Pediatric HIV infection: the state of antiretroviral therapy

Abstract

Pediatric HIV/AIDS has become less of a problem in resource-rich countries as the number of perinatal infections has reduced dramatically since the advent of antiretrovirals, resulting in the effective prevention of mother-to-child transmission. In resource-limited settings, however, pediatric HIV infection remains a colossal problem; a separate review in this same issue of Expert Review of Anti-Infective Therapy examines the international aspects of pediatric HIV/AIDS. Treatment of HIV infection in children differs from that in adults in the use of immunologic markers and owing to drug pharmacokinetics and age-related adherence issues. This review, geared for the general pediatrician or family practitioner who may see the HIV-positive child in the clinic or the hospital, summarizes the most recent pediatric data and guidelines for the testing and treatment of HIV, including the US NIH guidelines released in February 2008. Treatment-experienced patients, who should be cared for by pediatric HIV specialists, are not addressed here specifically. Adolescents, infected either perinatally or sexually, with their own unique issues, deserve a separate review.

Keywords::

• antiretroviral therapy
• HIV DNA/RNA PCR
• non-nucleoside reverse transcriptase inhibitor
• nucleoside analogue reverse-transcriptase inhibitor
• pediatric HIV infection
• protease inhibitor

Acknowledgements

The authors would like to thank Joseph Church, Children’s Hospital, Los Angeles, CA, USA.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Notes

Data from [85].

*Efavirenz is currently available only in capsule form; nevirapine would be the preferred NNRTI for children under age 3 years or who require a liquid formulation.

^‡With the exception of lopinavir/ritonavir and fosamprenavir in combination with low-dose ritonavir, data on the pharmacokinetics and safety of dual PI combinations are limited; use of other dual PIs as components of initial therapy is not recommended, although such regimens may have utility as secondary treatment regimens for children who have failed initial therapy. The use of low-dose ritonavir-boosted atazanavir (or saquinavir or indinavir) can be considered in special circumstances for adolescents who can receive standard adult doses.

NNRI: Non-nucleoside reverse-transcriptase inhibitor; NRTI: Nucleoside reverse-transcriptase inhibitor; PI: Protease inhibitor.

Data from [101].