HIV in Children

ANTIRETROVIRAL THERAPY

Dr. Ira Shah
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Last Updated: 7th November 2013
Antiretroviral therapy (ART)
ART helps in improving and restoring the immune system functioning and decreasing the mortality and morbidity associated with HIV infection. ART does not cure HIV infection and requires very close adherence in order to be effective and prevent emergence of resistance and thus patient has to be prepared for life long treatment in order to optimally control the virus replication.

Treatment of pediatric HIV infection has evolved since antiretroviral therapy began in the late 1980s. Currently, highly active combination regimens including at least three drugs are recommended.

Goals of pediatric ART


The aims of treatment with antiretroviral (ARV) drugs in HIV-infected children are to achieve and sustain full HIV RNA viral load (VL) suppression and minimize short and long-term ARV drug toxicity.

Duration of ART


HIV infection cannot be eradicated by the antiretroviral drugs that are currently available. Proviral DNA persists in sanctuary sites such as the CNS and testis, making lifelong treatment necessary.

When to start antiretroviral therapy


Decisions about when to start therapy, what drugs to choose in antiretroviral-naïve children, and how to treat antiretroviral experienced children remain complex, and should be made in consultation with a specialist in pediatric and adolescent HIV infection.


Treatment with ART depends on clinical condition, immune status of the child and HIV viral load. Antiretroviral drug-resistant virus can develop in both multidrug experienced children and children who received initial regimens containing one or two drugs that incompletely suppressed viral replication. Additionally, drug resistance may be seen in antiretroviral-naïve children who have become infected with HIV despite maternal/infant antiretroviral prophylaxis. Thus, decisions about when to start therapy and what drugs to choose in antiretroviral-naïve children and on how to best treat antiretroviral-experienced children remain complex.

ANTIRETROVIRAL THERAPY
Dr. Ira Shah
Incharge Pediatric HIV and TB Clinic, B.J.Wadia Hospital for Children, Mumbai, India Consultant in Pediatric Infectious Diseases, Nanavati Hospital, Mumbai, India.
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