Mortality and long-term virologic outcomes in children and infants treated with lopinavir/ritonavir.

Untreated HIV-infected children have a faster rate of progression than adults.[1] After the CHER Study demonstrated that early therapy in HIV-infected infants reduced mortality by 76%,[2] the WHO recommended HAART to all HIV-infected infants.[3] Based on the high risk of mortality among HIV-infected children under 2 years, the WHO also recommended treatment for children 12–24 months of age regardless of immunologic or clinical status, despite a lack of data from randomized clinical trials.[4–6] Lopinavir/ritonavir (LPV/r)-based therapy is the preferred first line option in children under 24 months exposed to maternal or infant NNRTIs because of high rates of NNRTI resistance. [7] However, there is concern that administration of LPV/r may not be feasible in many settings due to high cost, poor palatability, and inconvenient formulation.[5, 6] We conducted a retrospective study of HIV-infected children receiving care at the Hospital del Nino in Panama City, where since 2002 HAART became available through the Ministry of Health to all children infected with HIV. The objective of this study was to evaluate survival and long-term virologic outcomes in young children who received LPV/r-based therapy. The results of this study have implications regarding the timing of ARV initiation in children over 12 months of age and for resource-limited pediatric HIV programs expanding access to LPV/r-based therapy.