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Mortality and Long-term Virologic Outcomes in Children and Infants Treated With Lopinavir/Ritonavir

Estripeaut, Dora MD*; Mosser, Jon MPH; Doherty, Meg MD, MPH; Acosta, William BA; Shah, Harita BA; Castaño, Elizabeth MD*; Luciani, Kathia MD*; Pascale, Juan Miguel MD, PhD§; Bollinger, Robert C. MD, MPH; Page, Kathleen R. MD

Pediatric Infectious Disease Journal: December 2013 - Volume 32 - Issue 12 - p e466–e472
doi: 10.1097/INF.0b013e3182a09276
HIV Reports

Background: There is scant data on young children receiving protease inhibitor–based therapy in real-life resource-limited settings and on the optimal timing of therapy among children who survive infancy. Our aim was to evaluate outcomes at the Hospital del Niño, Panama, where children have been routinely treated with lopinavir/ritonavir (LPV/r)-based therapy since 2002.

Methods: Retrospective cohort analysis of all HIV-infected children enrolled in care between January 1, 1991, and June 1, 2011. Kaplan–Meier method and Cox proportional hazards regression were used to evaluate death, virologic suppression and virologic rebound.

Results: Of 399 children contributing 1944 person-years of follow-up, 254 (63.7%) were treated with LPV/r and 94 (23.6%) were never treated with antiretrovirals (ARVs). Among infants, improved survival was associated with male gender (hazard rate of death[HRdeath] 0.54, 95% confidence interval [CI]: 0.32–0.92) and treatment with highly active antiretroviral therapy (HRdeath 0.32, 95% CI: 0.12–0.83), whereas residence outside of Panama City was associated with poorer survival (HRdeath 1.72, 95% CI: 1.01–2.94). Among children who survived to 1 year of age without exposure to ARVs, LPV/r-based therapy improved survival (HRdeath 0.07, 95% CI: 0.01–0.33). Virologic suppression was achieved in 42.1%, 70.5% and 85.1% by 12, 24 and 60 months of follow-up among children treated with LPV/r. Virologic suppression was not associated with prior ARV exposure or age at initiation of therapy but was associated with residence outside of Panama City (HR suppression 1.93, 95% CI: 1.19–3.14). Patients with a baseline viral load >100,000 copies/mL were less likely to achieve suppression (HR suppression 0.37, 95% CI: 0.21–0.66). No children who achieved virologic suppression after initiating LPV/r died.

Conclusions: LPV/r-based therapy improved survival not only in infants but also in children over 1 year of age. Age at initiation of LPV/r-based therapy or prior ARVs did not impact virologic outcomes.

From 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.

Accepted for publication June 5, 2013.

D.E. and J.M. contributed equally to this work.

This work was supported by a grant from SENACYT (Secretaría Nacional de Ciencia, Tecnología e Innovación) in Panama (D.E.) and a K23 career development award (K23HD056957) from the National Institute of Allergy and Infectious Diseases and National Institutes of Health (K.R.P.). The authors have no other funding or conflicts of interest to disclose.

Address for correspondence: Kathleen R. Page, MD, 600 North Wolfe St. Phipps 524, Baltimore, MD 21287. E-mail: kpage2@jhmi.edu.

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© 2013 by Lippincott Williams & Wilkins, Inc.