Updated Treatment Guidelines for Children with HIV

Library of CME Programs

On February 29, the U.S. Department of Health and Human Services issued revised Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection. The latest version includes updated information in the following areas:

• When to initiate anti-HIV therapy, including:

• Change in recommendations for when to initiate therapy in HIV-infected children younger than 12 months of age;

• Reduction from 4 to 3 age categories for recommendations on when to initiate therapy (younger than 12 months, 1 to 5 years, and 5 years and older);

• Changes in CD4 cell thresholds for when to start antiretroviral therapy in children 1 year or older.
• Timing of diagnostic tests for infants exposed to HIV.

• New pediatric drug appendix and hyperlink on drug preparations, new dosage formulations, and pediatric studies;

• Use of recently approved antiretroviral agents in children:
• maraviroc (Selzentry), including a new section on co-receptor tropism screening;

• raltegravir (Isentress);

• etravirine (Intelence).

• Revised hyperlink with new tables on antiretroviral drug toxicity and its management in children.

Perhaps the key revision is the recommendation that all HIV-infected infants should receive antiretroviral therapy, regardless of CD4 cell count or clinical symptoms, based on recent data from the CHER study showing that immediate initiation of anti-HIV treatment after birth -- rather than waiting for signs of immune system decline -- was associated with a 75% lower risk of death.

The updated guidelines are available from the Pediatric Guidelines section of the federal government's AIDSinfo web site. The latest changes are highlighted in yellow throughout the text and tables. See the AIDSinfo Order Publications section for information on how to receive a copy of the revised guidelines by e-mail or postal mail.

03/04/08

Source
R Klein and K Struble (U.S. Food and Drug Administration). Updated Pediatric Treatment Guidelines available. February 29, 2008.