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AIDS Res Ther. 2012; 9: 20.
Published online Jun 18, 2012. doi:  10.1186/1742-6405-9-20
PMCID: PMC3469338
High virologic response rate after second-line boosted protease inhibitor-based antiretroviral therapy regimens in children from a resource limited setting
Thanyawee Puthanakit,1,2 Gonzague Jourdain,3 Piyarat Suntarattiwong,4 Kulkanya Chokephaibulkit,5 Umaporn Siangphoe,1 Tulathip Suwanlerk,1 Wasana Prasitsuebsai,1,5 Virat Sirisanthana,6 Pope Kosalaraksa,7 Witaya Petdachai,8 Rawiwan Hansudewechakul,9 Naris Waranawat,4 and Jintanat Ananworanichcorresponding author1,10,11, On behalf of the HIV-NAT 086 study team
1The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), Bangkok, Thailand
2Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
3Institut de Recherche pour le Développement (IRD), UMI 174, Program for HIV Prevention and Treatment, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
4Queen Sirikit National Institute of Child Health, Bangkok, Thailand
5Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
6Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
7Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
8Petchburi Hospital, Petchburi, Thailand
9Chiang Rai Regional Hospital, Chiang Rai, Thailand
10South East Asia Research Collaboration with Hawaii, Hawaii, Thailand
11Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
corresponding authorCorresponding author.
Thanyawee Puthanakit: thanyawee.p/at/hivnat.org; Gonzague Jourdain: gonzague.jourdain/at/phpt.org; Piyarat Suntarattiwong: drjunesunta/at/yahoo.com; Kulkanya Chokephaibulkit: sikch/at/mahidol.ac.th; Umaporn Siangphoe: umaporns1/at/gmail.com; Tulathip Suwanlerk: tulathip.s/at/hivnat.org; Wasana Prasitsuebsai: wasana.p/at/hivnat.org; Virat Sirisanthana: vsirisan/at/rihes.org; Pope Kosalaraksa: pkosalaraksa/at/yahoo.com; Witaya Petdachai: drwitaya/at/yahoo.com; Rawiwan Hansudewechakul: hanrawi/at/gmail.com; Naris Waranawat: dnaris/at/gmail.com; Jintanat Ananworanich: Jintanat.A/at/hivnat.org
Received December 14, 2011; Accepted June 9, 2012.
Abstract
Background
Limited data exist for the efficacy of second-line antiretroviral therapy among children in resource limited settings. We assessed the virologic response to protease inhibitor-based ART after failing first-line non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimens.
Methods
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.
Results
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).
Conclusion
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.
Keywords: Pediatric HIV, Drug resistance, Second-line antiretroviral therapy, Protease-inhibitors, Resource limited settings
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