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Prescrire Int. 2011 Apr;20(115):101-4.

First-line antiretroviral treatment of HIV-infected children. A choice largely based on adult data.

[No authors listed]


About 2 million children worldwide are infected with HIV.There are about 1500 HIV-infected children in France. This review examines the choice of first-line antiretroviral treatment for children under 12 years of age, based on a review of the literature using the standard Prescrire methodology. In children under 5 years of age, the percentage of CD4+ T lymphocytes among all circulating lymphocytes is more stable than the absolute count. The CD4+ T cell percentage is therefore used as a marker of immunological status in this age group. The decision to begin antiretroviral treatment in a child depends on the short or medium-term risk of progression to AIDS or death. Treatment is warranted for infants under 1 year of age, children under 6 years of age whose CD4+ T cell percentage is below 25%, and older children with a CD4+ T cell count below 350 per mm3. In Africa, antiretroviral treatment seems justified for all infected children under 2 years of age. First-line treatment for children is based on a combination of at least 3 antiretroviral drugs. Zidovudine and lamivudine remain the first-choice nucleoside reverse transcriptase inhibitors. The lopinavir + ritonavir combination is the first-choice HIV protease inhibitor, but the oral solution is poorly accepted by children because of its unpleasant taste and the high ethanol content of the ritonavir oral solution. As for the non-nucleoside reverse transcriptase inhibitors, efavirenz has not been assessed in children under 3 years of age; nevirapine can be used, but it has suboptimal antiviral activity. Antiretroviral drugs seem to have similar adverse effects in children and adults. Long-term data are lacking, however, especially on possible cardiac and metabolic effects. In view of the large number of children infected worldwide, more efforts are urgently needed to adapt first-line antiretroviral drugs to paediatric use. This means developing and assessing specific paediatric formulations and fixed-dose combinations.

[PubMed - indexed for MEDLINE]
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