Comparison of levels of antiretroviral drugs with efficacy in children with HIV infection.

Abstract

OBJECTIVE:

To determine the prevalence of low and high antiretroviral (ARV) plasma levels and to analyze correlation between ARV concentrations and the appearance of therapeutic failure and toxicity.

METHODS:

The authors present here a study evaluating antiretroviral plasma concentrations in HIV infected children on nonnucleoside reverse transcriptase inhibitors and protease inhibitors based therapy. The authors carried out a multicentre, cross-sectional study, including HIV-infected children from five large Hospitals in Madrid, Spain. Clinical, haematological, biochemical and immuno-virological parameters were assessed. Antiretroviral plasma trough levels were performed using a validated high performance liquid chromatography method.

RESULTS:

Between April 2006 and April 2008, 129 children were enrolled in the present study, with median treatment duration of 39.2 months. 25.5% of the non-nucleoside reverse transcriptase inhibitors levels were low and 17.6%, high. 27.9% percent of the protease inhibitors levels were low and 12.5%, high. A correlation was found among adequate or high levels of antiretrovirals and normal CD4 percentage and low viral load. Lopinavir/ritonavir plasma levels were correlated with an increase in lipodystrophy. Patients with Tanner stage 1 presented the lowest ARV plasma levels. Full adherence was reported for all the participants by a questionnaire.

CONCLUSION:

Many HIV-infected children show ARV plasma levels out of the therapeutic range which demands a child-adjusted approach. However, larger studies are urgently needed in pediatric populations to define optimal reference values.

• Authors: Ana Pilar Nso, Beatriz Larru, Jose Ma Bellón, Ma José Mellado, Jose Tomás Ramos, Ma Isabel González, María Luisa Navarro, María Angeles Muñoz-Fernández, María Isabel de José
• Journal: Indian journal of pediatrics (Indian J Pediatr) Vol. 77 Issue 4 Pg. 397-402 (Apr 2010) ISSN: 0973-7693 [Electronic] India
• PMID: 20422321 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Retroviral Agents
• HIV Protease Inhibitors
• Reverse Transcriptase Inhibitors

Topics

• Adolescent
• Anti-Retroviral Agents (pharmacokinetics, therapeutic use)
• CD4 Lymphocyte Count
• Child
• Child, Preschool
• Female
• HIV Infections (drug therapy, transmission)
• HIV Protease Inhibitors (pharmacokinetics, therapeutic use)
• HIV-1
• Humans
• Infant
• Infant, Newborn
• Infectious Disease Transmission, Vertical
• Male
• Reverse Transcriptase Inhibitors (pharmacokinetics, therapeutic use)
• Viral Load