english.prescrire.org > Spotlight > Archives : 2011 > HIV-infected children: few treatments that have been evaluated are both suitable and available

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HIV-infected children: few treatments that have been evaluated are both suitable and available

The choice of antiretroviral drugs for children is mostly extrapolated from evaluation in adults. Much progress remains to be made when it comes to the clinical evaluation and adaptation of pharmaceutical forms and fixed-dose drug combinations for children.

Worldwide, some 2 million children are infected by HIV, especially in poor countries (they number around 1500 in France). Transmission is primarily from mother to child, and through sexual intercourse in adolescents.

It is advisable to start treatment when there is a high short- or medium-term risk of death or of AIDS developing: in all infants under one year old (2 years old in Africa), and depending on the  CD4+ T lymphocyte count in older children.

As in adults, the aim is to reduce the viral load on a long-term basis. Treatment combines at least 3 antiretrovirals, 2 of which are nucleoside inhibitors of HIV reverse transcriptase (starting with the combination of zidovudine + lamivudine) and either one or two protease inhibitors (generally the combination of lopinavir + ritonavir), either a non-nucleoside inhibitor of reverse transcriptase (particularly efavirenz for children over the age of 3).

Not much is known about the long-term adverse effects. Some antiretrovirals are not available for children, or their pharmaceutical form is unsuitable (presence of alcohol, bitter taste, adult form, difficulty of adapting the dose, etc.).

Progress needs to be made on all these fronts as a matter of urgency.

©Prescrire 1 April 2011

"First-line antiretroviral treatment of HIV-infected children" Prescrire Int 2011; 20 (115): 101-104. (pdf, subscribers only)
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