellier

fINSERM U 1058

gUniversité Montpellier 1

hCHU Montpellier, Département de bactériologie-virologie et Département d’Information Médicale, Montpellier, France

iCentre Muraz

jService de Pédiatrie, CHU Sourô Sanou, Bobo Dioulasso, Burkina Faso

kUnité d’Immunologie, Hématologie et Rhumatologie Pédiatriques, AP-HP, Hôpital Necker Enfants Malades, Paris, France.

Correspondence to Naïm Bouazza, Unité de Recherche Clinique, Hôpital Tarnier, 89 rue d’Assas, 75006 Paris, France. Tel: +33158412884; fax: +33158411183; e-mail:

Received 14 March, 2012

Revised 23 October, 2012

Accepted 15 November, 2012

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© 2013 Lippincott Williams & Wilkins, Inc.