Kaletra and children

The aim of HIV treatment is to keep HIV under control in the body. HIV can’t yet be cured, but if HIV treatment is taken in the right amount, at the right time, every day, the level of HIV can be kept very low and this helps the immune system to stay strong.

HIV treatment is very effective in adults and children if it is taken as prescribed. However, sometimes children have difficulty swallowing tablets and parents or carers may break or crush tablets to make them easier to take.

Recent research in the United States looked at the level of an HIV drug reaching the bloodstream, comparing the level when the drug was swallowed whole and when it was crushed.

The drug they examined is called Kaletra, which is a combination of two HIV drugs, lopinavir and a small dose of ritonavir, included to boost the effect of lopinavir. Kaletra is recommended in European and US guidelines as a first choice of treatment for HIV-positive children.

The doctors carrying out the study work with a considerable number of children who have problems taking Kaletra. The instructions supplied with Kaletra state that the tablets should not be crushed, broken or chewed, but crushing tablets is often considered when children have difficulty swallowing them.

A small group of children, aged between 10 and 16, were enrolled in the study and they were put into two groups. Group A took whole Kaletra tablets with water at their first visit and crushed tablets at the second visit. Group B did the same but in reverse order. Tablets were crushed with a pill crusher and mixed into a dessert.

Blood was taken before the children took the drugs and then at regular intervals throughout the day. The level of lopinavir and ritonavir in the blood was measured was found to be reduced by an average of 40% when the tablets had been crushed.

This could mean that HIV treatment fails to suppress viral load, possibly leading to HIV developing resistance to the treatment, so it would no longer work.

If you or your child is having problems taking HIV treatment, for any reason, it’s important that you talk to your doctor, or someone else in your healthcare team, about it. They should be able to suggest useful methods of helping your child to take their treatment as well as any alternative treatment options. Kaletra is available as a liquid and a smaller paediatric tablet, and other HIV drugs are also available.