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

Dora Estripeaut, Jon Mosser, Meg Doherty, William Acosta, Harita Shah, Elizabeth Castaño, Kathia Luciani, Juan Miguel Pascale, Robert C. Bollinger, Kathleen R. Page

Research output: Contribution to journalArticle

Abstract

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 (HR death 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 (HR death 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.

Original languageEnglish (US)
JournalPediatric Infectious Disease Journal
Volume32
Issue number12
DOIs
StatePublished - 2013

Fingerprint

Lopinavir
Ritonavir
Mortality
Confidence Intervals
Panama
Survival
Therapeutics
Highly Active Antiretroviral Therapy
Protease Inhibitors
Viral Load
Cohort Studies
HIV

Keywords

  • Children
  • HIV infection
  • Lopinavir/ritonavir
  • Mortality
  • Virologic outcomes

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Infectious Diseases
  • Microbiology (medical)

Cite this

Mortality and long-term virologic outcomes in children and infants treated with lopinavir/ritonavir. / Estripeaut, Dora; Mosser, Jon; Doherty, Meg; Acosta, William; Shah, Harita; Castaño, Elizabeth; Luciani, Kathia; Pascale, Juan Miguel; Bollinger, Robert C.; Page, Kathleen R.

In: Pediatric Infectious Disease Journal, Vol. 32, No. 12, 2013.

Research output: Contribution to journalArticle

Estripeaut, Dora ; Mosser, Jon ; Doherty, Meg ; Acosta, William ; Shah, Harita ; Castaño, Elizabeth ; Luciani, Kathia ; Pascale, Juan Miguel ; Bollinger, Robert C. ; Page, Kathleen R. / Mortality and long-term virologic outcomes in children and infants treated with lopinavir/ritonavir. In: Pediatric Infectious Disease Journal. 2013 ; Vol. 32, No. 12.
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abstract = "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 Ni{\~n}o, 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 (HR death 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 (HR death 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.",
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AU - Estripeaut, Dora

AU - Mosser, Jon

AU - Doherty, Meg

AU - Acosta, William

AU - Shah, Harita

AU - Castaño, Elizabeth

AU - Luciani, Kathia

AU - Pascale, Juan Miguel

AU - Bollinger, Robert C.

AU - Page, Kathleen R.

PY - 2013

Y1 - 2013

N2 - 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 (HR death 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 (HR death 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.

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KW - HIV infection

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