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Antiretroviral Drug Therapy in Children

By

Geoffrey A. Weinberg

, MD, Golisano Children’s Hospital

Last full review/revision Jul 2020| Content last modified Jul 2020
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There are > 30 antiretroviral (ARV) drugs (see Table: Dosage and Administration of Selected Antiretroviral Drugs for Children* Dosage and Administration of Selected Antiretroviral Drugs for Children* There are > 30 antiretroviral (ARV) drugs (see Table: Dosage and Administration of Selected Antiretroviral Drugs for Children*), including multidrug combination products, available in the US... read more ), 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.

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 Selected Antiretroviral (ARV) Regimens for Initial Therapy of HIV Infection in Children* There are > 30 antiretroviral (ARV) drugs (see Table: Dosage and Administration of Selected Antiretroviral Drugs for Children*), including multidrug combination products, available in the US... read more ).

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.

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More Information

The following are some English-language resources that may be useful. Please note that THE MANUAL is not responsible for the content of these resources.

See the following continually updated government site for information on drug treatment, including adverse effects, dosing (especially for information on fixed-dose combination products), and drug interactions, educational materials, and quick links to related topics:

The following resources provide information about various other prevention, treatment, and education aspects of HIV/AIDS:

  • New York State Department of Health AIDS Institute HIV Clinical Guidelines Program: Disseminates practical, evidence-based clinical guidelines that promote quality medical care for people in New York who are living with and/or are at risk of acquiring HIV and certain other illnesses

  • UNAIDS: Comprehensive information on how the organization directs, advocates, coordinates, and provides technical support needed to connect leadership from governments, the private sector, and communities to deliver life-saving HIV services

  • National Clinician Consultation Center: Up-to-date HIV/AIDS guidelines and key treatment protocols for HIV/AIDS treatment, prevention, and exposure

  • Perinatal HIV Consultation and Referral Services Hotline 1-888-HIV-8765 (1-888-448-8765): Free 24-hour clinical consultation and advice on treating HIV-infected pregnant women and their infants

Drugs Mentioned In This Article

Drug Name Select Trade
KALETRA
EMTRIVA
Elvitegravir
Dolutegravir
Bictegravir
ISENTRESS
REYATAZ
EPIVIR
RETROVIR
VIRAMUNE
CARAFATE
NORVIR
PREZISTA
VIREAD
ZIAGEN
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