Skip to main content

Advertisement

SpringerLink
Log in

Updates in the Approach to Pediatric HIV Care and Prevention

  • Pediatric Infectious Disease (M Mitchell and F Zhu, Section Editors)
  • Published:
Current Treatment Options in Pediatrics Aims and scope Submit manuscript

Abstract

Purpose of review

Awareness of updates on the recommendations for the treatment and prevention of HIV in children and adolescents is of vital importance for pediatricians to support HIV elimination efforts in the USA.

Recent findings

Children with HIV infection have access to potent antiretroviral regimens in combined and easier to administer formulations. For youth with HIV, simpler and long-acting treatment regimens are available. For infants born to persons with HIV that have low risk of perinatal transmission, an abbreviated regimen is recommended. Breastfeeding is supported for individuals on HIV treatment who remain virally suppressed. For adolescents and young adults at significant risk of HIV, pre-exposure prophylaxis is recommended.

Summary

Early treatment remains paramount for best outcomes in children and adolescents living with HIV, aided by innovative drugs and delivery methods. These advances should strive to equally benefit both the pediatric and adult populations. Despite progress, youth still comprise a significant portion of new HIV cases. Inclusive prevention strategies led by pediatricians are essential for HIV elimination in adolescents and young adults.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1

Similar content being viewed by others

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Antiretroviral Therapy Cohort, C. Survival of HIV-positive patients starting antiretroviral therapy between 1996 and 2013: a collaborative analysis of cohort studies. Lancet HIV. 2017;4(8):e349–56.

    Article  Google Scholar 

  2. • Edwards JK, Cole SR, Breger TL, et al. Mortality among persons entering HIV care compared with the general U.S. population : an observational study. Ann Intern Med. 2021;174(9):1197–206. A comparison of 5-year all-cause mortality rates of adults entering HIV care compared to a matched US population showed that there was an 11% difference in mortality between 1999 and 2004 and that difference decreased to 2.7% between 2011 and 2017, likely reflecting advances in HIV care and treatment.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Van Dyke RB, Patel K, Siberry GK, et al. Antiretroviral treatment of US children with perinatally acquired HIV infection: temporal changes in therapy between 1991 and 2009 and predictors of immunologic and virologic outcomes. J Acquir Immune Defic Syndr. 2011;57(2):165–73.

    Article  PubMed  PubMed Central  Google Scholar 

  4. European Pregnancy and Paediatric HIV Cohort Collaboration (EPPICC) study group in EuroCoord, Judd A, et al. Long-term trends in mortality and AIDS-defining events after combination ART initiation among children and adolescents with perinatal HIV infection in 17 middle- and high-income countries in Europe and Thailand: a cohort study. PLoS Med. 2018;15(1):e1002491.

    Article  Google Scholar 

  5. Garcia F, de Lazzari E, Plana M, et al. Long-term CD4+ T-cell response to highly active antiretroviral therapy according to baseline CD4+ T-cell count. J Acquir Immune Defic Syndr. 2004;36(2):702–13.

    Article  PubMed  Google Scholar 

  6. Strategies for Management of Antiretroviral Therapy Study G, El-Sadr WM, Lundgren J, et al. CD4+ count-guided interruption of antiretroviral treatment. N Engl J Med. 2006;355(22):2283–96.

    Article  Google Scholar 

  7. Danel C, Moh R, Gabillard D, et al. A trial of early antiretrovirals and isoniazid preventive therapy in Africa. N Engl J Med. 2015;373(9):808–22.

    Article  CAS  PubMed  Google Scholar 

  8. Lundgren JD, Babiker AG, Gordin F, et al. Initiation of antiretroviral therapy in early asymptomatic HIV infection. N Engl J Med. 2015;373(9):795–807.

    Article  CAS  PubMed  Google Scholar 

  9. Cohen MS, Chen YQ, McCauley M, et al. Antiretroviral therapy for the prevention of HIV-1 transmission. N Engl J Med. 2016;375(9):830–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Bavinton BR, Pinto AN, Phanuphak N, et al. Viral suppression and HIV transmission in serodiscordant male couples: an international, prospective, observational, cohort study. Lancet HIV. 2018;5(8):e438–47.

