Determination of lopinavir/ritonavir concentrations in four different oral solutions for the application of antiretroviral therapy in very young, HIV-1-infected children.

An antiretroviral regimen containing lopinavir/ritonavir (LPV/r) in addition to two nucleoside reverse transcriptase inhibitors (NRTIs) is the main treatment option for HIV-1-infected infants in most African countries.7,8 The LPV/r combination is available as a meltrex tablet, in a fixeddose combination added to NRTIs, or as a liquid formulation that is bodyweight-dose adjusted.2,5,6,9,10,11,12,13 The tablet formulation is not applicable for very young children because of their inability to swallow the tablet. Crushing of the LPV/r meltrex formulation is not recommended, and the liquid formulation remains the only alternative for very young patients. However, as the taste of the pure LPV/r liquid formulation is unpalatable, many parents seek alternative ways to give the medicine, including mixing the LPV/r oral solution with formula milk, for example, as part of the child’s nutrition. However, flocculation of the oral solution results, and no bioavailability data are available.