- Category: HIV Treatment
- Published on Friday, 02 November 2012 00:00
- Written by Liz Highleyman
On November 1, 2012, the U.S. Department of Health and Human Services (HHS) released the latest revision of its Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection. Key changes include new information on HIV diagnosis of children, when to start treatment, and discussion of newer antiretroviral drugs.
Key updates and new information are summarized in What’s New in the Pediatric Guidelines? and are highlighted in yellow throughout the text and tables.
Selected updates include:
- New sections on HIV diagnostic testing in children, including exceptional situations such as additive exposure risk.
- Updated recommendations about when to start antiretroviral therapy (ART), including use of CD4 T-cell percentage and CD4 cell count to guide treatment initiation. While CD4 percentage has historically been preferred for monitoring children younger than 5 years, newer data show that CD4 cell count provides greater prognostic value for this age group.
- The guidelines panel continues to recommend treatment for all HIV-infected infants younger than 12 months, regardless of clinical status, CD4 percentage, or HIV viral load.
- The panel also generally recommends ART for all children age 1 year or older who have minimal or no symptoms, but providers may defer treatment based on individual clinical or psychosocial factors.
- Updated information about what agents to use for first-line therapy, with recommendations regarding antiretrovirals recently FDA-approved for children including tenofovir (Viread), etravirine (Intelence), rilpivirine (Edurant), boosted fosamprenavir (Lexiva), boosted darunavir (Prezista), and raltegravir (Isentres).
- Discussion of use of newer antiretroviral drug classes and specific agents for treatment experienced children, including those with treatment failure.
- Added information about ART use and pregnancy outcomes for HIV positive adolescent girls.
- Updated information about interactions between antiretroviral drugs and contraceptives.
- Addition of new pediatric data for specific antiretroviral agents in the Pediatric Antiretroviral Drug Information Appendix.
The full guidelines are available online at http://aidsinfo.nih.gov/contentfiles/lvguidelines/pediatricguidelines.pdf.
The HHS Panel on Antiretroviral Therapy and Medical Management of HIV-Infected Children invites feedback on the latest revisions November 14, 2012. Send comments to JLIB_HTML_CLOAKING with the subject header "Comments on Pediatric Guidelines."
HHS Panel on Antiretroviral Therapy and Medical Management of HIV-Infected Children. Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection. Updated November 1, 2012.
DHHS/Aidsinfo. Updated HHS Pediatric Antiretroviral Treatment Guidelines Now Available. AIDSinfo At-A-Glance 8(47). November 1, 2012.