Pediatric Drugs

, Volume 13, Issue 5, pp 303–316

Antiretroviral Therapy for Children in Resource-Limited Settings

Current Regimens and the Role of Newer Agents
Review Article

DOI: 10.2165/11593330-000000000-00000

Cite this article as:
Eley, B.S. & Meyers, T. Pediatr-Drugs (2011) 13: 303. doi:10.2165/11593330-000000000-00000

Abstract

WHO antiretroviral treatment guidelines for HIV-infected children have influenced the design of treatment programmes in resource-limited settings. This review analyses the latest WHO first- and second-line regimen recommendations.

The recommendation to use lopinavir/ritonavir-containing first-line regimens in young children with prior non-nucleoside reverse transcriptase inhibitor (NNRTI) exposure is based on good quality evidence. Recent research suggests that lopinavir/ritonavir-containing first-line regimens should be extended to all young children, irrespective of prior NNRTI exposure. Strategies for overcoming the adverse metabolic effects of rifampicin-containing anti-tuberculosis therapy on antiretroviral therapy regimens have been under-researched in HIV-infected children, creating uncertainty about global recommendations.

Preferred second-line recommendations are largely predictable. The exception is that NNRTI-containing second-line regimens are recommended for children previously exposed to NNRTIs and who subsequently did not respond to lopinavir/ritonavir-containing first-line therapy. In these patients, second-line regimens containing newer protease inhibitors (PIs) such as darunavir and tipranavir, or integrase inhibitors such as raltegravir, should be evaluated. Newer antiretroviral agents including second-generation NNRTIs and PIs, C-C chemokine receptor type 5 inhibitors, and integrase inhibitors may assist in further refinement of existing regimen options.

Copyright information

© Adis Data Information BV 2011

Authors and Affiliations

  1. 1.Paediatric Infectious Diseases UnitRed Cross War Memorial Children’s HospitalCape TownSouth Africa
  2. 2.Department of Paediatrics and Child HealthUniversity of Cape TownCape TownSouth Africa
  3. 3.Harriet Shezi Children’s Clinic, Department of Paediatrics, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
  4. 4.Department of Paediatrics and Child HealthRed Cross War Memorial Children’s HospitalRondebosch, Cape TownSouth Africa

Personalised recommendations