    Article  PubMed  Google Scholar 

  11. Rodger AJ, Cambiano V, Bruun T, et al. Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy. JAMA. 2016;316(2):171–81.

    Article  PubMed  Google Scholar 

  12. Rodger AJ, Cambiano V, Bruun T, et al. Risk of HIV transmission through condomless sex in serodifferent gay couples with the HIV-positive partner taking suppressive antiretroviral therapy (PARTNER): final results of a multicentre, prospective, observational study. Lancet. 2019;393(10189):2428–38.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Tubiana R, Le Chenadec J, Rouzioux C, et al. Factors associated with mother-to-child transmission of HIV-1 despite a maternal viral load <500 copies/ml at delivery: a case-control study nested in the French perinatal cohort (EPF-ANRS CO1). Clin Infect Dis. 2010;50(4):585–96.

    Article  PubMed  Google Scholar 

  14. Townsend CL, Cortina-Borja M, Peckham CS, et al. Low rates of mother-to-child transmission of HIV following effective pregnancy interventions in the United Kingdom and Ireland, 2000-2006. AIDS. 2008;22(8):973–81.

    Article  PubMed  Google Scholar 

  15. Violari A, Cotton MF, Gibb DM, et al. Early antiretroviral therapy and mortality among HIV-infected infants. N Engl J Med. 2008;359(21):2233–44.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Shiau S, Arpadi S, Strehlau R, et al. Initiation of antiretroviral therapy before 6 months of age is associated with faster growth recovery in South African children perinatally infected with human immunodeficiency virus. J Pediatr. 2013;162(6):1138–45. 1145 e1-2

    Article  PubMed  PubMed Central  Google Scholar 

  17. Jantarabenjakul W, Chonchaiya W, Puthanakit T, et al. Low risk of neurodevelopmental impairment among perinatally acquired HIV-infected preschool children who received early antiretroviral treatment in Thailand. J Int AIDS Soc. 2019;22(4):e25278.

    Article  PubMed  PubMed Central  Google Scholar 

  18. • Massanella M, Puthanakit T, Leyre L, et al. Continuous prophylactic antiretrovirals/antiretroviral therapy since birth reduces seeding and persistence of the viral reservoir in children vertically infected with human immunodeficiency virus. Clin Infect Dis. 2021;73(3):427–38. This study measured levels of HIV DNA and frequencies of cells producing multiply spliced RNA after stimulation in infants with perinatally-acquired HIV and noted that both were significantly lower in infants who received ARV prophylaxis and directly transitioned to ART after HIV diagnosis compared to infants who discontinued or never initiated ARV prophylaxis prior to ART.

    Article  CAS  PubMed  Google Scholar 

  19. Collaborative Initiative for Paediatric HIV Education and Research (CIPHER) Global Cohort Collaboration, Slogrove AL, et al. The epidemiology of adolescents living with perinatally acquired HIV: a cross-region global cohort analysis. PLoS Med. 2018;15(3):e1002514.

    Article  Google Scholar 

  20. United Nations Children's Fund. Elimination of mother-to-child trasmission. In: HIV/AIDS. UNICEF 2023. https://data.unicef.org/topic/hivaids/emtct/#status. Accessed 18 Jun 2023.

  21. Nielsen-Saines K, Watts DH, Veloso VG, et al. Three postpartum antiretroviral regimens to prevent intrapartum HIV infection. N Engl J Med. 2012;366(25):2368–79.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Neubert J, Pfeffer M, Borkhardt A, et al. Risk adapted transmission prophylaxis to prevent vertical HIV-1 transmission: effectiveness and safety of an abbreviated regimen of postnatal oral zidovudine. BMC Pregnancy Childbirth. 2013;13:22.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Nguyen TTT, Kobbe R, Schulze-Sturm U, et al. Reducing hematologic toxicity with short course postexposure prophylaxis with zidovudine for HIV-1 exposed infants with low transmission risk. Pediatr Infect Dis J. 2019;38(7):727–30.

