Early Outcomes of Darunavir- and/or Raltegravir-Based Antiretroviral Therapy in Children with Multidrug-Resistant HIV at a Pediatric Center in Botswana. (March 2013)

• Record Type: Journal Article
• Authors: Kirk, Brianna L.; Gomila, Andres; Matshaba, Mogomotsi; Marape, Marape; Joel, Dipesalema R.; Anabwani, Gabriel; Tolle, Michael A.
• Is Part Of: Journal of the International Association of Providers of AIDS Care. Volume 12:Number 2(2013)
• Page Start: 90
• Page End: 94
• Publication Date: 2013-03
• Subjects: HIV drug resistance -- pediatric antiretroviral therapy -- treatment failure -- HIV protease inhibitors -- integrase inhibitors -- Botswana; AIDS (Disease) -- Periodicals; 616.9792
• DOI: 10.1177/1545109712463073
• Languages: English
• ISSNs: 2325-9574

Abstract

Background: Data on the use of ritonavir-boosted darunavir (DRV/r) and/or raltegravir (RAL) in resource-limited settings are rare and there is currently no published data regarding their use among African children. Botswana has recently made DRV/r and RAL available for patients failing second-line antiretroviral therapy (ART). Methods: Retrospective chart review of 4 multidrug-resistant pediatric patients on DRV/r- and/or RAL-based regimens. Viral load, CD4 count, adherence by pill count, and World Health Organization (WHO) clinical stage prior to and after switch to DRV/r- and/or RAL-based regimen were assessed. Antiretroviral therapy history, duration of virologic failure, and time to viral suppression were also noted. Genotypic resistance assays reviewed for mutations present prior to switch. Results: All patients achieved viral suppression, showed improved/stable CD4 counts, and obtained or maintained WHO clinical treatment stage I, even after long-standing virologic/immunologic failure. Conclusions: Well tolerated by and effective in our patients, DRV/r and RAL provide potentially lifesaving ART options for children and adolescents in resource-limited settings failing ART due to ritonavir-boosted lopinavir (LPV/r) resistance.