pediatrics
Antiretroviral Therapy in Children
Introduction
There are>40 antiretroviral (ARV) medications, including multidrug combination products, available in the United States, each of which may have adverse effects and drug interactions with other ARV medications or commonly used antibiotics, antiseizure medications, and sedatives. New ARV medications, immunomodulators, and vaccines are under evaluation. 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 (FDC) of ≥ 3 medications 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 United States 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/nucleotide reverse transcriptase inhibitors (NRTI) plus an integrase strand transfer inhibitor (INSTI) or a protease inhibitor (PI), or, uncommonly, a non-nucleoside reverse transcriptase inhibitor (NNRTI) (see table). Use of ARV medications in treatment-experienced children and adolescents is complex; only the selected initial choices for treatment-naive children and adolescents are included in the table. For information on ARV medications for children, including dosing, fixed-dose combination products, adverse effects, and drug interactions, see the continually updated Panel on Antiretroviral Therapy and Medical Management of Children Living with HIV'sGuidelines for the Use of Antiretroviral Agents in Pediatric HIV Infectionand seeAppendix A: Pediatric Antiretroviral Drug Information. See also the Panel'sGuidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV. Useful treatment information is also available atNew York State Department of Health AIDS InstituteandUNAIDS. Consultation regarding ART, especially for issues surrounding HIV postexposure prophylaxis and prevention of HIV mother-to-child transmission (MTCT), is also available through theNational Clinician Consultation Center. (See also Human Immunodeficiency Virus (HIV) Infection in Infants and Children .) 