    Article  PubMed  Google Scholar 

  24. US Department of Health and Human Services. Item of interest: FDA approves PrEP therapy for adolescents at risk of HIV. In: National Institute of Child Health and Human Development Newsroom. 2018. https://www.nichd.nih.gov/newsroom/news/051618-PrEP. Accessed 26 May 2023.

  25. Centers for Disease Control and Prevention. HIV Surveillance Report; vol. 34. CDC 2021. https://www.cdc.gov/hiv/library/reports/hiv-surveillance/vol-34/index.html. Accessed 12 Jul 2023.

  26. •• Lampe MA, Nesheim SR, Oladapo KL, Ewing AC, Wiener J, Kourtis AP. Achieving Elimination of perinatal HIV in the United States. Pediatrics. 2023;151(5):e2022059604. This study demonstrated that the diagnosis rates declined from 1.9 to 0.9 per 100 000 live births and the transmission rates from 1.6 to 0.9% achieving perinatal HIV elimination goals in 2019.

  27. Nesheim S, Taylor A, Lampe MA, et al. A framework for elimination of perinatal transmission of HIV in the United States. Pediatrics. 2012;130(4):738–44.

    Article  PubMed  Google Scholar 

  28. Panel of Antiretroviral Therapy and Medical Management of Children Living with HIV. Guidelines for the use of antiretroviral agents in pediatric HIV infection. Department of Health and Human Services. https://clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/pediatric-arv/guidelines-pediatric-arv.pdf. Accessed 23 Aug 2023.

  29. von Hentig N. Clinical use of cobicistat as a pharmacoenhancer of human immunodeficiency virus therapy. HIV AIDS (Auckl). 2016;8:1–16.

    Google Scholar 

  30. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in adults and adolescents with HIV. Department of Health and Human Services, 2023. https://clinicalinfo.hiv.gov/en/guidelines/adult-and-adolescent-arv. Accessed 7 Jun 2023.

  31. Faye A, Le Chenadec J, Dollfus C, et al. Early versus deferred antiretroviral multidrug therapy in infants infected with HIV type 1. Clin Infect Dis. 2004;39(11):1692–8.

    Article  PubMed  Google Scholar 

  32. Luzuriaga K. Early combination antiretroviral therapy limits HIV-1 persistence in Children. Annu Rev Med. 2016;67:201–13.

    Article  CAS  PubMed  Google Scholar 

  33. Luzuriaga K, McManus M, Catalina M, et al. Early therapy of vertical human immunodeficiency virus type 1 (HIV-1) infection: control of viral replication and absence of persistent HIV-1-specific immune responses. J Virol. 2000;74(15):6984–91.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Bitnun A, Samson L, Chun TW, et al. Early initiation of combination antiretroviral therapy in HIV-1-infected newborns can achieve sustained virologic suppression with low frequency of CD4+ T cells carrying HIV in peripheral blood. Clin Infect Dis. 2014;59(7):1012–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Kariyawasam D, Peries M, Foissac F, et al. Lopinavir-ritonavir impairs adrenal function in infants. Clin Infect Dis. 2020;71(4):1030–9.

    Article  CAS  PubMed  Google Scholar 

  36. Simon A, Warszawski J, Kariyawasam D, et al. Association of prenatal and postnatal exposure to lopinavir-ritonavir and adrenal dysfunction among uninfected infants of HIV-infected mothers. JAMA. 2011;306(1):70–8.

    Article  CAS  PubMed  Google Scholar 

  37. U.S Food and Drug Administriation. Drug safety communication: serious health problems seen in premature babies given kaletra (lopinavir/ritonavir) oral solution. In: Drug Safety and Availability. FDA, 2021. https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-serious-health-problems-seen-premature-babies-given-kaletra. Accessed 23 Aug 2023.

  38. McArthur MA, Kalu SU, Foulks AR, et al. Twin preterm neonates with cardiac toxicity related to lopinavir/ritonavir therapy. Pediatr Infect Dis J. 2009;28(12):1127–9.

    Article  PubMed  Google Scholar 

  39. Bekker A, Decloedt EH, Slade G, et al. Single dose abacavir pharmacokinetics and safety in neonates exposed to human immunodeficiency virus (HIV). Clin Infect Dis. 2021;72(11):2032–4.

