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Antiretroviral Treatment of HIV-Infected Children

The pathology and treatment of HIV/AIDS is similar across patient groups. However, children present unique treatment considerations.

Most children are infected through perinatal exposure.
Depending on prenatal care, the infant may have received antiretroviral therapy (ART) in utero or postpartum.
Age-specific differences in CD4 cell counts.
Drug metabolism and clearance differ depending on systems maturation.
Neonatal serological tests can reflect maternal HIV antibodies for 18-24 months.
Clinical presentations differ in the immature body.
Psychosocial needs vary with age
Special compliance issue.

Routine Assessment of Medication Adherence in Clinical Care	Description
Monitor viral load.	Viral load monitoring should be done more frequently after initiating or changing medication
Assess a quantitative self-report of missed doses.	Ask the patient and/or caregiver about the number of missed doses over a defined period (1, 3, or 7 days).
Request a description of the medication regimen.	Ask the patient and/or caregiver about the name, appearance, and number of medications, and how often the medications are taken.
Assess barriers to medication administration.	Engage the patient and caregiver in a dialogue about potential barriers to adherence and strategies to overcome them.
Monitor pharmacy refills.	Approaches include a pharmacy-based or clinic-based assessment of on-time medication refills.
Employ telemedicine to monitor and support medication administration.	Telemedicine visits allow remote and often face-to-face contact and provide new opportunities to support families; to visualize ART preparation, handling, and swallowing; and to conduct DOT in the home setting.
Conduct announced and unannounced pill counts.	Approaches include asking patients to bring medications to the clinic, conducting home visits, or providing referral to community health nursing.
Targeted Approaches to Monitoring Adherence in Special Circumstances	Description
Implement directly observed therapy in person and via telemedicine.	Include a brief period of hospitalization if indicated.
Measure drug concentration in plasma or DBS.	Measuring drug concentrations can be considered for particular drugs.
Approaches to Monitoring Medication Adherence in Research Settings	Description
Measure drug concentrations in hair.	Measuring hair drug concentrations can be considered for particular drugs; it provides a good measure of adherence over time.18,49,50
Use electronic monitoring devices.	Approaches include MEMS caps and Wisepill.
Use cellphone-based technologies.	Approaches include interactive voice response, text messaging, and mobile apps.
Panel on Antiretroviral Therapy and Medical Management of Children Living with HIV. Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection. Available at http://aidsinfo.nih.gov/contentfiles/lvguidelines/pediatricguidelines.pdf. Accessed (5/17/21)