High virologic response rate after second-line boosted protease inhibitor-based antiretroviral therapy regimens in children from a resource limited setting

A retrospective chart review was conducted at 8 Thai sites of children who switched to PI –based regimens due to failure of NNRTI –based regimens. Primary endpoints were HIV RNA？<？400 copies/ml and CD4 change over 48？weeks.Data from 241 children with median baseline values before starting PI-based regimens of 9.1？years for age, 10% for CD4%, and 4.8 log10 copies/ml for HIV RNA were included; 104 (41%) received a single ritonavir-boosted PI (sbPI) with 2 NRTIs and 137 (59%) received double-boosted PI (dbPI) with/without NRTIs based on physician discretion. SbPI children had higher baseline CD4 (17% vs. 6%, p？<？0.001), lower HIV RNA (4.5 vs. 4.9 log10 copies/ml, p？<？0.001), and less frequent high grade multi-NRTI resistance (12.4% vs 60.5%, p？<？0.001) than the dbPI children. At week 48, 81% had HIV RNA？<？400 copies/ml (sbPI 83.1% vs. dbPI 79.8%, p？=？0.61) with a median CD4 rise of 9% (+7%vs.？+？10%, p？<？0.005). However, only 63% had HIV RNA？<？50 copies/ml, with better viral suppression seen in sbPI (76.6% vs. 51.4%, p 0.002).Second-line PI therapy was effective for children failing first line NNRTI in a resource-limited setting. DbPI were used in patients with extensive drug resistance due to limited treatment options. Better access to antiretroviral drugs is needed.