    Article  CAS  PubMed  Google Scholar 

  40. Bekker A, Capparelli EV, Violari A, et al. Abacavir dosing in neonates from birth to 3 months of life: a population pharmacokinetic modelling and simulation study. Lancet HIV. 2022;9(1):e24–31.

    Article  CAS  PubMed  Google Scholar 

  41. World Health Organization. Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring: recommendations for a public health approach. Geneva: World Health Organization; 2021. p. 594.

    Google Scholar 

  42. • Panel on Treatment of HIV During Pregnancy and Prevention of Perinatal Transmission. Recommendations for the use of antiretroviral drugs during pregnancy and interventions to reduce perinatal HIV Transmission in the United States. Department of Health and Human Services. https://clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/perinatal-hiv/guidelines-perinatal.pdf. Accessed 23 Aug 2023. The January 2023 updates to the guidelines contain significant changes to their infant feeding recommendations to support birthing parents who wish to breast/chestfeed after decades of discouraging this practice. The document summarizes the evidence that breastfeeding can be performed safely under specific circumstances and with ongoing support by providers. Though not zero, the risk of postnatal HIV transmission through breast milk can be <1%.

  43. de Waal R, Rabie H, Technau KG, et al. Abacavir safety and effectiveness in young infants with HIV in South African observational cohorts. Antivir Ther. 2023;28(2):13596535231168480.

    PubMed  Google Scholar 

  44. Clarke DF, Mirochnick M, Acosta E, et al. Use of modeling and simulations to determine raltegravir dosing in neonates: a model for safely and efficiently determining appropriate neonatal dosing regimens: IMPAACT P1110. J Acquir Immune Defic Syndr. 2019;82(4):392–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Clarke DF, Acosta E, Cababasay M, et al. Raltegravir (RAL) in neonates: dosing, pharmacokinetics (PK), and safety in HIV-1-exposed neonates at risk of infection (IMPAACT P1110). J Acquir Immune Defic Syndr. 2020;84(1):70–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Witvrouw M, Pannecouque C, Switzer WM, et al. Susceptibility of HIV-2, SIV and SHIV to various anti-HIV-1 compounds: implications for treatment and postexposure prophylaxis. Antivir Ther. 2004;9(1):57–65.

    Article  CAS  PubMed  Google Scholar 

  47. Panel on opportunistic infections in children with and exposed to HIV. Guidelines for the prevention and treatment of opportunistic infections in children with and exposed to HIV. Department of Health and Human Services. [cited 2023 August 25th]; Available from: https://clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/pediatric-oi/guidelines-pediatric-oi.pdf.

  48. Ruel TD, Acosta E, Liu J, et al. Pharmacokinetics, safety, tolerability, and antiviral activity of dolutegravir dispersible tablets in infants and children with HIV-1 (IMPAACT P1093): results of an open-label, phase 1-2 trial. Lancet HIV. 2022;9(5):e332–40.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Gilead Sciences. U.S. Food and Drug Administration Approves Expanded Indication of Gilead’s Biktarvy® for Treatment of HIV-1 in Pediatric Populations. In: Press Releases. 2021. https://www.gilead.com/news-and-press/press-room/press-releases/2021/10/us-food-and-drug-administration-approves-expanded-indication-of-gileads-biktarvy-for-treatment-of-hiv1-in-pediatric-populations. Accessed 25 Aug 2023.

  50. Gilead Sciences. Study of bictegravir/emtricitabine/tenofovir alafenamide fixed dose combination in adolescents and children with human immunodeficiency virus-1. 2023. https://clinicaltrials.gov/study/NCT02881320. Accessed 25 Aug 2023.

  51. ViiV Healthcare US. ViiV Healthcare announces us FDA approval of TRIUMEQ PD, the first dispersable single tablet regimen containing dolutegravir, a once-daily treatment for children living with HIV. In: News & Events. 2022. https://viivhealthcare.com/en-us/media-center/news/press-releases/2022/march/viiv-healthcare-announces-us-fda-approval/. Accessed 25 Aug 2023.

