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5th International AIDS Society Conference on HIV Pathogenesis and TreatmentCape Town - July 19 - 22, 2009 |
HOW WELL DO THE REVISED WORLD HEALTH ORGANISATION WEIGHT-BASED DOSING GUIDELINES FOR LOPINAVIR/RITONAVIR IN INFANTS AND CHILDREN CORRELATE WITH BODY SURFACE AREA-BASED DOSING RECOMMENDATIONS?
IAS Conf HIV Pathog Treat 2009 Jul 19-22;5th: Abstract No. MOAB105
J. Nuttall
1, B. Eley1, M.-A. Davies2
1University of Cape Town, Paediatric Infectious Diseases Unit, Cape Town, South Africa, 2University of Cape Town, Infectious Diseases Epidemiology Unit, Cape Town, South Africa
BACKGROUND: In mid-2008, the World Health Organisation (WHO) published revised weight-based antiretroviral dosing guidelines for children 3-24.9 kg body weight and recommended that all HIV-infected infants should be started on antiretroviral therapy (ART). Recent research suggests that lopinavir/ritonavir (L/r) doses of ±300/75 mg/m2 are required to attain therapeutic plasma trough levels of lopinavir in young children. The objective of this study was to compare weight-based (WB) and body surface area-based (BSAB) dosing for L/r in children.
METHODS: Using actual heights and weights from HIV-infected children <15 years of age and weighing 3- <25 kg at the time of initiating ART at our hospital, we calculated the median (IQR) dose of L/r in mg/m2 that WB dosing of L/r solution and tablets would provide for each applicable weight band in the revised WHO dosing table. We also calculated the percentage of children in each weight band for whom the WB dose was 90-125% of a target body BSAB-dose of 300/75mg/m2 for L/r.
RESULTS: 976 children (50% females) matched inclusion criteria. Median age and weight (IQR) was 11.2 months (4.7-33.7) and 6.6kg (4.7-11). Median (IQR) dose (mg/m2) of L/r solution (3- <25 kg) and tablets (10- <25 kg) provided by WB dosing was 335 (295-390) and 291 (275-308) respectively. Median (IQR) dose (mg/m2) of L/r solution provided by WB dosing for children < 6months of age was 397 (359-444). Across all applicable weight bands, the WB dose was within the 90-<125% range of the target BSAB-dose (300/75 mg/m2) in 60.7% (95%CI: 57.6-63.7) of children for L/r solution and 80.3% (95%CI: 75.7-84.9) for tablets.
CONCLUSIONS: The revised WHO weight-based dosing guidelines for L/r solution provide doses in excess of 300/75mg/m2, particularly for children <6 months of age. Pharmacokinetic studies using weight-based L/r dosing strategies in infants and incorporating careful monitoring of drug levels and toxicity should be undertaken.
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2009-07-22
MOAB105
Oral Abstract Session: MOAB1 - Paediatric ART: Successes and Challenges
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