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15 - Initiating and changing antiretroviral therapy

Published online by Cambridge University Press:  23 December 2009

By
Lynne M. Mofenson  and
Leslie K. Serchuck
Edited by
Steven L. Zeichner  and
Jennifer S. Read
Lynne M. Mofenson
Affiliation:
Center for Research for Mothers and Children, National Institute of Child Health & Human Development, National Institutes of Health, Bethesda, MD
Leslie K. Serchuck
Affiliation:
Center for Research for Mothers and Children, National Institute of Child Health & Human Development, National Institutes of Health, Bethesda, MD
Steven L. Zeichner
Affiliation:
National Cancer Institute, Bethesda, Maryland
Jennifer S. Read
Affiliation:
National Institutes of Health, Bethesda, Maryland
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Summary

Introduction

Guidelines for antiretroviral therapy (ART) in children must incorporate certain unique considerations, including: age-related changes in drug pharmacokinetics; initiation of therapy during primary HIV infection; normal age-related changes in immunologic parameters; pediatric-specific features of the natural history of HIV infection (i.e., virologic parameters during primary infection, rapidity of disease progression, and frequency of central nervous system and growth abnormalities); prior antiretroviral (ARV) exposure of newborns (in utero and neonatal); and pediatric-specific adherence issues (i.e., availability and palatability of drug formulations; relationship of drug administration to food intake in infants; dependence on caregiver for drug administration).

Guidelines for treatment of HIV-infected children often rely on data regarding virologic/immunologic response to drug regimens in adult clinical trials, taking into account the specific considerations in pediatric HIV infection delineated above, and with attention to data from pediatric populations. Guidelines for pediatric ART have been developed in the USA and Europe, and by the World Health Organization. US pediatric ART guidelines [1], as well as adult guidelines (applicable to postpubertal adolescents) [2], are available at http://AIDSInfo.nih.gov. Guidelines for pediatric ART in Europe (http://www.ctu.mrc.ac.uk/PENTA) [3] and in resource-poor settings (http://www.who.int/hiv/pub/prev_care/en/ScalingUp_E.pdf) have been developed. The US pediatric guidelines for ART are the focus of this chapter, and the other guidelines are addressed only briefly. None of these guidelines is intended to supplant the clinical judgment of experienced clinicians. Whenever possible, HIV-infected children should be managed by, or in consultation with, a pediatric HIV specialist.

Type
Chapter
Information
Handbook of Pediatric HIV Care , pp. 415 - 438
Publisher: Cambridge University Press
Print publication year: 2006

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References

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  • Initiating and changing antiretroviral therapy
    • By Lynne M. Mofenson, Center for Research for Mothers and Children, National Institute of Child Health & Human Development, National Institutes of Health, Bethesda, MD, Leslie K. Serchuck, Center for Research for Mothers and Children, National Institute of Child Health & Human Development, National Institutes of Health, Bethesda, MD
  • Edited by Steven L. Zeichner, National Cancer Institute, Bethesda, Maryland, Jennifer S. Read
  • Book: Handbook of Pediatric HIV Care
  • Online publication: 23 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544781.017
Available formats
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To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

  • Initiating and changing antiretroviral therapy
    • By Lynne M. Mofenson, Center for Research for Mothers and Children, National Institute of Child Health & Human Development, National Institutes of Health, Bethesda, MD, Leslie K. Serchuck, Center for Research for Mothers and Children, National Institute of Child Health & Human Development, National Institutes of Health, Bethesda, MD
  • Edited by Steven L. Zeichner, National Cancer Institute, Bethesda, Maryland, Jennifer S. Read
  • Book: Handbook of Pediatric HIV Care
  • Online publication: 23 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544781.017
Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Initiating and changing antiretroviral therapy
    • By Lynne M. Mofenson, Center for Research for Mothers and Children, National Institute of Child Health & Human Development, National Institutes of Health, Bethesda, MD, Leslie K. Serchuck, Center for Research for Mothers and Children, National Institute of Child Health & Human Development, National Institutes of Health, Bethesda, MD
  • Edited by Steven L. Zeichner, National Cancer Institute, Bethesda, Maryland, Jennifer S. Read
  • Book: Handbook of Pediatric HIV Care
  • Online publication: 23 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544781.017
Available formats
×