  52. Gilead Sciences. A phase 2/3, open-label study of the pharmacokinetics, safety, and antiviral activity of the elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide (E/C/F/TAF) Single Tablet (STR) in HIV-1 Infected Antiretroviral Treatment-Naive Adolescents and Virologically Suppressed Children. 2023. https://clinicaltrials.gov/study/NCT01854775. (Identification No NCT01854775). Accessed 25 Aug 2023.

  53. Connor EM, Sperling RS, Gelber R, et al. Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment. Pediatric AIDS Clinical Trials Group Protocol 076 Study Group. N Engl J Med. 1994;331(18):1173–80.

    Article  CAS  PubMed  Google Scholar 

  54. Wade NA, Birkhead GS, Warren BL, et al. Abbreviated regimens of zidovudine prophylaxis and perinatal transmission of the human immunodeficiency virus. N Engl J Med. 1998;339(20):1409–14.

    Article  CAS  PubMed  Google Scholar 

  55. Myer L, Phillips TK, McIntyre JA, et al. HIV viraemia and mother-to-child transmission risk after antiretroviral therapy initiation in pregnancy in Cape Town, South Africa. HIV Med. 2017;18(2):80–8.

    Article  CAS  PubMed  Google Scholar 

  56. Mandelbrot L, Tubiana R, Le Chenadec J, et al. No perinatal HIV-1 transmission from women with effective antiretroviral therapy starting before conception. Clin Infect Dis. 2015;61(11):1715–25.

    PubMed  Google Scholar 

  57. Townsend CL, Byrne L, Cortina-Borja M, et al. Earlier initiation of ART and further decline in mother-to-child HIV transmission rates, 2000-2011. AIDS. 2014;28(7):1049–57.

    Article  PubMed  Google Scholar 

  58. Boucher FD, Modlin JF, Weller S, et al. Phase I evaluation of zidovudine administered to infants exposed at birth to the human immunodeficiency virus. J Pediatr. 1993;122(1):137–44.

    Article  CAS  PubMed  Google Scholar 

  59. Taha TE, Kumwenda NI, Hoover DR, et al. The impact of breastfeeding on the health of HIV-positive mothers and their children in sub-Saharan Africa. Bull World Health Organ. 2006;84(7):546–54.

    Article  PubMed  PubMed Central  Google Scholar 

  60. World Health Organization. United Nations Children’s Fund. Guideline: updates on HIV and infant feeding: the duration of breastfeeding, support from health services to improve feeding practices among mothers living with HIV. Geneva: World Health Organization; 2016.

    Google Scholar 

  61. Flynn PM, Taha TE, Cababasay M, et al. Prevention of HIV-1 transmission through breastfeeding: efficacy and safety of maternal antiretroviral therapy versus infant nevirapine prophylaxis for duration of breastfeeding in HIV-1-infected women with high CD4 cell count (IMPAACT PROMISE): a randomized, open-label, clinical trial. J Acquir Immune Defic Syndr. 2018;77(4):383–92.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  62. Yusuf HE, Knott-Grasso MA, Anderson J, et al. Experience and outcomes of breastfed infants of women living with HIV in the United States: findings from a single-center breastfeeding support initiative. J Pediatric Infect Dis Soc. 2022;11(1):24–7.

    Article  PubMed  Google Scholar 

  63. Weiss F, von Both U, Rack-Hoch A, et al. Brief report: HIV-positive and breastfeeding in high-income settings: 5-year experience from a perinatal center in Germany. J Acquir Immune Defic Syndr. 2022;91(4):364–7.

    Article  PubMed  Google Scholar 

  64. Nashid N, Khan S, Loutfy M, et al. Breastfeeding by women living with human immunodeficiency virus in a resource-rich setting: a case series of maternal and infant management and outcomes. J Pediatric Infect Dis Soc. 2020;9(2):228–31.

    Article  CAS  PubMed  Google Scholar 

  65. Koay WLA, Rakhmanina NY. Supporting mothers living with HIV in the United States who choose to breastfeed. J Pediatric Infect Dis Soc. 2022;11(5):239.

    Article  PubMed  Google Scholar 

  66. Prestileo T, Adriana S, Lorenza DM, Argo A. From undetectable equals untransmittable (U=U) to breastfeeding: Is the Jump Short? Infect Dis Rep. 2022;14(2):220–7.

