HIV protease inhibitor use in pediatrics is challenging due to the poor palatability and/or toxicity of concomitant low-dose ritonavir. Atazanavir without ritonavir (unboosted) is not recommended for patients with prior virologic failure, a common problem for perinatally-infected adolescents. Atazanavir 400 mg once-daily provided suboptimal exposure. Higher unboosted doses or splitting the daily dose to twice-daily warrants investigation in this treatment-experienced population.
From the *Program for HIV Prevention and Treatment (IRD UMI 174), Faculty of Associated Medical Sciences, Department of Medical Technology, Chiang Mai University, Chiang Mai, Thailand; †Harvard T.H Chan School of Public Health, Boston, Massachusetts; ‡National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Maternal and Pediatric Infectious Disease Branch, Bethesda, Maryland; §Jacobi Medical Center, Bronx, New York; ¶Columbia University Medical Center, New York, New York; ‖HJF-DAIDS, a Division of The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Contractor to NIAID, NIH, DHHS, Bethesda, Maryland; **Frontier Science & Technology, Amherst, New York, New York; ††University of Alabama at Birmingham, Birmingham, Alabama; and ‡‡Children’s Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Accepted for publication March 8, 2016.
J.R.K., PharmD is currently at the Clinical Pharmacokinetics, AbbVie Inc., North Chicago, Illinois.
Supported by National Institutes of Health, US.
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The authors have no conflicts of interest to disclose.
Address for correspondence: Tim R. Cressey, PhD, PHPT-IRD UMI 174, Faculty of Associated Medical Sciences, Department of Medical Technology, 6th Floor, 110 Inthawaroros Road, Mueang Chiang Mai 50200, Thailand. E-mail: firstname.lastname@example.org.