Lopinavir Dosing in HIV-infected Children in the United Kingdom and Ireland

Katherine Donegan, Katja Doerholt, Ali Judd*, Hermione Lyall, Esse Mason, Karina Butler, Pat Tookey, Andrew Riordan, Delane Shingadia, Gareth Tudor-Williams, Di M. Gibb, A. Sarah Walker, Collaborative HIV Paediat Study C

*Corresponding author for this work

    Research output: Contribution to journalArticlepeer-review

    11 Citations (Scopus)


    Background: Uncertainty surrounds the correct dosing of lopinavir/r (LPV/r) in HIV-infected children not receiving non-nucleoside reverse transcriptase inhibitors. The licensed total daily dose is 460 mg/m2, whereas the original study, reporting excellent viral load (VL) suppression, used a higher 600 mg/m2 dose.

    Methods: We calculated LPV/r daily doses prescribed from 2000 to 2009 within the UK/Irish national Collaborative HIV Paediatric Study (CHIPS) cohort. Logistic and binomial mixed models were used to explore whether higher LPV/r doses affected VL suppression.

    Results: Four hundred forty-four of 1201 (37%) children on antiretroviral therapy in CHIPS had taken lopinavir/r without non-nucleoside reverse transcriptase inhibitors. Of 1065 recorded doses, 48% were syrup, 27% capsules and 25% tablets. Ten percent of doses were >10% below 460 mg/m2 per day, and 12% were >10% above 600 mg/m2. In multivariable models, predictors of lower doses were: once versus twice daily dosing (32 mg/m2 lower); syrup versus tablets/capsules (33 mg/m2 lower); higher weight-for-age and height-for-age (24 mg/m2and 13 mg/m2 lower per unit higher, respectively); and older age (13 mg/m2 lower per year older for those aged >10 years, P < 0.05). Dosing varied widely by hospital (P = 0.0004), with some targeting higher and others lower doses. For those receiving lopinavir/r for ≥6 months, there was a greater chance of VL <400 copies/mL with higher doses (odds ratio = 1.15 [95% confidence interval: 1.06–1.25 per 50 mg/m2 higher], P = 0.001).

    Conclusions: Findings suggest substantial variation and large hospital-level effects in the LPV/r dose prescribed to HIV-infected children in the United Kingdom/Ireland. Higher doses appeared to improve long-term VL suppression, which may be critical in children who need life-long therapy. Results highlight the importance of optimizing dosing in HIV-infected children of all ages.
    Original languageEnglish
    Pages (from-to)45-50
    Number of pages6
    JournalPediatric Infectious Disease Journal
    Issue number1
    Publication statusPublished - Jan 2013


    • lopinavir
    • dosing
    • children
    • HIV
    • United Kingdom
    • Ireland


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