Combination Therapy of AIDS

Part of the series Milestones in Drug Therapy MDT pp 141-157

Highly active antiretroviral treatment (HAART) of pediatric HIV-1 infection

  • Nicole T. TobinAffiliated withDepartments of Pediatrics, University of Washington
  • , Lisa M. FrenkelAffiliated withLaboratory Medicine, University of Washington

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Implementing successful HAART of HIV-1-infected children poses several unique challenges. Children appear to have less virologic success from HAART than adults. However, careful consideration of multiple factors may assist in maximizing the virologic efficacy of HAART, including its duration [1]. Obstacles to successful HAART of children include: difficulties in administering drugs; difficulties adhering to complicated and even simple regimens; variable, erratic or unknown pharmacokinetics for certain drugs, especially in young infants; adverse reactions to drugs and drug-related toxicities; and the selection of drug-resistant virus. Drug-resistant mutants are selected when drug combinations are insufficient to inhibit HIV-1 replication yet remain at levels that exert selective pressure. The goal of health care providers should be to prescribe sufficiently potent HAART to avoid selection of drug-resistant virus on the basis of inadequate drug pressure, while minimizing adverse sequelae from the drugs and unnecessary expense by utilization of an excessive number of drugs. Achieving these therapeutic goals with the currently available antiretrovirals is often difficult due to the extremely high degree of adherence to therapy (>95%) that appears to be required to preclude the emergence of drug-resistant virus [2], the persistence of drug-resistant virus in the child [3], HIV-1 cross-resistance to drugs within each class and adverse reactions associated with antiretroviral therapy.