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22 - Initiating and changing antiretroviral therapy

from Part III - Antiretroviral therapy

Published online by Cambridge University Press:  03 February 2010

By
Lynne M. Mofenson  and
Leslie K. Serchuck
Edited by
Steven L. Zeichner  and
Jennifer S. Read
Lynne M. Mofenson
Affiliation:
Chief, Pediatric, Adolescent and Maternal AIDS Branch, Center for Research for Mothers and Children, NIH, Rockville, MD
Leslie K. Serchuck
Affiliation:
Medical Officer, Pediatric, Adolescent and Maternal AIDS Branch, Center for Research for Mothers and Children, NIH Rockville, MD
Steven L. Zeichner
Affiliation:
National Cancer Institute, Bethesda, Maryland
Jennifer S. Read
Affiliation:
National Cancer Institute, Bethesda, Maryland
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Summary

Introduction

Guidelines for antiretroviral therapy in children must incorporate considerations unique to pediatric HIV infection. Such considerations include: age-related changes in drug pharmacokinetics; issues related to diagnosis of perinatal infection (early diagnosis permits therapy to be initiated during primary HIV infection); normal age-related changes in immunologic parameters; differences between children and adults in the natural history of HIV infection (i.e. differences in virologic parameters during primary infection, in the rapidity of disease progression, and in the frequency of central nervous system (CNS) and growth abnormalities); prior antiretroviral exposure of newly infected infants (in utero and neonatal exposure to drugs used for maternal treatment and transmission prophylaxis); and pediatric-specific adherence issues (i.e. availability and palatability of drug formulations; relationship of drug administration to food intake in young infants; dependence on caregiver for administration of drugs).

Prospective, randomized, controlled clinical trials offer the best evidence for formulation of guidelines. However, most antiretroviral drugs are approved for use in pediatric patients based on efficacy data from clinical trials in adults, with supporting pharmacokinetic and safety data from phase I/II trials in children; additionally, efficacy in most adult trials has been based on surrogate marker data, as opposed to clinical endpoints. Thus, guidelines for treatment of HIV-infected children often have to 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 when available.

Type
Chapter
Information
Textbook of Pediatric HIV Care , pp. 355 - 376
Publisher: Cambridge University Press
Print publication year: 2005

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  • Initiating and changing antiretroviral therapy
    • By Lynne M. Mofenson, Chief, Pediatric, Adolescent and Maternal AIDS Branch, Center for Research for Mothers and Children, NIH, Rockville, MD, Leslie K. Serchuck, Medical Officer, Pediatric, Adolescent and Maternal AIDS Branch, Center for Research for Mothers and Children, NIH Rockville, MD
  • Edited by Steven L. Zeichner, National Cancer Institute, Bethesda, Maryland, Jennifer S. Read, National Cancer Institute, Bethesda, Maryland
  • Book: Textbook of Pediatric HIV Care
  • Online publication: 03 February 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544798.025
Available formats
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  • Initiating and changing antiretroviral therapy
    • By Lynne M. Mofenson, Chief, Pediatric, Adolescent and Maternal AIDS Branch, Center for Research for Mothers and Children, NIH, Rockville, MD, Leslie K. Serchuck, Medical Officer, Pediatric, Adolescent and Maternal AIDS Branch, Center for Research for Mothers and Children, NIH Rockville, MD
  • Edited by Steven L. Zeichner, National Cancer Institute, Bethesda, Maryland, Jennifer S. Read, National Cancer Institute, Bethesda, Maryland
  • Book: Textbook of Pediatric HIV Care
  • Online publication: 03 February 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544798.025
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, Chief, Pediatric, Adolescent and Maternal AIDS Branch, Center for Research for Mothers and Children, NIH, Rockville, MD, Leslie K. Serchuck, Medical Officer, Pediatric, Adolescent and Maternal AIDS Branch, Center for Research for Mothers and Children, NIH Rockville, MD
  • Edited by Steven L. Zeichner, National Cancer Institute, Bethesda, Maryland, Jennifer S. Read, National Cancer Institute, Bethesda, Maryland
  • Book: Textbook of Pediatric HIV Care
  • Online publication: 03 February 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544798.025
Available formats
×