Antiretroviral drug therapy in children

[PussyCat]

There are gt; 30 antiretroviral (ARV) drugs (see Table: Dosage and Administration of Selected Antiretroviral Drugs for Children*), including multidrug combination products, available in the US, each of which may have adverse effects and drug interactions with other ARV drugs or commonly used antibiotics, antiseizure drugs, and sedatives. New ARV drugs, immunomodulators, and vaccines are under evaluation.
Clinical and laboratory monitoring are important for identifying drug toxicity and therapeutic failure.
Because expert opinions on therapeutic strategies change rapidly, consultation with experts is strongly advised. Tablets containing fixed-dose combinations of ≥ 3 drugs are now widely used in older children and adolescents to simplify regimens (termed single-tablet regimens; one tablet once a day) and improve adherence; for young children, such combinations are unavailable in the US or are difficult to use. The standard treatment for children is similar to that for adults: combination antiretroviral therapy (ART) to maximize viral suppression and minimize selection of drug-resistant strains. Preferred regimens vary somewhat by age but typically contain 2 nucleoside reverse transcriptase inhibitors (NRTI) plus either a nonnucleoside reverse transcriptase inhibitor (NNRTI), protease inhibitor (PI), or integrase strand transfer inhibitor (INSTI) (see table Selected Antiretroviral (ARV) Regimens for Initial Therapy of HIV Infection in Children).
For current information on dosing, adverse effects, and drug interactions, see guidelines for the use of antiretroviral agents in pediatric HIV infection and guidelines for the use of antiretroviral agents in adults and adolescents with HIV. Useful treatment information is also available at New York State Department of Health AIDS Institute and UNAIDS. Consultation regarding ART, especially for issues surrounding HIV postexposure prophylaxis and prevention of HIV mother-to-child transmission (MTCT), is also available through the National Clinician Consultation Center.
(See also HIV infection in Infants and Children.)