Antiretroviral Therapy in Children: Recent Advances Authors
Symposium on Pediatric HIV/AIDS
First Online: 27 November 2012 Received: 13 June 2012 Accepted: 04 October 2012 DOI:
Cite this article as: Lodha, R. & Manglani, M. Indian J Pediatr (2012) 79: 1625. doi:10.1007/s12098-012-0903-9 Abstract
Availability and successful use of various antiretroviral drugs has transformed HIV/AIDS from an incurable to a treatable chronic condition. The antiretroviral therapy can successfully suppress viral replication and preserve the immune system for many years. The implementation of antiretroviral therapy program in resource limited settings using the ‘public health approach’ of the World Health Organization has had a dramatic impact on the lives of millions of HIV infected individuals. Antiretroviral therapy (ART) in children has many challenges: use of appropriate formulations, regular need for modification of doses as the child grows, adherence issues,
etc. To reduce the high morbidity and mortality in HIV infected children, it is currently recommended that all HIV infected children less than 24 mo should receive ART; in older children the indications are based on clinical and/or immunological criteria. Highly active antiretroviral therapy regimens include at least 3 antiretroviral drugs. The first line therapy recommended for children is a combination of two nucleoside reverse transcriptase inhibitors and a non-nucleoside reverse transcriptase inhibitor. Infants who have had exposure to nevirapine should receive a combination of two nucleoside reverse transcriptase inhibitors and a protease inhibitor; the protease inhibitor of choice is ritonavir boosted lopinavir. The success of therapy is dependent on >95 % adherence. The second line regimen, used when the first line therapy fails, is based on a protease inhibitor. The ongoing research focuses on simplification of regimen, discovery of more potent drugs, availability of more pediatric formulations, treatment of drug resistant strains etc. The optimal indications for initiation of therapy in children, are also being studied. Keywords Antiretroviral therapy Children HIV/AIDS Recent advances References
Fisher AG, Collalti E, Ratner L, Gallo RC, Wong-Staal F. A molecular clone of HTLV-III with biological activity. Nature. 1985;316:262–5.
Gadelha AJ, Accacio N, Costa RL, et al. Morbidity and survival in advanced AIDS in Rio de Janeiro, Brazil. Rev Inst Med Trop Sao Paulo. 2002;44:179–86.
Gilks CF, Crowley S, Ekpini R, et al. The WHO public-health approach to antiretroviral treatment against HIV in resource-limited settings. Lancet. 2006;368:505–10.
Bartlett JG, Gallant JE. Medical management of HIV infection. Baltimore: Johns Hopkins Medicine Health Publishing Business Group;2004; pp 49.
Molina JM, Podsadecki TJ, Johnson MA, et al. A Lopinavir/ritonavir-based once-daily regimen results in better compliance and is non-inferior to a twice-daily regimen through 96 wk. AIDS Res Hum Retrovir. 2007;23:1505–14.
Violari A, Cotton MF, Gibb DM, CHER Study team, et al. Early antiretroviral therapy and mortality among HIV-infected infants. N Engl J Med. 2008;359:2233–44.
World Health Organization. Antiretroviral therapy of HIV infection in infants and children: towards universal access: recommendations for a public health approach - 2010 revision. Geneva 2010.
PENTA Steering Committee. PENTA 2009 guidelines for the use of antiretroviral therapy in paediatric HIV-1 infection. HIV Med. 2009;10:591–613.
Panel on Antiretroviral Therapy and Medical Management of HIV-Infected Children. Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection. August 11, 2011; pp 1–268.Available at
Accessed (September 5, 2011).
Guidelines for HIV care and treatment in Infants and Children. November 2006. published by IAP and NACO, available on
Palumbo P, Lindsey JC, Hughes MD, et al. Antiretroviral treatment for children with peripartum nevirapine exposure. N Engl J Med. 2010;363:1510–20.
Palumbo P, Violari A, Lindsey L, et al. NVP-
vs LPV/r-based ART among HIV + infants in resource-limited settings: the IMPAACT P1060 trial [abstract no.129LB]. 18th Conference on Retroviruses and Opportunistic Infections;2011 Feb 27-Mar 2; Boston (MA).
