Lopinavir/ritonavir: role in the treatment of HIV-infected children

Abstract

Lopinavir (LPV) is a highly potent and selective inhibitor of HIV type 1 protease, an essential enzyme for the production of a mature and infective virus. Lopinavir/ritonavir (LPV/r) is a coformulation of LPV and ritonavir (RTV). LPV is the active portion of the preparation, and RTV acts as a pharmacokinetic enhancer to enhance systemic exposure of LPV. Current pediatric guidelines recommend LPV/r as the preferred protease inhibitor for the treatment in naive and pretreated HIV-infected children older than 6 months of age. This is based on its high virological potency in adults and pediatric studies (both naive and pretreated patients), adequate toxicity profile and high barrier to development of resistance mutations on the HIV-protease gene. However, all these advantages might be reduced owing to metabolic complications such as dyslipidemia or fat misdistribution. Thus, further studies, contributing to improving LPV/r use among children, are still needed.