To summarize the effectiveness and safety of darunavir (DRV) and lopinavir (LPV) in treating HIV in infants, children, and adolescents, thereby supporting WHO's 2025 treatment recommendations by providing evidence-based insights.
Key Findings:
DRV/r is recommended as an alternative second-line therapy for children and adolescents if dolutegravir regimens fail, highlighting its role in treatment strategy.
LPV/r is recommended as a first-line option when dolutegravir is unsuitable and as a second-line option after dolutegravir failure, emphasizing its importance in treatment protocols.
Challenges with LPV/r formulations include poor palatability and toxicity concerns in neonates, which need to be addressed in clinical practice.
Interpretation:
The review underscores the necessity for clear guidelines on the use of DRV and LPV in pediatric populations, particularly addressing formulation challenges and treatment efficacy to optimize patient outcomes.
Limitations:
Variability in study designs and formulations used may affect the generalizability of findings, potentially limiting the applicability of results to broader populations.
Exclusion of studies with unspecified LPV formulations or those including outdated NRTIs limits the comprehensiveness of the review, which may impact the overall conclusions drawn.
Conclusion:
The systematic review provides critical insights into the efficacy and safety of DRV and LPV in treating HIV in young populations, which is essential for informing future WHO recommendations and improving treatment strategies.
by John O’Rourke, Claire L. Townsend, Edith Milanzi, Hannah Castro, Intira Jeannie Collins, Ali Judd, Julie Jesson, Valériane Leroy, Martina Penazzato, Marissa Vicari, Françoise Renaud
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