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Concentration-response Model of Lopinavir/Ritonavir in HIV-1–infected Pediatric Patients

Bouazza, Naïm PhD*†; Urien, Saik MD, PhD*†‡; Blanche, Stéphane MD*‡§; Hirt, Déborah PharmD, PhD*†; Foissac, Frantz PhD*†; Benaboud, Sihem PharmD, PhD*†; Tréluyer, Jean-Marc MD, PhD*†‡¶; Frange, Pierre MD

The Pediatric Infectious Disease Journal: August 2014 - Volume 33 - Issue 8 - p e213–e218
doi: 10.1097/INF.0000000000000298
HIV Reports

Objectives: The aims of this study were to analyze the viral load and CD4+ lymphocyte outcomes and the concentration-response of lopinavir/ritonavir (LPV/r) in the treatment of HIV-1–infected antiretroviral-naive children, to determine whether current dosing guidelines for LPV/r achieve Ctrough above 1.0 mg/L for naive patients to compare efficacy of World Health Organization 2010 and Food and Drug Administration dosing recommendations.

Methods: Clinical and biologic examinations were performed before treatment, 1 month, 3 months and then every 3 months in 47 antiretroviral-naive children who started an LPV/r-based regimen. LPV concentrations were also monitored on a routine basis, after 2 weeks of treatment initiation, between 1 and 24 hours after dosing in all children. A population pharmacokinetic-pharmacodynamic analysis was performed using an HIV dynamic model. Simulations of World Health Organization 2010 and Food and Drug Administration dosing recommendations were compared in terms of viral suppression.

Results: The HIV dynamic model adequately described the data. According to the concentration-effect curve, the LPV concentration providing 90% (CLPV90) and 95% (CLPV95) of effect were 1.2 and 2.4 mg/L, respectively. The World Health Organization 2010 guidelines should provide a higher probability of viral success, particularly in infants.

Conclusions: The CLPV90 derived from this model supports current dosing guidelines. However, the target of 2.4 mg/L corresponding to CLPV95 could be used to enhance the efficacy of this drug in treatment-naive children.

From the *EA 3620, Université Paris Descartes, Sorbonne Paris Cité; Unité de Recherche Clinique, Assistance Publique—Hôpitaux de Paris (AP-HP), Hôpital Tarnier; CIC-0901 Inserm, Cochin-Necker; §Unité d’Immunologie, Hématologie et Rhumatologie Pédiatriques, AP-HP, Hôpital Necker Enfants Malades, Paris; Service de Pharmacologie Clinique, AP-HP, Hôpital Cochin-Saint-Vincent-de-Paul, Université Paris—Descartes, Sorbonne Paris Cité, France.

Accepted for publication January 23, 2014.

J.-M.T. and P.F. contributed equally to this article.

P.F. received grants from French National Agency for Research on AIDS and viral hepatitis (ANRS; to his institution) and from SIDACTION. The authors have no other funding or conflicts of interest to disclose.

Address for correspondence: Naïm Bouazza, PhD, Unité de Recherche Clinique, Hôpital Tarnier, 89 rue d’Assas, 75006 Paris, France. E-mail: naim.bouazza@cch.aphp.fr.

© 2014 by Lippincott Williams & Wilkins, Inc.