Wasana PrasitsuebsaiStephen J. KerrKhanh Huu TruongJintanat AnanworanichViet Chau DoLam Van NguyenNia KurniatiPope KosalaraksaTavitiya SudjaritrukKulkanya ChokephaibulkitNarukjaporn ThammajarukThida SingtorojSirinya TeeraananchaiHoward HorngPeter BacchettiMonica GandhiAnnette H. SohnThe HIV Netherlands Australia Thailand Research CollaborationChildren's Hospital 1Walter Reed Army Institute of ResearchHJFChildren's Hospital 2National Hospital of Pediatrics HanoiUniversity of Indonesia, RSUPN Dr. Cipto MangunkusumoKhon Kaen UniversityChiang Mai UniversityMahidol UniversityTREAT Asia/amfAR-The Foundation for AIDS ResearchUniversity of California, San Francisco2018-11-232018-11-232015-01-01AIDS Research and Human Retroviruses. Vol.31, No.10 (2015), 1009-101419318405088922292-s2.0-84941950858https://repository.li.mahidol.ac.th/handle/20.500.14594/36182© 2015, Mary Ann Liebert, Inc. We conducted a prospective monitoring study to determine whether antiretroviral (ARV) levels in hair of Asian children on second-line protease inhibitor-based ARV therapy (ART) are associated with virologic failure (VF), compared to plasma drug levels and self-reported adherence. HIV-infected Asian children on second-line ART regimens were enrolled into a longitudinal cohort. Traditional adherence measures, plasma, and hair samples were collected 24 weeks after study enrollment. Hair ARV levels were determined via liquid chromatography/tandem mass spectrometry. Among 149 children on lopinavir/ritonavir-based regimens, 47% were female; the median [interquartile range (IQR)] age was 10.3 (7.9-13.3) years. The median CD4% was 26% (IQR 21.7-32.1%) and the median CD4 cell count 754 (IQR 596-1,013) cells/mm³. The median duration of lopinavir-based ART prior to week 24 of the study was 2.9 (IQR 1.6-4.2) years. Adherence was >95% in 91% (135/148) by visual analogue scale and 89% (129/145) by pill count. The median lopinavir hair concentrations were 5.43 (IQR 3.21-9.01) ng/mg in children with HIV RNA >1,000 copies/ml and 9.96 (IQR 6.51-12.31) ng/mg in children with HIV RNA <1,000 copies/ml (p = 0.003). Plasma trough and lopinavir hair concentrations were not statistically significantly correlated (Pearson's correlation coefficient 0.20; p = 0.13). Increasing lopinavir hair concentrations in quartiles were strongly associated with virologic success (odds ratios ≥4.0, overall p = 0.02), while self-reported adherence, pill count, and plasma lopinavir levels were not. Based on this first report of hair ARV concentrations and virologic outcomes in children, ARV hair concentrations, representing longer-term adherence, may be useful to identify children at risk for VF.Mahidol UniversityImmunology and MicrobiologyArticleSCOPUS10.1089/aid.2015.0111