Roles of Protease Inhibitors for HIV-infected Children

Jintanat Ananworanich

National Security Office Database

• As of July 20, 2013– N of Thai children on ART = 5543– N of children on LPV/r = 1548– N of children on ATV/r = 32– Also some children on double-boosted PI (LPV/r

+ SQV or IDV) and on IDV/r– A few on unboosted IDV or treatment dose of

RTV (not recommended) 

Data from Mr. Artit Pusamang and Dr. Sorakij Bhakeecheep

Use of PI in Treating Pediatric HIV

First-line

Second-line

Third-line/salvage

Failure ~ 30% at 4 yrs1

Failure ~ 30% at 1 yr2

Failure ~ 20% at 7 mo3

1Puthanakit T, PIDJ 2007; 2Puthanakit T, AIDS Res Ther 2012; 3Ananworanich J, 2012 IAS

N=1600 in NHSO

N=480

N=96

HIVNAT 113 patient population(Failed NRTI/NNRTI/PI)

Parameters Values

Total N 47

Mean age 16.5 years

N for each DRV/r dosing20 to < 30kg (375/100mg)30 to < 40kg (450/100mg)

≥ 40kg (600/100mg)

20%35%45%

HIV-NAT, Siriraj, Bamrasnaradura, Srinagarind, Nakornping, Chiang Rai, Prapokklao, Surin

Data in Adults

Virologic Responses of Commonly Used Third ARV for the Initial HAART

EFV0

20

40

60

80

100

89 *82

RAL

86

ATV/r

74*

LPV/r

77

68 71

D

79*

Data from various clinical trials of treatment-naïve patients% of patients with VL<50 at 96 weeks except STARTMRK at 48 weeks (ITT)

*EFV, ATV/r, DRV/r superiority to LPV/r

All combined with 2 NRTIs

ACTG5142

STARTMRK

CASTLE

ARTEMIS

ACTG 5142, CASTLE, ARTEMIS = 96 weeks, STARTMRK=48 weeks

results

From the slide collection of Prof. Kiat Ruxrungtham

Virologic Responses in Treatment-experienced Trials (most data at 48 wks)

TORO 1,2

DUET 1,2

BENCHMARK

POWER 1,2

MOTIVATE 1,2

TITAN

ODIN TRIO

0102030405060708090

100

18

57

3747

6271 72

86

% patients with VL<50

Wk 96 Wk 144

Active    50%        37% <33%          75%            17%  OBR≥2

ETR+DRV/r RAL DRV/r MVC DRV/r DRV/r   RAL+ETR+DRV/rENF