    Article  PubMed  PubMed Central  Google Scholar 

  67. ••Levison, J., J. McKinney, A. Duque, et al., Breastfeeding among people with HIV in North America: a multisite study. Clin Infect Dis. 2023;ciad235. This multi-site retrospective study from 11 sites in the USA and Canada of 72 individuals with HIV who were on ART and breastfed their infants showed that no cases of infant HIV transmission occurred among the 94% of infants for whom HIV testing results were available at least 6 weeks after weaning.

  68. Wood SM, Dowshen N, Lowenthal E. Time to improve the global human immunodeficiency virus/AIDS care continuum for adolescents: a generation at stake. JAMA Pediatr. 2015;169(7):619–20.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Griffith DC, Farmer C, Gebo KA, et al. Uptake and virological outcomes of single- versus multi-tablet antiretroviral regimens among treatment-naive youth in the HIV Research Network. HIV Med. 2019;20(2):169–74.

    Article  CAS  PubMed  Google Scholar 

  70. Molina JM, Clotet B, van Lunzen J, et al. Once-daily dolutegravir versus darunavir plus ritonavir for treatment-naive adults with HIV-1 infection (FLAMINGO): 96 week results from a randomised, open-label, phase 3b study. Lancet HIV. 2015;2(4):e127–36.

    Article  PubMed  Google Scholar 

  71. Squires K, Kityo C, Hodder S, et al. Integrase inhibitor versus protease inhibitor based regimen for HIV-1 infected women (WAVES): a randomised, controlled, double-blind, phase 3 study. Lancet HIV. 2016;3(9):e410–20.

    Article  PubMed  PubMed Central  Google Scholar 

  72. Cahn P, Madero JS, Arribas JR, et al. Durable efficacy of dolutegravir plus lamivudine in antiretroviral treatment-naive adults with HIV-1 infection: 96-week results from the GEMINI-1 and GEMINI-2 randomized clinical trials. J Acquir Immune Defic Syndr. 2020;83(3):310–8.

    Article  PubMed  Google Scholar 

  73. Cahn P, Madero JS, Arribas JR, et al. Dolutegravir plus lamivudine versus dolutegravir plus tenofovir disoproxil fumarate and emtricitabine in antiretroviral-naive adults with HIV-1 infection (GEMINI-1 and GEMINI-2): week 48 results from two multicentre, double-blind, randomised, non-inferiority, phase 3 trials. Lancet. 2019;393(10167):143–55.

    Article  CAS  PubMed  Google Scholar 

  74. Aboud M, Orkin C, Podzamczer D, et al. Efficacy and safety of dolutegravir-rilpivirine for maintenance of virological suppression in adults with HIV-1: 100-week data from the randomised, open-label, phase 3 SWORD-1 and SWORD-2 studies. Lancet HIV. 2019;6(9):e576–87.

    Article  PubMed  Google Scholar 

  75. Weld ED, Rana MS, Dallas RH, et al. Interest of youth living with HIV in long-acting Antiretrovirals. J Acquir Immune Defic Syndr. 2019;80(2):190–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  76. Flexner C, Owen A, Siccardi M, Swindells S. Long-acting drugs and formulations for the treatment and prevention of HIV infection. Int J Antimicrob Agents. 2021;57(1):106220.

    Article  CAS  PubMed  Google Scholar 

  77. Margolis DA, Gonzalez-Garcia J, Stellbrink HJ, et al. Long-acting intramuscular cabotegravir and rilpivirine in adults with HIV-1 infection (LATTE-2): 96-week results of a randomised, open-label, phase 2b, non-inferiority trial. Lancet. 2017;390(10101):1499–510.

    Article  CAS  PubMed  Google Scholar 

  78. •• Orkin C, Arasteh K, Gorgolas Hernandez-Mora M, et al. Long-acting cabotegravir and rilpivirine after oral induction for HIV-1 infection. N Engl J Med. 2020;382(12):1124–35. This randomized open label trial compared adults with HIV who achieved viral suppression after 20 weeks of ABC/3TC/DTG and randomized them to continue oral therapy or switch to CAB+RPV oral for one month followed by monthly injections LA CAB + RPV. This study demonstrated that LA CAB + RPV was non inferior that ABC/3TC/DTG in maintaining HIV suppression.