The PENPACT-1 (PENTA 9/PACTG 390) Study Team. First-line antiretroviral therapy with a protease inhibitor versus non-nucleoside reverse transcriptase inhibitor and switch at higher versus low viral load in HIV-infected children: an open-label, randomised phase 2/3 trial. Lancet Infect Dis. 2011;11:273–83.
Mulenga V, Cook A, Walker AS, et al. Strategies for nevirapine initiation in HIV-infected children taking pediatric fixed-dose combination “baby pills” in Zambia: a randomized controlled trial. Clin Infect Dis. 2010;51:1081–9.
World Health Organization. Rapid advice. Antiretroviral therapy for HIV infection in adults and adolescents. Geneva: WHO; 2009.
Kumarasamy N, Venkatesh KK, Cecelia AJ, et al. Spectrum of adverse events after generic HAART in southern Indian HIV-infected patients. AIDS Patient Care STDs. 2008;22:337–44.
Shah I. Adverse effects of antiretroviral therapy in HIV-1 infected children. J Trop Pediatr. 2006;52:244–8.
Agarwal D, Chakravarty J, Chaube L, Rai M, Agrawal NR, Sundar S. High incidence of zidovudine induced anaemia in HIV infected patients in eastern India. Indian J Med Res. 2010;132:386–9.
Romanelli F, Empey K, Pomeroy C. Macrocytosis as an indicator of medication (zidovudine) adherence in patients with HIV infection. AIDS Patient Care STDS. 2002;16:405–11.
Paediatric European Network for Treatment of AIDS (PENTA). Lamivudine/abacavir maintains virological superiority over zidovudine/lamivudine and zidovudine/abacavir beyond 5 y in children. AIDS. 2007;21:947–55.
McKinney Jr RE, Rodman J, Hu C, et al. Long-term safety and efficacy of a once-daily regimen of emtricitabine, didanosine, and efavirenz in HIV-infected, therapy-naive children and adolescents: pediatric AIDS clinical trials group protocol P1021. Pediatrics. 2007;120:e416–23.
Scherpbier HJ, Bekker V, Pajkrt D, Jurliaans S, Lange JM, Kujjpers TW. Once-daily highly active antiretroviral therapy for HIV-infected children: safety and efficacy of an Efavirenz-containing regimen. Pediatrics. 2007;119:e705–15.
Fagard C, Oxenius A, Günthard H, et al; Swiss HIV Cohort Study. A prospective trial of structured treatment interruptions in human immunodeficiency virus infection. Arch Intern Med. 2003;163:1220–6.
Yerly S, Gunthard HF, Fagard C, et al. Swiss HIV Cohort Study. Proviral HIV-DNA predicts viral rebound and viral setpoint after structured treatment interruptions. AIDS. 2004;18:1951–3.
Lori F, Lisziewicz J. Structured treatment interruptions for the management of HIV infection. JAMA. 2001;286:2981–7.
Lori F, Maserati R, Foli A, Seminari E, Timpone J, Lisziewicz J. Structured treatment interruptions to control HIV. Lancet. 2000;355:287–8.
Miller V, Sabin C, Hertogs K, et al. Virological and immunological effects of treatment interruptions in HIV-1 infected patients with treatment failure. AIDS. 2000;14:2857–67.
Lori F, Lewis MG, Xu J, et al. Control of HIV rebound through structured treatment interruptions during early infection. Science. 2000;290:1591–3.
Giard M, Boibieux A, Ponceau B, et al. Treatment interruption in HIV infected patients: clinical and biological evolution. Med Malad Infect. 2005;35:525–9.
Borkowsky W, Yogev R, Muresan P, et al. Planned multiple exposures to autologous virus in HIV type 1-infected pediatric populations increases HIVspecific immunity and reduces HIV viremia. AIDS Res Hum Retrovir. 2008;24:401–11.
Palacios GC, Sanchez LM, Briones E, et al. Structured interruptions of highly active antiretroviral therapy in cycles of 4 wk off/12 wk on therapy in children having a chronically undetectable viral load cause progressively smaller viral rebounds. Int J Infect Dis. 2010;14:e34–40.
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