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AIDS Res Hum Retroviruses. 2015 Oct;31(10):1009-14. doi: 10.1089/AID.2015.0111. Epub 2015 Aug 26.

Using Lopinavir Concentrations in Hair Samples to Assess Treatment Outcomes on Second-Line Regimens Among Asian Children.

Author information

1 The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), The Thai Red Cross AIDS Research Centre , Bangkok, Thailand .
2 Children's Hospital 1 , Ho Chi Minh City, Vietnam .
3 U.S. Military HIV Research Program, Walter Reed Army Institute of Research , Silver Spring, Maryland and the Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland.
4 Children's Hospital 2 , Ho Chi Minh City, Vietnam .
5 National Hospital of Pediatrics , Hanoi, Vietnam .
6 Cipto Mangunkusumo General Hospital , Jakarta, Indonesia .
7 Division of Infectious Diseases, Department of Pediatrics, Khon Kaen University , Khon Kaen, Thailand .
8 Research Institute for Health Sciences and Faculty of Medicine, Chiang Mai University , Chiang Mai, Thailand .
9 Faculty of Medicine Siriraj Hospital, Mahidol University , Bangkok, Thailand .
10 TREAT Asia/amfAR-The Foundation for AIDS Research , Bangkok, Thailand .
11 Department of Bioengineering and Therapeutic Sciences, University of California , San Francisco, San Francisco, California.
12 Department of Epidemiology and Biostatistics, University of California , San Francisco, San Francisco, California.
13 Department of Medicine, University of California , San Francisco, San Francisco, California.


We conducted a prospective monitoring study to determine whether antiretroviral (ARV) levels in hair of Asian children on second-line protease inhibitor-based ARV therapy (ART) are associated with virologic failure (VF), compared to plasma drug levels and self-reported adherence. HIV-infected Asian children on second-line ART regimens were enrolled into a longitudinal cohort. Traditional adherence measures, plasma, and hair samples were collected 24 weeks after study enrollment. Hair ARV levels were determined via liquid chromatography/tandem mass spectrometry. Among 149 children on lopinavir/ritonavir-based regimens, 47% were female; the median [interquartile range (IQR)] age was 10.3 (7.9-13.3) years. The median CD4% was 26% (IQR 21.7-32.1%) and the median CD4 cell count 754 (IQR 596-1,013) cells/mm(3). The median duration of lopinavir-based ART prior to week 24 of the study was 2.9 (IQR 1.6-4.2) years. Adherence was >95% in 91% (135/148) by visual analogue scale and 89% (129/145) by pill count. The median lopinavir hair concentrations were 5.43 (IQR 3.21-9.01) ng/mg in children with HIV RNA >1,000 copies/ml and 9.96 (IQR 6.51-12.31) ng/mg in children with HIV RNA <1,000 copies/ml (p = 0.003). Plasma trough and lopinavir hair concentrations were not statistically significantly correlated (Pearson's correlation coefficient 0.20; p = 0.13). Increasing lopinavir hair concentrations in quartiles were strongly associated with virologic success (odds ratios ≥4.0, overall p = 0.02), while self-reported adherence, pill count, and plasma lopinavir levels were not. Based on this first report of hair ARV concentrations and virologic outcomes in children, ARV hair concentrations, representing longer-term adherence, may be useful to identify children at risk for VF.

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