Antiretroviral Treatment of HIV-Infected Children
Adapted from
Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection
The pathology and treatment of HIV/AIDS is similar across patient groups. However, children present unique treatment considerations.
Perinatal care
Maternal HIV infection should be identified prior to pregnancy or as early in pregnancy as possible. This provides the best opportunity to prevent infant HIV infection and to identify and start therapy as soon as possible in infants who become infected. Universal HIV counseling and voluntary HIV testing are recommended as the standard of care for all pregnant women in the United States by The Panel on Antiretroviral Therapy and Medical Management of HIV-Infected Children.
HIV testing in infants
When to Initiate Antiretroviral Therapy in HIV-Infected Children | ||
Age |
Criteria |
Recommendation |
<12 months | Regardless of clinical symptoms, immune status, or viral load | Urgent treatment <12 weeks of age |
1 to <6 years | CDC Stage 3-defining opportunistic illnesses | Urgent treatment |
CDC Stage 3 immunodeficiency: CD4 <500 cells/mm3 | Urgent treatment | |
Moderate HIV-related symptoms | Treat | |
HIV RNA >100,000 copies/mL | Treat | |
CD4 cell countd 500–999 cells/mm3 | Treat | |
Asymptomatic or mild symptoms and CD4 cell count ≥1000 cells/mm3 | Consider Treatment | |
>6 years | CDC Stage 3-defining opportunistic illnesses | Urgent treatment |
CDC Stage 3 immunodeficiency:d CD4 <200 cells/mm3 | Urgent treatment | |
Moderate HIV-related symptoms | Treat | |
HIV RNA >100,000 copies/mL | Treat | |
CD4 cell countd 200–499 cells/mm3 | Treat for CD4 cell count <350 cells/mm3 | |
Asymptomatic or mild symptoms and CD4 cell count ≥500 cells/mm3 | Consider treatment |
Initiating Combination Antiretroviral Therapy (cART) — Factors
cART Regimens Recommended for Initial Therapy of Antiretroviral-Naive Infants & Children |
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Initial cART in treatment-naive children should include a Preferred agent plus a Dual-nucleoside/nucleotide reverse transcriptase inhibitor backbone combination. | ||||
Age |
Preferred agent |
Plus |
Dual-nucleoside/nucleotide reverse transcriptase inhibitor backbone | |
Neonate & Children <3 years |
lopinavir or ritonavir | Age |
Agents | |
Infants <3 months | zidovudine plus (lamivudine or emtricitabine) | |||
≥3 months | Either:
|
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Children >3 years but <6 years |
efavirenz or lopinavir or ritonavir | >12 years | abacavir plus lamivudine or plus emtricitabine | |
Children aged ≥6 years |
atazanavir/ritonavir or efavirenz or lopinavir/ritonavir |
|
Stage-3-Defining Opportunistic Illnesses In HIV Infection |
|
a Only among children aged <6 years. b Only among adults, adolescents, and children aged ≥6 years. |