Pediatric antiretroviral therapy

Abstract

The rate of perinatal HIV transmission has decreased significantly in developed countries. However, worldwide, it remains the main source of HIV infection within the pediatric population. Recent advances as a result of findings from clinical trials, viral resistance testing and the advent of new drugs have increased the options for initial treatment regimens. This article provides an overview of antiretroviral therapy in treatment-naive children, including recent pediatric data and updated guidelines from the NIH. It also provides information on new drugs approved for the pediatric age group, dosage information, drug resistance testing and monitoring suggestions for children and adolescents receiving antiretroviral therapy. Special issues pertaining to adherence, disclosure and contraception are also highlighted.

Keywords::

• adherence
• antiretroviral therapy
• drug resistance
• non-nucleoside reverse transcriptase inhibitor
• nucleoside reverse transcriptase inhibitor
• pediatric HIV infection
• protease inhibitor

Acknowledgement

The authors would like to acknowledge Aisha Qureshi for her artistic contribution in Figure 2.

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 [207].

^†Efavirenz is currently only available in capsule form and should only be used in children 3 years and older with a weight of ≥10 kg; nevirapine would be the preferred NNRTI for children age <3 years of age or who require a liquid formulation. Unless adequate contraception can be assured, efavirenz-based therapy is not recommended for adolescent females who are sexually active and may become pregnant.

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

Data from [207].