    Article  CAS  PubMed  Google Scholar 

  79. Swindells S, Andrade-Villanueva JF, Richmond GJ, et al. Long-acting cabotegravir and rilpivirine for maintenance of HIV-1 suppression. N Engl J Med. 2020;382(12):1112–23.

    Article  CAS  PubMed  Google Scholar 

  80. Moore C, Capparelli E, Calabrese K, et al. Safety and PK of long-acting cabotegravir and rilpivirine in adolescents, in: Conference on Retroviruses and Opportunistic Infections. 2022. https://www.impaactnetwork.org/sites/default/files/inline-files/IMPAACT%202017_Updated%20SAFETY%20and%20PK%20MOCHA%20Poster%20738_0.pdf. Accessed 25 Aug 2023.

  81. Johnson&Johnson. U.S. FDA approves CABENUVA (cabotegravir and rilpivirine) for adolescents, expanding the indication of the first and only complete long-acting injectable HIV regimen. In: Innovation. 2022. https://www.jnj.com/u-s-fda-approves-cabenuva-cabotegravir-and-rilpivirine-for-adolescents-expanding-the-indication-of-the-first-and-only-complete-long-acting-injectable-hiv-regimen. Accessed 19 Jun 2023.

  82. Lowenthal E, Chapman J, Calabrese K, et al. Adolescent and parent experiences with long-acting injectables in the MOCHA study, in Conference on Retroviruses and Opportunistic Infections. 2022. https://www.croiconference.org/wp-content/uploads/sites/2/posters/2022/CROI2022_Poster_739.pdf. Accessed 11 Jul 2023.

  83. • Parker B, Ward T, Hayward O, et al. Cost-effectiveness of the long-acting regimen cabotegravir plus rilpivirine for the treatment of HIV-1 and its potential impact on adherence and viral transmission: a modelling study. PLoS One. 2021;16(2):e0245955. Peforming parameterisation of pooled data from CAB+RPV trials, CAB+RPV was predicted to be more cost-saving and generating more life-year gains than oral ART, demonstrating the impact of improved adherence on heath and economic outcomes.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  84. • Centers for Disease Control and Prevention. Preexposure prophylaxis for the prevention of HIV infection in the United States - 2021 Update clinical practice guideline. CDC. 2021.https://www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-guidelines-2021.pdf. Accessed 11 Jul 2023. The PrEP Guidelines were updated in 2021 to include the recommendation to offer PrEP to any sexually active adolescent with a history of a bacterial STI, inconsistent condom use or a partner with known HIV infection.

  85. Grant RM, Lama JR, Anderson PL, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010;363(27):2587–99.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  86. Baeten JM, Donnell D, Ndase, et al. Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. N Engl J Med. 2012;367(5):399–410.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  87. Thigpen MC, Kebaabetswe PM, Paxton LA, et al. Antiretroviral preexposure prophylaxis for heterosexual HIV transmission in Botswana. N Engl J Med. 2012;367(5):423–34.

    Article  CAS  PubMed  Google Scholar 

  88. Choopanya K, Martin M, Suntharasamai, et al. Antiretroviral prophylaxis for HIV infection in injecting drug users in Bangkok, Thailand (the Bangkok Tenofovir Study): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet. 2013;381(9883):2083–90.

    Article  PubMed  Google Scholar 

  89. Hosek SG, Landovitz RJ, Kapogiannis B, et al. Safety and feasibility of antiretroviral preexposure prophylaxis for adolescent men who have sex with men aged 15 to 17 years in the United States. JAMA Pediatr. 2017;171(11):1063–71.

    Article  PubMed  PubMed Central  Google Scholar 

  90. Molina JM, Capitant C, Spire B, et al. On-demand preexposure prophylaxis in men at high risk for HIV-1 infection. N Engl J Med. 2015;373(23):2237–46.

    Article  CAS  PubMed  Google Scholar 

  91. Molina JM, Charreau I, Spire B, et al. Efficacy, safety, and effect on sexual behaviour of on-demand pre-exposure prophylaxis for HIV in men who have sex with men: an observational cohort study. Lancet HIV. 2017;4(9):e402–10.

