{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:01:17Z","timestamp":1753891277661,"version":"3.41.2"},"reference-count":48,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,12,22]],"date-time":"2023-12-22T00:00:00Z","timestamp":1703203200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009331","name":"Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support","doi-asserted-by":"publisher","award":["ZYLX202126"],"award-info":[{"award-number":["ZYLX202126"]}],"id":[{"id":"10.13039\/501100009331","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Antiretroviral Therapy (ART) in children remains challenging due to resource-constrained settings. We conducted a 13-year, prospective, multicenter cohort study on the effectiveness and safety of LPV\/r-based regimens in ART-naive and ART-experienced children.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>From January 2008 to May 2021, children living with HIV-1 were recruited with LPV\/r-based regimens from 8 clinical research sites in 6 provinces in China. Effectiveness outcomes were virologic failure (defined as at least two consecutive measurements of VL\u2009&amp;gt;\u2009200 copies\/mL after 6 months of ART) and immune response (defined as CD4% recovered to more than 25% after 12\u2009months of treatment). The safety outcomes were treatment-related grade 2\u20134 adverse events and abnormal laboratory test results.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 345 ART-na\u00efve children and 113 ART-experienced children were included in this cohort study. The median follow-up time was 7.3 (IQR 5.5\u201310.5) years. The incidence density of virologic failure was 4.1 (95% CI 3.3\u20134.9) per 100 person-years in ART-na\u00efve children and 5.0 (95% CI 3.5\u20136.5) per 100 person-years in ART-experienced children. Kaplan Meyer (KM) curve analysis showed children with ART experience were at a higher risk of virologic failure (<jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.05). The risk factors of virologic failure in ART-na\u00efve children were clinic setting in rural hospitals (aHR\u2009=\u20092.251, 1.108\u20134.575), annual missed dose times &amp;gt;5\u2009days of LPV intake (aHR\u2009=\u20091.889, 1.004\u20133.554); The risk factor of virologic failure in ART-experienced children was missed dose times &amp;gt;5\u2009days (aHR\u2009=\u20092.689, 1.299\u20135.604) and mother as caregivers for ART administration (aHR\u2009=\u20090.475, 0.238\u20130.948). However, during long-term treatment, viral suppression rates between ART-na\u00efve and ART-experienced children remained similar. No significant differences were observed in the immune response, treatment-related grade 2\u20134 events, and abnormal laboratory test results between ART-na\u00efve children and ART-experienced children.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our research underscores that with consistent, long-term treatment of LPV\/r-based regimens, ART-experienced children can achieve therapeutic outcomes comparable to ART-na\u00efve children. It provides crucial insights on LPV\/r-based regimens in pediatric HIV treatment, especially in resource-limited settings where high-cost Integrase Strand Transfer Inhibitors (INSTs) are inaccessible. This evidence-based understanding provides an essential addition to the global therapeutic strategies for pediatric HIV treatment.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2023.1313734","type":"journal-article","created":{"date-parts":[[2023,12,22]],"date-time":"2023-12-22T04:39:41Z","timestamp":1703219981000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Thirteen-year viral suppression and immunologic recovery of LPV\/r-based regimens in pediatric HIV treatment: a multicenter cohort study in resource-constrained settings of China"],"prefix":"10.3389","volume":"10","author":[{"given":"Xiaojie","family":"Lao","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hanxi","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liting","family":"Yan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hongxin","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qingxia","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hongyan","family":"Lu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuewu","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huiqin","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jinfeng","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fuxiu","family":"Ye","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fengting","family":"Yu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qing","family":"Xiao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qun","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xuelei","family":"Liang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaojie","family":"Yang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chang","family":"Yan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fujie","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2023,12,22]]},"reference":[{"year":"2023","key":"ref1","article-title":"Global HIV & AIDS statistics-fact sheet"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1007\/164_2019_246","article-title":"Pediatric antiretroviral therapy","volume":"261","author":"Dirajlal-Fargo","year":"2020","journal-title":"Handb Exp Pharmacol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"e658","DOI":"10.1016\/s2352-3018(22)00101-1","article-title":"Advancing the prevention and treatment of HIV in children: priorities for research and development","volume":"9","author":"Penazzato","year":"2022","journal-title":"Lancet HIV"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"976","DOI":"10.1097\/INF.0000000000001627","article-title":"Sustained viral suppression in HIV-infected children on once-daily Lopinavir\/ritonavir in clinical practice","volume":"36","author":"Gondrie","year":"2017","journal-title":"Pediatr Infect Dis J"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1016\/j.arcped.2019.06.002","article-title":"Second-line antiretroviral therapy failure and characterization of HIV-1 drug resistance patterns in children in Mali","volume":"26","author":"Sylla","year":"2019","journal-title":"Arch Pediatr"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"e2217","DOI":"10.1093\/cid\/ciaa1068","article-title":"Drug resistance mutations among south African children living with HIV on WHO-recommended ART regimens","volume":"73","author":"Hackett","year":"2021","journal-title":"Clin Infect Dis"},{"year":"2021","key":"ref7","article-title":"The role of HIV viral suppression in improving individual health and reducing transmission."},{"year":"2023","key":"ref8","article-title":"Guidelines for the use of antiretroviral agents in adults and adolescents with HIV. 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