There are > 40 antiretroviral (ARV) medications, including multidrug combination products, available in the United States, each of which may have adverse effects and drug interactions with other ARV medications or commonly used antibiotics, antiseizure medications, and sedatives. New ARV medications, immunomodulators, and vaccines are under evaluation.
Clinical and laboratory monitoring are important for identifying drug toxicity and therapeutic failure.
Because expert opinions on therapeutic strategies change rapidly, consultation with experts is strongly advised. Tablets containing fixed-dose combinations (FDC) of ≥ 3 medications are now widely used in older children and adolescents to simplify regimens (termed single-tablet regimens; one tablet once a day) and improve adherence; for young children, such combinations are unavailable in the United States or are difficult to use.
The standard treatment for children is similar to that for adults: combination antiretroviral therapy (ART) to maximize viral suppression and minimize selection of drug-resistant strains. Preferred regimens vary somewhat by age but typically contain 2 nucleoside/nucleotide reverse transcriptase inhibitors (NRTI) plus an integrase strand transfer inhibitor (INSTI) or a protease inhibitor (PI), or, uncommonly, a non-nucleoside reverse transcriptase inhibitor (NNRTI) (see table Selected Antiretroviral (ARV) Regimens for Initial Therapy of HIV Infection in Children). Use of ARV medications in treatment-experienced children and adolescents is complex; only the selected initial choices for treatment-naive children and adolescents are included in the table.
For information on ARV medications for children, including dosing, fixed-dose combination products, adverse effects, and drug interactions, see the continually updated Panel on Antiretroviral Therapy and Medical Management of Children Living with HIV's Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection and see Appendix A: Pediatric Antiretroviral Drug Information. See also the Panel's Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV.
Useful treatment information is also available at New York State Department of Health AIDS Institute and UNAIDS. Consultation regarding ART, especially for issues surrounding HIV postexposure prophylaxis and prevention of HIV mother-to-child transmission (MTCT), is also available through the National Clinician Consultation Center.
Selected Antiretroviral (ARV) Regimens for Initial Therapy of HIV Infection in Children*
Age Group | NRTI Backbone Component (Use 2) | NNRTI, PI, or INSTI Component (Use 1) |
|---|---|---|
Infants birth to < 14 days | plus | or |
Children ≥ 14 days to < 4 weeks | plus | or |
Children ≥ 4 weeks, weight > 3 kg | plus | |
Children ≥ 2 years, weight ≥ 14 kg | plus | Bictegravir |
Adolescents > 12 years, weight ≥ 25 kg | plus | Bictegravir |
* Each regimen is designed to contain 2 NRTI antiretroviral (ARV) medications plus either an NNRTI, PI, or INSTI component. Several alternative ARV regimens exist; consultation with an expert in pediatric HIV medicine is advised. For information on adverse effects, other doses (especially for information on fixed-dose combination products), and drug interactions, see the continually updated Panel on Antiretroviral Therapy and Medical Management of Children Living with HIV's Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection. Accessed 02/08/2023. | ||
INSTI = integrase strand transfer inhibitor; NNRTI = non-nucleoside reverse transcriptase inhibitor; NRTI = nucleoside/nucleotide reverse transcriptase inhibitor; PI = protease inhibitor. | ||
(See also HIV infection in Infants and Children.)
More Information
The following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of these resources.
See the following US government sites for information on drug treatment, including adverse effects, dosing (especially for information on fixed-dose combination products), and drug interactions, educational materials, and quick links to related topics:
ClinicalInfo.HIV.gov: Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection
ClinicalInfo.HIV.gov: Recommendations for the Use of Antiretroviral Drugs During Pregnancy and Interventions to Reduce Perinatal HIV Transmission in the United States
ClinicalInfo.HIV.gov: Maternal HIV Testing and Identification of Perinatal HIV Exposure
ClinicalInfo.HIV.gov: Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV
ClinicalInfo.HIV.gov: Appendix A: Pediatric Antiretroviral Drug Information
Centers for Disease Control and Prevention (CDC): Pre-Exposure Prophylaxis (PrEP)
The following resources provide information about various other prevention, treatment, and education aspects of HIV/AIDS:
New York State Department of Health AIDS Institute HIV Clinical Guidelines Program: Disseminates practical, evidence-based clinical guidelines that promote quality medical care for people in New York who are living with and/or are at risk of acquiring HIV and certain other illnesses
UNAIDS: Comprehensive information on how the organization directs, advocates, coordinates, and provides technical support needed to connect leadership from governments, the private sector, and communities to deliver life-saving HIV services
National Clinician Consultation Center: Up-to-date HIV/AIDS guidelines and key treatment protocols for HIV/AIDS treatment, prevention, and exposure
Perinatal HIV Consultation and Referral Services Hotline 1-888-HIV-8765 (1-888-448-8765): Free 24-hour clinical consultation and advice on treating pregnant women with HIV infection and their infants