    Article  PubMed  Google Scholar 

  92. U.S. Food and Drug Administration. FDA Approves second drug to prevent HIV infection as part of ongoing efforts to end the HIV epidemic. In: Press Announcements. FDA. 2019. https://www.fda.gov/news-events/press-announcements/fda-approves-second-drug-prevent-hiv-infection-part-ongoing-efforts-end-hiv-epidemic. Accessed 12 Jul 2023.

  93. •• Mayer KH, Molina JM, Thompson MA, et al. Emtricitabine and tenofovir alafenamide vs emtricitabine and tenofovir disoproxil fumarate for HIV pre-exposure prophylaxis (DISCOVER): primary results from a randomised, double-blind, multicentre, active-controlled, phase 3, non-inferiority trial. Lancet. 2020;396(10246):239–54. 5857 cisgender men who have sex with me or transgender women who have sex with men were randomyly assigned to receive either daily FTC/TDF or FTC/TAF for PrEFTC/TAF was shown to be non-inferior that FTC/TDF for HIV prevention.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  94. •• Landovitz RJ, Donnell D, Clement ME, et al. Cabotegravir for HIV prevention in cisgender men and transgender women. N Engl J Med. 2021;385(7):595–608. 4566 cisgender men who have sex with men and transgender women who have sex with men and who were at-risk for HIV were randomized to receive either TDF/FTC or LA injectable CAB for PrEThe trial was stopped early for efficacy during the first interim end-point analysis that showed 3 times as many incident HIV infections in the TDF/FTC arm. LA CAB was superior to TDF/FTC in preventing HIV.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  95. •• Delany-Moretlwe S, Hughes J, Bock P, et al. Cabotegravir for the prevention of HIV-1 in women: results from HPTN 084, a phase 3, randomised clinical trial. Lancet. 2022;399(10337):1779–89. This phase 3 clinical trial enrolled 3224 individuals assigned female at birth at risk of HIV, who were randomly assigned to receive either TDF/FTC or LA CAB for PrEIncident HIV infection was 9 times higher in the TDF/FTC group, demonstrating superiority of LA CAB in preventing HIV infection in women.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  96. Landovitz RJ, Li S, Eron JJ Jr, et al. Tail-phase safety, tolerability, and pharmacokinetics of long-acting injectable cabotegravir in HIV-uninfected adults: a secondary analysis of the HPTN 077 trial. Lancet HIV. 2020;7(7):e472–81.

    Article  PubMed  PubMed Central  Google Scholar 

  97. Centers for Disease Control and Prevention. National Center for HIV, Viral Hepatitis, STD, and TB Prevention AtlasPlus. CDC. 2023. https://www.cdc.gov/nchhstp/atlas/index.htm. Accessed 12 Jul 2023.

Download references

Funding

Dr. Vicetti Miguel receives funding from the Health Resources and Services Administration and the State of Wisconsin. Dr. Henderson receives funding from the Health Resources and Services Administration.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Division of Infectious Diseases, Medical College of Wisconsin, Milwaukee, WI, USA

    Claudia Vicetti Miguel MD

  2. Children’s Corporate Center, 999 N 92nd St, Suite 450, Wauwatosa, WI, 53226, USA

    Claudia Vicetti Miguel MD

  3. Deparment of Pediatrics, Division of Infectious Diseases, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Sheryl L. Henderson MD, PhD

Authors
  1. Claudia Vicetti Miguel MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sheryl L. Henderson MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Claudia Vicetti Miguel MD.

Ethics declarations

Conflict of Interest

Claudia Vicetti Miguel declares that she has no conflicts of interest. Sheryl Henderson declares that she has had stock in Pfizer, Inc., Moderna Inc., Viatris Inc. and Inovio Inc.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vicetti Miguel, C., Henderson, S.L. Updates in the Approach to Pediatric HIV Care and Prevention. Curr Treat Options Peds 9, 165–184 (2023). https://doi.org/10.1007/s40746-023-00278-x

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40746-023-00278-x

Keywords

Search

Navigation